D'Amore is Now an Approved Treatment Provider for Kaiser
The intersection of Obsessive-Compulsive Disorder (OCD) and gambling disorder represents one of mental health’s most clinically significant yet poorly understood relationships. While these conditions appear distinct—one characterized by anxiety-driven rituals, the other by behavioral addiction—emerging research reveals profound neurological, psychological, and behavioral connections that create unique challenges for those experiencing both.
Understanding how OCD and gambling disorder interact, influence each other, and respond to treatment is essential for anyone affected by these conditions, whether as a patient, family member, or mental health professional.
According to the National Institute of Mental Health (NIMH), both OCD and gambling disorder involve dysregulation in overlapping brain regions. Neuroimaging research published by the National Institutes of Health (NIH) has identified remarkably similar patterns of brain activity in individuals with both conditions, particularly in:
The Orbitofrontal Cortex: This region processes decision-making, evaluates rewards and punishments, and helps inhibit inappropriate behaviors. In both OCD and gambling disorder, this area shows abnormal activation patterns, leading to difficulties with impulse control and repetitive behaviors.
The Anterior Cingulate Cortex: Responsible for error detection and conflict monitoring, this region becomes hyperactive in OCD and shows altered function in gambling disorder. This shared dysfunction may explain why individuals with both conditions struggle to recognize when their behaviors are counterproductive.
The Striatum: Central to reward processing and habit formation, the striatum plays a crucial role in both conditions. In OCD, it contributes to the formation of compulsive rituals. In gambling disorder, it becomes sensitized to gambling-related cues and rewards.
The Prefrontal Cortex: This executive control center, responsible for planning and impulse inhibition, shows reduced activity in both conditions, particularly when individuals try to resist compulsive urges.
Both conditions involve similar neurochemical disruptions:
Serotonin Dysregulation: OCD has long been associated with serotonin system dysfunction, which is why selective serotonin reuptake inhibitors (SSRIs) are often effective treatments. Research from the American Psychiatric Association indicates that gambling disorder also involves serotonergic abnormalities, particularly in brain regions controlling impulse regulation.
Dopamine Dysfunction: The brain’s dopamine system, which regulates reward and motivation, operates abnormally in both conditions. In gambling disorder, dopamine release becomes excessively tied to gambling activities. In OCD, dopamine irregularities contribute to the repetitive performance of rituals despite lack of actual reward.
Glutamate Abnormalities: Emerging research suggests that glutamate, the brain’s primary excitatory neurotransmitter, functions atypically in both OCD and gambling disorder, potentially contributing to the intrusive thoughts and behavioral compulsivity characteristic of both conditions.
Understanding the scope of co-occurrence helps contextualize the clinical significance of this relationship:
According to the NIMH, approximately 1-2% of the general population experiences OCD at some point in their lives. The National Council on Problem Gambling reports that roughly 1% of U.S. adults meet criteria for gambling disorder, with an additional 2-3% experiencing problematic gambling that doesn’t reach full disorder severity.
However, when examining clinical populations, the overlap becomes striking:
Among OCD Patients: Research indicates that between 2-10% of individuals with OCD also struggle with gambling disorder or problematic gambling behaviors—a rate significantly higher than the general population prevalence of 1%.
Among Gambling Disorder Patients: Studies suggest that 15-20% of individuals seeking treatment for gambling problems also meet diagnostic criteria for OCD, representing a dramatically elevated rate compared to the general population.
Gender Differences: While OCD affects men and women at roughly equal rates, gambling disorder has traditionally been more prevalent among men. However, this gender gap is narrowing, and women with gambling problems appear particularly likely to have co-occurring OCD or other anxiety disorders.
Several factors increase the likelihood of developing both conditions:
Early Age of OCD Onset: Individuals who develop OCD during childhood or adolescence appear at higher risk for subsequently developing gambling problems, particularly during late adolescence or early adulthood when gambling opportunities increase.
Severity of Obsessional Symptoms: People experiencing more severe obsessive thoughts and compulsive rituals show elevated rates of gambling problems, suggesting a dose-response relationship between OCD severity and gambling vulnerability.
Family History: Both conditions show familial clustering, and individuals with family histories of either OCD or addictive behaviors face elevated risk for developing both conditions.
Comorbid Conditions: The presence of other mental health conditions—particularly depression, anxiety disorders, ADHD, or substance use disorders—increases the likelihood of experiencing both OCD and gambling problems.
