Ms. A was a 66-year-old Japanese woman who had settled in a large city in the east of Japan. Her father was a violent alcoholic; her mother worked hard because her father did not work regularly. Her father died when Ms. A was in her twenties. She married at 25 years old, and had one daughter and one son. Following her divorce at age 37, she began working as a transportation driver. Since the age of 62, she has been on welfare because of her being bankrupt.
Ms. A started gambling on Pachinko games at age 37, ostensibly for a change of pace, and occasionally bet small amounts of money. During her 40s, she gambled every weekend, but she did not lose a control. At age 53, her mother died in a rest home for older persons. The cause of death was pneumonia, which presented subsequent to a falling incident and resultant thighbone fracture. Although this death was an accident, Ms. A nonetheless felt deep guilt, thinking, “My mother might not have died if she had been living with me.” Subsequent to her mother’s death, Ms. A began to engage in gambling behavior during her free time, every day, except during working hours, in an attempt to relieve these guilty feelings, or, as she herself puts it, “to forget it all.”
In her late 50s, Ms. A began to borrow money from her relatives and friends to compensate for her gambling losses. She often lied to her daughter about her gambling and debts, and arguments between her and her daughter were frequent occurrences. She occasionally frightened her daughter and relatives into giving her money by threatening to commit suicide. Gradually she began to be absent from work because of her gambling, until she was finally dismissed, thereby necessitating that she receive welfare, owing to bankruptcy, at the age of 62.
In spite of these harmful consequences, Ms. A could not prevent herself from gambling. She attended GA meetings several times, but derived no comfort from the GA group, where her feelings of guilt and shame continued to increase. At the age of 66, her daughter ordered her to visit a psychiatric hospital because of her repeated self-harming behavior. Her daughter hoped that she quitted gambling. Eventually, she visited our hospital after an unsuccessful suicide attempt. She remained abstinent for 2 months prior to her first hospital visit.
Ms. A exhibited a depressed countenance, and stated, “I really want to stop gambling, but irritability and guilt over my mother rise up and I fall into repeated gambling. I am so ashamed”. Ms. A conveyed the impression that her overwhelming desire to gamble gave her pain. However, we found that she had feelings of resentment toward her father, as evidenced by her statement, “My father frightened my mother with his violence and alcoholism”. Ms. A also spoke uncomfortably also about her daughter, saying, “I have brought up her through many troubles. Nevertheless she speaks unkindly about my gambling, and says that it is shameful”.
Ms. A exhibited persistent and recurrent maladaptive gambling behavior, which could not be accounted for by a manic episode. She satisfied DSM-5 criteria (8/9) for gambling disorder (American Psychiatric Association 2013), which are as follows: (1) increased preoccupation with gambling; (2) unsuccessful efforts to stop gambling; (3) restlessness and irritability when trying to stop gambling; (4) after losing money gambling, returning another day in order to get even (“chasing” her losses); (5) hiding the extent of her gambling from her family; (6) feeling she was jeopardizing her relationship with her daughter as a result of her gambling; (7) gambling as a way to relieve a dysphoric mood; and (8) relying on others to provide money to relieve her financial situation.
Although she did not satisfy one of the foregoing criteria, “Increasing amounts of money to achieve excitement,” Ms. A was nonetheless classifiable as severe and persistent. Her SOGS score was 14 (Kido and Shimazaki 2007). And her score of The Gambling Symptom Assessment Scale (G-SAS) was 31 (48) (Kim et al. 2009). In addition, her negative feelings towards her parents had been governing her own behavior and exerting an influence on the extent of her gambling. Ms. A reported experiencing several depressive symptoms over the past few weeks, including dysphoria, or little pleasure in doing things, guilt, and increased irritability. However, she did not meet the diagnostic threshold for any other psychiatric disorder, including depression.