with increased rates of gambling disorder. Gambling disorder also appears to aggregate
with antisocial personality disorder, depre ssive and bipolar disorders, and other sub-
stance use disorders, particul arly with alcohol disorders. 
Genetic and physiological. Gambling disorder can aggregate in families, and this effect
appears to relate to both environmental and genetic factors. Gambling problems are more
frequent in monozygotic than in dizygotic twins. Gambling disorder is also more preva-
lent among first-degree relati ves of individuals with modera te to severe alcohol use dis-
order than among the general population.
Course modifiers. Many individuals, including adolesce nts and young adults, are likely to
resolve their problems with gambling disorder over time, although a strong predictor of
future gambling problems is  prior gambling problems.
Culture-Related Diagnostic Issues
Individuals from specific cultures and races/ethnicities are more likely to participate in
some types of gambling activities than others (e.g., pai gow, cockfights , blackjack, horse rac-
ing). Prevalence rates of gambling disorder are higher among African Americans than
among European Americans, with rates for Hi spanic Americans similar to those of Euro-
pean Americans. Indigenous populations have high prevalence rates of gambling disorder. 
Gender-Related Diagnostic Issues
Males develop gambling disorder at higher rates than females, alth ough this gender gap
may be narrowing. Males tend to wager on di fferent forms of gambling than females, with
cards, sports, and horse race gambling more prevalent among males, and slot machine and
bingo gambling more common among females.