The International OCD Foundation identifies magical thinking as a core cognitive distortion in OCD—the belief that specific thoughts, rituals, or behaviors can prevent harm or influence outcomes despite no logical connection.
This cognitive pattern translates powerfully into gambling contexts:
Number Obsessions: Individuals may develop elaborate beliefs about lucky or unlucky numbers, feeling compelled to only bet on specific number patterns or sequences. These numbers often relate to OCD-related obsessions (such as needing things in multiples of four).
Ritualized Betting Patterns: Gambling behaviors may become rigidly ritualized, with individuals feeling compelled to follow exact sequences—sitting in specific seats, using particular machines, following preset betting patterns—driven by the belief that deviation will result in negative outcomes.
Compensatory Gambling: Some individuals feel compelled to gamble to “undo” intrusive thoughts or prevent feared outcomes, similar to how OCD compulsions function. For example, someone might feel driven to make a bet to prevent something bad from happening to a loved one.
Pre-Gambling Rituals: Before gambling sessions, individuals may perform elaborate rituals (hand-washing sequences, specific clothing choices, verbal or mental routines) that must be completed “correctly” or they believe they cannot gamble successfully.
OCD’s characteristic checking behaviors manifest uniquely in gambling contexts:
Result Checking: Repeatedly verifying gambling results, outcomes, or account balances far beyond what’s reasonable or necessary. This checking may occur dozens or hundreds of times per day, driven by obsessive doubt about whether results were correctly recorded.
Strategy Verification: Obsessively reviewing past gambling decisions, replaying scenarios mentally, and seeking excessive reassurance from others about whether choices were “right.” This checking never provides lasting relief, creating an exhausting cycle.
Rule Adherence: Compulsively researching and verifying gambling rules, regulations, or odds, driven by intolerable uncertainty rather than practical need for information.
The intrusive thoughts that characterize OCD can become inextricably linked with gambling urges:
Gambling-Focused Obsessions: Persistent, unwanted thoughts about gambling that dominate mental space—constantly thinking about past gambling sessions, future gambling opportunities, strategies, or potential wins.
Ego-Dystonic Urges: Unlike typical gambling disorder where urges may feel pleasure-driven, individuals with co-occurring OCD often experience gambling urges as ego-dystonic (inconsistent with their values and sense of self), yet feel powerless to resist them.
Mental Rituals About Gambling: Some individuals develop mental compulsions—repetitive mental calculations, rehearsals of gambling scenarios, or internal debates about whether to gamble—that consume hours and create significant distress.
Both OCD and gambling disorder centrally involve difficulty tolerating uncertainty, but this manifests differently when conditions co-occur:
Paradoxical Attraction to Gambling: Despite OCD’s characteristic need for certainty and control, some individuals become drawn to gambling’s unpredictability. This apparent contradiction often reflects an attempt to resolve the intolerable uncertainty of OCD obsessions through the concrete outcomes gambling provides.
Inability to Accept Losses: The uncertainty about whether a loss is “final” or whether the next bet might recover losses becomes intolerable, driving continued gambling despite mounting consequences—a pattern often more severe in co-occurring conditions than in gambling disorder alone.
Reassurance Seeking About Gambling: Constantly seeking reassurance from others that gambling will be okay, that debts can be repaid, or that stopping gambling is the right choice—yet never feeling satisfied by the reassurance provided.
Understanding the self-perpetuating cycle is crucial for recognizing why co-occurring conditions are particularly challenging:
OCD symptoms activate—intrusive thoughts emerge, anxiety spikes, or situations trigger obsessional concerns. The discomfort becomes overwhelming, and the individual’s normal coping mechanisms feel insufficient.
Gambling provides temporary relief through multiple mechanisms:
Cognitive Distraction: The focus required for gambling temporarily crowds out intrusive thoughts, providing mental respite from obsessional preoccupations.
Emotional Numbing: The excitement and adrenaline of gambling can temporarily override the anxiety and distress of OCD symptoms.
Sense of Control: Making betting decisions can provide an illusion of control that temporarily counters OCD’s characteristic feelings of powerlessness.
Dopamine Release: The neurochemical reward from gambling (even from losses in some cases) temporarily alleviates the dysphoric state associated with OCD.
Gambling sessions end, and reality intrudes:
Financial Problems: Losses accumulate, creating real-world problems and stress.
