Emotional and Decisional Profiles in Individuals With Gambling Disorder: Associations With Emotional Dysregulation, Alexithymia, and Suicidal Ideation

Abstract

Background: Gambling Disorder (GD) is associated with elevated emotional dysregulation, maladaptive decision-making, and heightened suicide risk, yet the relationships among these domains remain insufficiently integrated within a single clinical framework.

Methods: Forty-four treatment-seeking adults with a Diagnostic and Statistical Manual of Mental Disorders (5th edn, DSM-5) diagnosis of GD completed measures of gambling severity (National Opinion Research Center DSM-IV Screen for Gambling Problems (NODS)), emotional dysregulation (Difficulties in Emotion Regulation Scale (DERS)), alexithymia (20-item Toronto Alexithymia Scale (TAS-20)), hot decision-making (Iowa Gambling Task (IGT), Mixed Gamble Task (MGT)), cold decision-making and decisional style (Lottery Choice Task (LCT), General Decision-Making Style questionnaire (GDMS)), suicidal ideation (Columbia-Suicide Severity Rating Scale (C-SSRS)), and psychological functioning (Symptom Checklist-90-Revised (SCL-90-R), Satisfaction With Life Scale (SWLS)). Exploratory correlational analyses and k-means clustering, confirmed with hierarchical clustering, were conducted.

Results: Higher emotional dysregulation was associated with lower loss aversion in hot decision-making and with more avoidant and spontaneous decision-making styles; recent gambling severity was also associated with lower loss aversion as well. Higher alexithymia was associated with reduced gain and loss sensitivity in cold decision making. Cluster analysis identified a higher-risk profile characterized by greater emotional dysregulation, higher recent gambling severity, greater suicidal ideation, higher alexithymia, and a more spontaneous decisional style. 

Conclusions: Although exploratory, these findings support a multidimensional risk framework in which emotional vulnerability and decisional tendencies jointly characterize clinically relevant heterogeneity in GD. The results underscore the importance of incorporating emotion focused and suicide-risk assessment strategies into the clinical evaluation of individuals with GD.