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2. Evident impairment of the ability to control use of alcohol. This can be related to difficulties in
avoiding initial use, difficulties in discontinuing use, difficulties in controlling the level of use
3. Withdrawal state, or use of the substance to mitigate or avoid withdrawal symptoms, and subjective
awareness of the efficacy of this behaviour
The essential feature of the disorder is persistently repeated gambling, which continues and often
increases despite adverse social consequences such as impoverishment, impaired family relationships,
and disruption of personal life.
For a definite diagnosis, there must be either or both of (a) and (b), plus (c) and (d):
(a)depersonalization symptoms, i.e. the individual feels that his or her own feelings and/or experiences
are detached, distant, not his or her own, lost, etc;
(b)derealization symptoms, i.e. objects, people, and/or surroundings seem unreal, distant, artificial,
colourless, lifeless, etc;
(c)an acceptance that this is a subjective and spontaneous change, not imposed by outside forces or
other people (i.e. insight);
Dissociative amnesia
(a)amnesia, either partial or complete, for recent events that are of a traumatic or stressful nature
(these aspects may emerge only when other informants are available);
A persistent instability of mood, involving numerous periods of mild depression and mild
elation. This instability usually develops early in adult life and pursues a chronic
course, although at times the mood may be normal and stable for months at a time.
The mood swings are usually perceived by the individual as being unrelated to life
Because the mood swings are relatively mild and the periods of mood elevation may
cases this may be because the mood change, although present, is less prominent than
required, age of onset may be specified as early (in late teenage or the twenties) or
late.