Relationship Strain: Time spent gambling and consequences of gambling damage important relationships.
Guilt and Shame: Remorse about gambling intensifies, creating additional emotional distress.
Practical Consequences: Work problems, legal issues, or other tangible difficulties arise from gambling behavior.
The problems created by gambling become new sources of anxiety and obsessional concern:
Financial Obsessions: Worries about debt, money, and financial security may become new obsessional themes.
Responsibility Concerns: Guilt about hurting family members may trigger OCD obsessions about being a bad person or causing harm to others.
Relationship Anxiety: Fear of losing relationships may create new checking or reassurance-seeking compulsions.
Contamination of Daily Life: The shame and secrecy of gambling problems may trigger or worsen contamination obsessions or avoidance behaviors.
With OCD symptoms worsened by gambling consequences and gambling urges intensified by increased anxiety, both conditions escalate:
Increased Frequency: Both gambling episodes and OCD compulsions become more frequent.
Greater Severity: The intensity of obsessions, anxiety, and gambling urges all increase.
Reduced Functioning: Ability to work, maintain relationships, and engage in normal activities deteriorates.
Hopelessness: The individual may feel trapped in an inescapable cycle, leading to depression and potentially suicidal ideation.
According to the American Psychological Association, Exposure and Response Prevention stands as the gold-standard psychological treatment for OCD. Research increasingly demonstrates its effectiveness for gambling disorder as well, particularly when conditions co-occur.
The therapy operates through two interconnected mechanisms:
Exposure: Systematically and gradually confronting situations, thoughts, images, or objects that trigger obsessions and anxiety. Rather than avoiding triggers (which maintains fear), clients learn to approach them in a structured, therapeutic manner.
The exposure process operates on the principle of habituation—when repeatedly exposed to anxiety-triggering stimuli without engaging in compulsions, anxiety naturally decreases over time. The brain learns that:
Response Prevention: Deliberately resisting the urge to perform compulsive behaviors or mental rituals following obsessive thoughts or anxiety. This interrupts the learned cycle where compulsions temporarily relieve anxiety, thereby maintaining obsessions.
In treating OCD, ERP follows a hierarchical approach:
Between-Session Practice: Clients practice exposures independently between therapy sessions, generalizing skills and accelerating progress.
The same principles apply powerfully to gambling disorder:
Identifying Gambling Triggers: Mapping the situations, emotions, thoughts, and environmental cues that precede gambling urges—such as financial stress, specific locations, certain times of day, or emotional states.
Creating Controlled Exposures: Systematically exposing clients to gambling-related stimuli without gambling. This might include:
Response Prevention Skills: Learning to experience gambling urges without acting on them, tolerating the discomfort, and allowing urges to peak and subside naturally.
Building Competing Responses: Developing alternative behaviors that compete with gambling when urges arise—physical exercise, calling support persons, engaging in incompatible activities.
When treating co-occurring OCD and gambling disorder, ERP protocols must address both conditions simultaneously:
Identifying Interconnections: Understanding how OCD symptoms trigger gambling and how gambling consequences worsen OCD helps target interventions effectively.
Combined Hierarchies: Creating exposure hierarchies that address both OCD triggers and gambling cues, recognizing that addressing one often impacts the other.
Dual Response Prevention: Teaching clients to resist both OCD compulsions and gambling urges, recognizing similar underlying mechanisms and applying consistent principles.
Addressing Magical Thinking: Specifically targeting the superstitious beliefs and magical thinking that often connect OCD and gambling, using exposures that challenge these beliefs.
While ERP represents a specific form of CBT, broader cognitive-behavioral approaches contribute significantly to treatment:
Cognitive Restructuring: Identifying and challenging distorted thinking patterns common to both conditions:
Probability Distortions: Both conditions involve misperceptions of probability—in OCD, overestimating the likelihood that feared outcomes will occur; in gambling, misunderstanding odds and believing wins are more likely than they are.
Thought-Action Fusion: The OCD-related belief that thinking about something makes it more likely to occur can extend to gambling contexts, where people believe their thoughts influence random outcomes.
Illusion of Control: Both conditions involve believing one has more control over outcomes than is realistically possible.
Catastrophizing: Overestimating how terrible outcomes would be if feared events occurred or gambling losses continue.
Behavioral Activation: Increasing engagement in meaningful, rewarding activities that naturally compete with both OCD compulsions and gambling:
Identifying Values: Exploring what truly matters to the individual beyond symptoms and behaviors.
