Gambling Disorder is a behavioural addiction characterized by persistent, maladaptive gambling behaviour that leads to significant psychosocial and financial consequences for affected individuals, their families, and society (Ferrara et al., 2018). Once classified as an impulse control disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; Gambling, 1999), it is now recognized as a ‘Substance-Related and Addictive Disorder’ in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5; Rennert, 2014) and ‘Disorders due to substance use or addictive behaviours’ in ICD-11. This reflects its neurobiological and symptomatic overlap with substance use disorders (Weinstock & Rash, 2014).

This transition shaped the trajectory of gambling-focused research, with some of the subsequent literature examining gambling through the lens of substance use identifying differing crossovers between the two conditions (Goudriaan et al., 2019, Holt et al., 2023; Leeman & Potenza, 2012; Rash et al., 2016). As a result, many assessment tools and treatment approaches originally meant for substance use disorders have been successfully adapted and applied in the context of gambling (Lupi et al., 2014; Rash & Petry, 2014; Ribeiro et al., 2021). Similar cross-application is also evident between other behavioural addictions and substance use disorders (Black, 2013). A comparable trend is now emerging between gambling and gaming, with theoretical models and strategies from the former being increasingly applied to the latter (James & Tunney, 2017).

The original intention of gambling disorder being grouped within addictive disorders was primarily concerned with increased awareness and attention on the comorbidity between disorders (Weinstock & Rash, 2014). More than 50% of individuals with gambling disorder had a lifetime history of substance use disorder (André et al., 2021), and rates of gambling disorder are also elevated among individuals with substance use disorders compared to the general population (Petry et al., 2005). As discussed previously and in line with this overlap, treatments for gambling disorder are often comparable to those used for alcohol and other substance use disorders. However, while awareness of the relationship between the two conditions may have increased, gambling disorder still remains infrequently diagnosed and untreated in both outpatient and inpatient substance use disorder treatment settings (Weinstock & Rash, 2014).

While these alignments have been helpful to build our current understanding of the parallels and non-parallels between gambling and other addictive disorders, it is equally important to move beyond this substance-use-centric framework. Recognition and awareness of gambling disorder as a distinct clinical entity will require a broader exploration of its clinical and neurocognitive features. It will allow gambling disorder to be examined in relation to a broader range of psychiatric conditions that share partially overlapping cognitive and behavioural mechanisms, such as executive functioning, impulsivity, reward processing, and decision making domains. From a theoretical perspective, this approach supports transdiagnostic models of psychopathology by identifying shared and disorder-specific cognitive processes that cut across diagnostic boundaries. Clinically, such comparisons may help refine cognitive phenotypes, improve assessment precision in comorbid presentations, and inform more targeted interventions rather than treatments for gambling adapted solely from substance use models.

Exploration of neurocognitive literature reveals that comparisons of gambling behaviour has expanded beyond substance use (Mallorquí-Bagué et al., 2016) to include a wide range of psychiatric and neurodevelopmental disorders, such as obsessive-compulsive disorder, attention-deficit/hyperactivity disorder, eating disorders, alexithymia, and Tourette syndrome among others (Aïte et al., 2014; Álvarez-Moya et al., 2009; Goudriaan et al., 2005; Kertzman et al., 2018). This body of research typically involves cognitive profiling, in which individuals are assessed across multiple neurocognitive domains, and inferences about strengths and weaknesses are drawn from their performance on standardized cognitive measures (McGill et al., 2018). When applied across individuals with the same diagnosis, such profiling helps characterize the extent and pattern of neurocognitive functioning associated with a given disorder and is commonly used to inform diagnostic evaluation and treatment planning. While many of these studies have focused on contrasting these populations with healthy controls, only a small minority of them directly provided findings focused on the cognitive similarities and differences between gambling disorder and these clinical groups themselves. Research also showed substantial degree of comorbidity, with reciprocal relationships shared between gambling disorder and conditions like substance use disorders, mood and anxiety disorders, post-traumatic stress disorder, attention-deficit/hyperactivity disorder, and obsessive-compulsive disorder (Dowling et al., 2015; Sharma & Weinstein, 2025). Additionally, research examining cognitive profiles in sub-groups of gamblers with comorbidities has started gaining traction.

Understanding the neurocognitive functioning associated with different disorders is of clinical and theoretical relevance. Cognitive deficits have implications for the aetiology, assessment, and treatment of gambling behaviour (Potenza, 2014). However, despite the presence of empirical studies exploring these domains, there remains a need to synthesize findings from available literature examining how individuals with gambling disorder compare neurocognitively to those with other psychiatric and comorbid conditions. Given the increasing rate of gambling due to high accessibility and normalization of gambling activities, it is imperative to expand the scope of inquiry beyond comparisons with substance use disorders alone. Mapping cognitive patterns across multiple disorders can help identify both shared and specific impairments, allowing for better understanding of gambling disorder and its clinical profile.

This review will reflect the continuum of gambling severity represented in the populations of past literature, from subsyndromal presentations to diagnostically defined gambling disorder, and uses the term ‘gambling behaviour’ to encompass this spectrum in the absence of a universally accepted alternative. The decision to not only include participants with a diagnosable symptamology was based on the results of a recent meta-analysis which found a prevalence of moderate risk/at-risk gambling to be 2.43% and of problem/pathological gambling to be 1.29% in the adult population (Gabellini et al. 2023). Gambling research has found that there is a large number of individuals with low-risk and moderate-risk for gambling who also experience harm (Blanco et al., 2006; Sharma & Weinstein, 2025).

This systematic review aims to bridge this gap by synthesizing research findings from studies that compared neurocognitive functioning in individuals with gambling behaviour to those with a broad range of psychiatric and other comorbid conditions. In doing so, it attempts to identify patterns of convergence and divergence in cognitive performance between different diagnostic groups, and give way to more informed research, diagnosis, and intervention strategies for gambling-related problems.