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The patient’s history forms the most important basis for diagnosing a compulsive buying disorder.[ 23] The initial goal is to define the buying problem through relatively non-intrusive inquiries, and then move on to specific shopping behaviors and patterns. For general screening purposes, a clinician might ask:
• Do you feel overly preoccupied with shopping and spending?
Positive responses should be followed by more detailed inquiries about the shopping and spending behavior, such as how frequently the behavior occurs, what the individual prefers to buy, and how much money is spent.
It is important to carefully assess the patient’s psychiatric history because research has shown that most individuals with compulsive buying disorder have comorbid psychiatric disorders. The presence of comorbidity may suggest particular treatment strategies or approaches, as well as suggest explanations for excessive spending and shopping that may be helpful in counseling patients.
A patient’s history of physical illness, surgical procedures, drug allergies and medical treatment is important, as it may help rule out medical illness as an explanation for compulsive buying (e.g. neurological disorders, brain tumors) or conditions that may contraindicate the use of certain medications prescribed for the disorder. Bipolar disorder should be ruled out because many individuals with the disorder exhibit excessive shopping and spending during manic episodes.
In evaluating the individual, normal shopping and spending behavior must be distinguished from compulsive buying, although it may sometimes be difficult to draw a clear distinction. The clinician must be aware of the inherent differences in shopping behavior of typical men and women, and understand that shopping and spending generally occurs within a cultural context. In American culture, shopping is typically viewed from a female perspective, a fact not lost on advertisers, who aim their advertisements mainly at women. Additionally, persons may go through periods when their shopping and spending behavior may take on a compulsive quality, for example, around special holidays and birthdays. Persons who receive an inheritance or win a lottery may experience spending sprees or binges as well. As with any disorder, the clinician needs to exercise judgment in applying the diagnostic criteria, and must be mindful of the need for evidence of distress or impairment before making the diagnosis.
These efforts led Faber and O’Guinn to develop the Compulsive Buying Scale (CBS), an instrument expressly designed to identify individuals who exhibit compulsive buying. They began their effort with 29 items based on the earlier work; each item (rated on a 5-point scale) was chosen because it reflected important characteristics of compulsive buying. Using logistic regression, 7 items representing specific behaviors, motivations and feelings associated with compulsive buying were found to correctly classify approximately 88% of the individuals tested. The scale is now considered an important tool by researchers in identifying and diagnosing compulsive buying.
Christenson et al. have developed the Minnesota Impulsive Disorder Interview (MIDI), which is used to assess the presence of compulsive buying, kleptomania, trichotillomania, intermittent explosive disorder, pathological gambling, compulsive sexual behavior and compulsive exercise. The diagnostic instrument is fully structured and designed for use in research settings. The section on compulsive buying consists of 4 core questions and 5 follow-up questions. The developers recommend administering their 82-question expanded module to persons screening positive for compulsive buying. Lejoyeux et al. have developed a questionnaire consisting of 19 items which tap the basic features of compulsive buying. These dimensions include:
Its psychometric properties have not been reported. Monahan and colleagues modified the Yale- Brown Obsessive-Compulsive Scale (YBOCS) to create the YBOCS-shopping version (YBOCS-SV) to assess cognitions and behaviors associated with compulsive buying. The authors conclude that their scale is reliable and valid in measuring severity and change during clinical trials. Like its parent instrument, The YBOCS-SV consists of 10 items, 5 which rate preoccupations and 5 which rate behaviors. For assessing both preoccupations and behaviors, individuals are asked about time involved, interference due to the preoccupations or behaviors, distress associated with shopping, the resistance to the thoughts or behaviors, and the degree of control over the symptoms. In the sample described by Monahan et al., the mean YBOCS-SV score for individuals thought to have compulsive buying was 21 (range 18 to 25) compared with 4 (range 1 to 7) for unaffected individuals.
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