Activity Scheduling: Systematically planning and engaging in activities aligned with values and providing natural rewards.
Building Mastery: Creating opportunities for achievement and competence in non-gambling, non-compulsive domains.
Relapse Prevention: Developing specific strategies for maintaining gains:
Trigger Identification: Recognizing early warning signs that symptoms are returning.
Coping Strategy Review: Maintaining proficiency in therapeutic skills learned during treatment.
High-Risk Situation Planning: Preparing for challenging situations that might trigger either condition.
Support System Engagement: Maintaining connections with supportive others who can assist during difficult periods.
Originally developed for borderline personality disorder, DBT offers valuable skills for managing co-occurring OCD and gambling disorder:
Mindfulness Skills: Learning to observe thoughts, urges, and emotions without immediately reacting to them—a crucial capability for both resisting compulsions and managing gambling urges.
Distress Tolerance: Developing capacity to tolerate uncomfortable emotions and situations without resorting to maladaptive coping (compulsions or gambling):
TIPP Skills: Temperature change, Intense exercise, Paced breathing, Progressive muscle relaxation for managing acute distress.
Self-Soothing: Using the five senses to create comfort without harmful behaviors.
Radical Acceptance: Accepting reality as it is rather than struggling against unchangeable circumstances.
Emotion Regulation: Understanding and managing intense emotional states that often trigger both OCD symptoms and gambling:
Identifying Emotions: Recognizing and labeling emotional experiences accurately.
Reducing Vulnerability: Maintaining routines (sleep, nutrition, exercise) that support emotional stability.
Opposite Action: Acting opposite to emotion-driven urges when emotions don’t fit facts.
Interpersonal Effectiveness: Improving relationships often damaged by both conditions:
Assertiveness Skills: Asking for what you need and saying no when appropriate.
Relationship Building: Strengthening connections with supportive others.
Conflict Resolution: Managing disagreements without resorting to avoidance or aggression.
While psychotherapy remains the primary treatment, psychiatric medications can play important supporting roles:
For OCD
According to NIMH guidance, medication can significantly reduce OCD symptoms:
Selective Serotonin Reuptake Inhibitors (SSRIs): Medications like fluoxetine, sertraline, paroxetine, and fluvoxamine often reduce OCD symptoms, though typically requiring higher doses than used for depression.
Clomipramine: A tricyclic antidepressant with strong anti-obsessional effects, though with more side effects than SSRIs.
Augmentation Strategies: When SSRIs provide insufficient relief, adding low-dose antipsychotic medications (risperidone, aripiprazole, quetiapine) sometimes enhances effectiveness.
For Gambling Disorder
Research on gambling disorder medications shows more mixed results, but some approaches demonstrate promise:
Naltrexone: This opioid antagonist, approved for alcohol use disorder, shows effectiveness for gambling disorder in some studies, possibly by reducing the rewarding effects of gambling.
N-Acetylcysteine: This glutamate modulator has shown preliminary benefits for gambling disorder in research settings.
SSRIs: While less consistently effective for gambling than for OCD, SSRIs sometimes reduce gambling urges, particularly when co-occurring depression or anxiety is present.
Integrated Medication Management
When both conditions co-occur, medication strategies may include:
Prioritizing OCD Treatment: Starting with SSRI treatment at doses effective for OCD often provides benefits for both conditions.
Monitoring Response: Carefully tracking how each condition responds to medication, adjusting as needed.
Combination Approaches: In some cases, combining medications (such as an SSRI plus naltrexone) may provide optimal results.
Coordinating with Therapy: Medication works best when combined with evidence-based psychotherapy, not as a standalone treatment.
Multiple pathways lead to appropriate treatment:
Mental Health Professionals: Psychologists, licensed clinical social workers, counselors, and psychiatrists with training in:
Specialized Treatment Programs: Some treatment facilities offer specialized programming for:
Levels of Care: Treatment intensity should match clinical need:
Outpatient Therapy: Weekly individual or group therapy for stable individuals with supportive environments.
Intensive Outpatient Programs (IOP): Multiple sessions per week (typically 9-12 hours weekly) for those needing more structure while maintaining work or school.
Partial Hospitalization Programs (PHP): Day programs (typically 20-30 hours weekly) providing intensive treatment while allowing individuals to return home evenings.
