Anxiety and Distress Tolerance as Mediators between Complex Posttraumatic Stress Disorder Symptoms and Gambling Severity in Veterans

Abstract

Experiences of gambling-related harm are significant concerns among military veterans, particularly those with posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD). CPTSD, as outlined in the ICD-11, includes disturbances in self-organisation (DSO), encompassing affective dysregulation, negative self-concept, and interpersonal difficulties. While anxiety and distress tolerance (DT) have been implicated in PTSD-related maladaptive behaviours, their roles in the relationship between CPTSD and gambling risk severity remain unclear. This study examines whether anxiety and DT mediate the association between CPTSD symptom clusters (PTSD and DSO) and gambling severity in UK Armed Forces veterans. A cross-sectional study was conducted with UK ex-service personnel (n = 346) who completed the International Trauma Questionnaire for CPTSD, the Generalised Anxiety Disorder scale, the Distress Tolerance Scale, and the Problem Gambling Severity Index. Mediation analyses were conducted using bootstrapped regression models. Anxiety was found to be a significant indirect pathway between CPTSD symptoms and gambling risk severity, with a stronger indirect effect observed for DSO symptoms than PTSD-specific symptoms. In contrast, DT did not show a significant indirect pathway, indicating that deficits in DT may not be central to gambling behaviours in veterans with CPTSD. These findings highlight the critical role of anxiety in gambling-related harm among veterans with symptoms of CPTSD, suggesting that interventions targeting anxiety regulation may be beneficial than those targeting distress tolerance in reducing gambling risk severity. Future research should explore additional potential pathways, such as impulsivity and trauma-related dissociation to further clarify associations between CPTSD and gambling severity.