588 Substance-Related and Addictive Disorders
friends. Development of early-life gambling diso rder appears to be associated with impul-
sivity and substance abuse. Many high scho ol and college students who develop gambling
disorder grow out of the disorder over time , although it remains a lifelong problem for
some. Mid- and later-life onse t of gambling disorder is more common among females than
among males. 
There are age and gender variations in the type of gambling activities and the preva-
lence rates of gambling disorder. Gambling d isorder is more common among younger and
middle-age persons than among older adults . Among adolescents and young adults, the
disorder is more prevalent in males than in females. Younger indivi duals prefer different
forms of gambling (e.g., sports betting), while older adults are more likely to develop
problems with slot machine and bingo gamblin g. Although the proportions of individuals
who seek treatment for gambling disorder ar e low across all age groups, younger individ-
uals are especially unlikely to present for treatment. 
Males are more likely to begin gambling earlie r in life and to have a younger age at on-
set of gambling disorder than females, who ar e more likely to begin gambling later in life
and to develop gambling disorder in a shorte r time frame. Females with gambling disor-
der are more likely than males with gambling disorder to have depressive, bipolar, and
anxiety disorders. Females also have a later age at onset of the disorder and seek treatment
sooner, although rates of treatment seekin g are low (<10%) among individuals with gam-
bling disorder regardless of gender. 
Risk and Prognostic Factors
Temperamental. Gambling that begins in childhood or early adolescence is associated
with increased rates of gambling disorder. Gambling disorder also appears to aggregate