Residential Treatment: 24/7 care in therapeutic environments for those requiring intensive stabilization or who have inadequate support systems.
Inpatient Hospitalization: Brief acute stabilization for crisis situations, suicidal ideation, or severe symptom exacerbations.
Connecting with others facing similar challenges provides invaluable benefits:
Gamblers Anonymous: A 12-step fellowship specifically for gambling disorder, offering:
Gam-Anon: Support specifically for family members affected by someone else’s gambling, providing:
OCD Support Groups: Many communities offer OCD-specific groups through:
Online Communities: Digital support includes:
Immediate help is available for those in crisis:
National Suicide Prevention Lifeline: 988 or 1-800-273-8255
SAMHSA National Helpline: 1-800-662-4357
National Problem Gambling Helpline: 1-800-522-4700
Crisis Text Line: Text “HELLO” to 741741
Emergency Services: Call 911 or go to nearest emergency room for:
Reliable information helps individuals and families understand conditions and treatment:
Government Resources:
Professional Organizations:
Gambling-Specific Resources:
For individuals in Southern California struggling with co-occurring OCD and gambling disorder, D’Amore Mental Health offers comprehensive, evidence-based treatment specifically designed to address both conditions simultaneously.
D’Amore recently opened a dedicated treatment facility specifically for individuals with OCD and related disorders, representing a significant advancement in specialized care for Orange County residents. Our OCD treatment center provides:
Expert Clinical Team: Licensed mental health professionals with advanced training and certification in:
Evidence-Based Protocols: Structured treatment programming based on research demonstrating effectiveness:
Dual Diagnosis Expertise: Recognition that OCD rarely exists in isolation, with specialized treatment for:
D’Amore’s signature Build Me Up Program® distinguishes our approach through:
Positive Reinforcement Focus: Rather than solely targeting symptom reduction, we emphasize building positive behaviors, celebrating progress, and fostering growth.
Gracious Redundancy®: Our philosophy of providing multiple overlapping layers of support ensures no client experiences gaps in care. This includes:
Holistic Treatment Approach: Recognizing that mental health recovery involves the whole person:
Understanding that individuals enter treatment with varying needs and circumstances, D’Amore offers multiple treatment intensities:
Residential Treatment: 24/7 therapeutic environment for those requiring:
Partial Hospitalization Program (PHP): Structured daytime programming (typically 6-8 hours daily, 5 days weekly) providing:
Intensive Outpatient Program (IOP): Flexible programming (typically 9-15 hours weekly) enabling individuals to:
Outpatient Treatment: Ongoing therapy for:
D’Amore Mental Health works with most major insurance providers to make treatment accessible:
In-Network Providers:
Out-of-Network Benefits: We also work with most PPO insurance plans, helping maximize out-of-network benefits when applicable.
Verification Process: Our admissions team provides:
Living with co-occurring OCD and gambling disorder can feel overwhelming. The intrusive thoughts, compulsive rituals, urges to gamble, financial stress, relationship strain, and profound shame may seem insurmountable. The vicious cycle where each condition worsens the other can create a sense of hopelessness.
But recovery is not only possible—it happens every day for individuals who access appropriate, evidence-based treatment. The neuroplasticity of the brain means that new patterns can be established, replacing dysfunctional ones. The behavioral chains maintaining both conditions can be broken through systematic intervention. The skills needed to manage symptoms can be learned and strengthened.
Treatment works. Research consistently demonstrates that:
The journey requires courage—courage to acknowledge problems, courage to ask for help, courage to face fears through exposure therapy, courage to sit with discomfort rather than seeking relief through compulsions or gambling, and courage to persist through setbacks on the path to recovery.
You don’t have to face this journey alone. Professional treatment, peer support, family involvement, and community resources all contribute to successful recovery. The first step is reaching out.
If you or a loved one are struggling with OCD, gambling disorder, or both conditions together, help is available. Whether through D’Amore Mental Health’s specialized programs, other qualified treatment providers, support groups, or crisis resources, pathways to recovery exist.
Take the first step today. Call 714-375-1110 to speak with our admissions team about how D’Amore’s specialized OCD and dual diagnosis treatment programs can support your recovery journey.
Jamie Mantel is a Licensed Marriage and Family Therapist, with a Psy.D. in psychology. Jamie has worked for non-profits for over 20 years working with agencies, as well as her private practice in Huntington Beach, California.
