Impulse Control Disorders

Here are some highlights from this 2010 book:

Pathological Gambling: Promoting Risk, Provoking Ruin

* Americans spend more money on gambling than on any other form of entertainment (Volberg 2001). From 1995 to 2006, consumer spending on commercial casino gambling almost doubled, from $18 billion to $34 billion. Revenues from casinos, pari-mutuel wagering, lotteries, legal bookmaking, charitable gambling and bingo, Indian reservations, and card rooms experienced similar growth, from $51 billion in 1997 to $94 billion in 2007.

* One hundred years ago, gambling was essentially outlawed in the United States, and it
remained so until 30 years ago, when it was first legalized. By 2007, there were casinos in 32 states, and every state except Hawaii and Utah had some form of legalized gambling.

* A preoccupation with gambling can result in poor job performance, absenteeism, health
problems, job loss, and unemployment. A national study established that problem and
pathological gamblers were more than four times as likely as low-risk gamblers to have
lost a job and more than three times as likely to have been fired within the past year. They were also six times more likely than their low-risk counterparts to collect unemployment.

* Efforts to replace words such as “pathological gambling,” “compulsive gambling,” and
“gambling addiction” with the term “disordered” gambling and the like are intended to
replace language clinically recognized by the American Psychiatric Association or well
established in the literature. Industry also substitutes the word “gaming” for “gambling” in an effort to have the public view their venues purely as entertainment and fun.

Virtual Violence: The Games People Play

* Experimental and correlational studies have reported that playing violent video games is associated with increased levels of physiological arousal, decreased prosocial behaviors, greater hostility, more frequent arguments with teachers and poorer school performance, and more frequent physical fights and aggressive or antisocial behavior…

* A hypothetical analogy may be useful here: how would society treat video games that
portray child abuse (physical or sexual)? Although exposure to such video games would not
necessarily cause one to abuse children, these games would be considered to promote or
condone child abuse, perhaps in a way that child pornography does. As a result, such video games would probably be illegal in most countries, as is child pornography. If exposure to most violent video games also promotes or condones aggression without necessarily causing it, why should these video games be legal and held to a different standard? This is a paradox that is ultimately related to societal attitudes and values. Video games that depict particularly extreme forms of violence such as decapitation and dismemberment or feature violence directed against defenseless women are less socially acceptable and are frequently banned or censored in some countries. However, many modern Western societies consider “ordinary” aggressive behavior to be to some extent socially acceptable and tolerate it, while (at least publicly) showing zero tolerance for aggressive behavior toward children. As a reflection of these societal norms, in the realm of video games, killing an adult might seem more acceptable than hitting a child. This double standard sends conflicting and confusing messages about the type and amount of aggression that is or that could be tolerated by the society.

The Sex Industry: Public Vice, Hidden Victims

* Sanders (2004), in interviews with women working mainly in indoor settings, found
that emotional and psychological distress related primarily to feelings of depersonalization and loss of self-esteem as well as to the fear of discovery by family and intimate partners. The workers identified the practical and emotional difficulties encountered in keeping their working and private lives separate as a greater threat to their well-being than either violence or infection. There seems little doubt that sex trading as an occupation has a propensity to cause psychological distress, although common sense also suggests that the context in terms of the physical setting, levels of violence, drug dependence, coercion from pimps, and pressure from police must have a major impact on the extent to which this occurs.

Sex work is a dangerous business. The constant threat of violence, the consequences of sexually transmitted disease, and the cumulative damage to mental health are all compounded by the effects of heroin, crack cocaine, and other drugs.

About Luke Ford

I've written five books (see My work has been covered in the New York Times, the Los Angeles Times, and on 60 Minutes. I teach Alexander Technique in Beverly Hills (
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