Extreme cases of problem gambling may cross over into the realm of mental disorders. Pathological gambling was recognized as a psychiatric disorder in the DSM-III, but the criteria were significantly reworked based on large-scale studies and statistical methods for the DSM-IV. As defined by American Psychiatric Association, pathological gambling is an impulse control disorder that is a chronic and progressive mental illness.

Pathological gambling is now defined as persistent and recurrent maladaptive gambling behavior meeting at least five of the following criteria, as long as these behaviors are not better explained by a manic episode:

1. Preoccupation. The subject has frequent thoughts about gambling experiences, whether past, future, or fantasy.
2. Tolerance. As with drug tolerance, the subject requires larger or more frequent wagers to experience the same "rush."
3. Withdrawal. Restlessness or irritability associated with attempts to cease or reduce gambling.
4. Escape. Subject gambles to improve mood or escape problems.
5. Chasing. Subject attempts to win back gambling losses with more gambling.
6. Lying. Subject attempts to hide the extent of his or her gambling by lying to family, friends, or therapists.
7. Loss of control. Subject has unsuccessfully attempted to reduce gambling.
8. Illegal acts. Subject has broken the law in order to obtain gambling money or recover gambling losses.
9. Risked significant relationship. The subject gambles despite risking or losing a relationship, job, or other significant opportunity.
10. Bailout. Subject turns to family, friends, or another third party for financial assistance as a result of gambling.

As with many disorders, the DSM-IV definition of pathological gambling is widely accepted and used as a basis for research and clinical practice internationally.

The most common instrument used to screen for "probable pathological gambling" behavior is the South Oaks Gambling Screen (SOGS) developed by Lesieur and Blume (1987) at the South Oaks Hospital in New York. This screen is undoubtedly the most cited instrument in psychological research liturature.

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