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Compulsive buying disorder is characterized by excessive or poorly controlled preoccupations, urges or behaviors regarding shopping and spending, which lead to adverse consequences.
Compulsive buying disorder has been estimated to affect from 2 to 8% of the general adult population in the US; 80 to 95% of those affected are female. Onset occurs in the late teens or early twenties, and the disorder is generally chronic. Psychiatric comorbidity is frequent, particularly mood, anxiety, substance use, eating and personality disorders. Treatment has not been well delineated, but individual and group psychotherapy, cognitive-behavioral therapy and 12-step programs may be helpful. Debt consolidation and credit counseling will be appropriate for many individuals who have compulsive buying disorder. Serotonin (5-hydroxytryptamine; 5-HT) re- uptake inhibitors may help some patients regulate their buying impulses. Self-help books are also available.
Compulsive buying disorder has been the subject of growing interest in the professional and lay literature, much of it prompted by the recent interest in ‘compulsive’ behaviors.[1-3] Although many believe compulsive buying disorder to be a new phenomenon, German psychiatrist Emil Kraepelin described ‘oniomania’ 85 years ago, and is quoted by Eugen Bleuler in his 1924 Textbook of Psychiatry: ‘The particular element is compulsiveness; they cannot help it, which sometimes even expresses itself in the fact that… the patients are absolutely incapable to think differently, and to conceive the senseless consequences of their act and the possibilities of not doing it’. Kraepelin and Bleuler both classified compulsive buying as one of the ‘impulsive insanities’, alongside kleptomania and pyromania.
In the past decade, there has been a renewed interest in disorders characterized by behavioral excess. The effectiveness of serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors in relieving obsessive-compulsive symptoms has led psychiatrists and researchers to use these drugs to treat other disorders that may lie along a continuum with obsessive-compulsive disorder (OCD), including body dysmorphic disorder, compulsive sexual behavior, pathological gambling and compulsive buying.[1-3] Although it is unclear whether compulsive buying disorder is in any way related to OCD, renewed interest in this disorder can be traced directly to the emergence of the ‘obsessive-compulsive spectrum’ concept.
Apart from the early interest in compulsive buying shown by Kraepelin and Bleuler, professional interest was essentially limited to occasional in-depth case reports authored by psychoanalysts,[ 7-9] or reports in the consumer behavior literature.[ 10-14] The situation changed when McElroy et al. published a report describing the improvement observed in 3 individuals with compulsive buying disorder who were administered antidepressants. On the heels of this report came 3 independent case series[16-18] reporting on a total of 90 persons with compulsive buying disorder.
Definition and Classification
As an alternative, McElroy and her colleagues offered an operational definition for clinical and research use (see table I). The definition recognizes that compulsive buying has both cognitive and behavioral components, each potentially causing impairment. Impairment can be manifested through personal distress; social, marital or occupational dysfunction; or financial or legal problems. The DSM-IV has no category for compulsive buying disorder, individuals with the condition are relegated to the residual category ‘Disorder of Impulse Control Not Otherwise Specified’. According to the
The definition of compulsive buying disorder developed by McElroy et al. has achieved wide acceptance among psychiatric researchers. Although the appropriate classification of compulsive buying disorder is unclear, biologically oriented researchers have focused on the similarity of compulsive buying disorder to OCD, other impulse control disorders such as pathological gambling, and to the mood and anxiety disorders.[1,2,16,20] Other investigators[21,22] have suggested that compulsive buying is similar, in many respects, to alcohol and drug addiction.
Considered by some to fall within an ‘obsessive-compulsive spectrum’, there are few data other than those provided by McElroy et al. to suggest that the two disorders overlap, nor are there any data from family history studies showing an excess of OCD among the relatives of individuals who have compulsive buying disorder, and vice versa. Compulsive buying appears to overlap with other impulse control disorders, particularly pathological gambling. Pathological gambling is primarily a disorder of men, but the two disorders are similar in terms of cognitive and behavioral symptoms; each could represent gender-specific manifestations of an underlying impulsive tendency.
Table I. Diagnostic criteria for compulsive buying
- frequent preoccupation with buying or impulses to buy that is/are experienced as irresistible, intrusive and/or senseless
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