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Individuals suffering from pathological gambling (PG) show impaired decision making, but it is still not clear how this impairment is related to other traits and neuroanatomical characteristics. In this study, we investigated how the influence of PG on decision making (1) is connected to different impulsivity facets and (2) how it is related to gray matter volume (GMV) in various brain regions. Twenty-eight diagnosed PG patients and 23 healthy controls completed the cups task to measure decision making. In this task, participants had to decide between safe and risky options, which varied in expected value (EV) between risk advantageous, equal EV, and risk disadvantageous choices. A delay discounting task and the Barrant Impulsiveness Scale were applied to assess multiple impulsivity facets. In addition, structural magnetic resonance images were acquired. In comparison to the control group PG patients demonstrated more deficits in decision making, indicated by less EV sensitivity, but there was no significant difference in number of overall risky choices. Also, PG patients showed increased impulsivity in nearly every dimension. Results revealed (1) a positive correlation between decision making impairments and non-planning impulsivity but no significant relation to other impulsivity facets. Although we found no GMV differences between PG patients and controls, (2) a regions of interest analysis showed a correlation between medial orbitofrontal GMV and EV sensitivity in PG patients. Our findings showed that (1) the association between decision making and impulsivity can also be found in PG patients, but only for certain impulsivity facets. This suggests that it is essential to consider measuring different dimensions, when investigating impulsivity in a PG sample. Secondly, our findings revealed that (2) dysfunctional decision making—particularly the component of risk evaluation—is related to decreased GMV in the medial orbitofrontal cortex, a brain region concerned with processing of rewards. Interestingly, we did not find more risky choices for PG patients, and thus, we assume that decision making deficits in PG are primarily related to risk evaluation, not risk seeking, which is in line with our GMV findings.

Deficient Decision Making in Pathological Gamblers Correlates With Gray Matter Volume in Medial Orbitofrontal Cortex