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Section 10
Compulsive Buying Disorder Part III: Epidemiology

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Faber and O’Guinn[12] also used the CBS to estimate the prevalence of compulsive buying in the US at between 1.8 and 8.1%. The two figures represent different thresholds set for the definition of a disorder based on the CBS score.

Among individuals who self-identified as compulsive buyers,[14] and in clinical samples,[16-18,26,27] the disorder shows a female preponderance ranging from80 to 95% . Both Kraepelin[4] and Bleuler[5] had noted that compulsive buying disorder mainly involves women.

Age at onset has been reported to range from 18 to 30 years, and the mean age at interview ranged in 6 studies from 31 to 41 years. The differences in age of onset and presentation probably stem from how the samples were selected. For example, McElroy et al.[16] used a clinic/hospital sample, while both Schlosser et al.[17] and Christenson et al.[18] advertised for study participants in the community.

Compulsive buying disorder is found worldwide. Reports on the disorder have come from Brazil,[29] England,[30]France,[27] Germany[11] and the US.[16-18] However, the disorder appears confined to the developed countries; compulsive consumption in an undeveloped country seems unlikely except among the wealthy elite.

Persons with compulsive buying disorder frequently meet criteria for other Axis I and Axis II disorders.[16-18] In particular, mood, anxiety, substance use and eating disorders are common. In 3 of the case series listed in table III, data from a comparison group were presented. Christenson et al.[18] compared individuals who exhibited compulsive and noncompulsive buying, and reported that only anxiety disorders, eating disorders, substance use disorders and impulse control disorders were significantly more frequent among the former. Black et al.[26] used a community recruited control group, and reported that individuals with compulsive buying disorder had significantly more major depression and ‘any mood disorder’, and were also Significantly more likely to have ‘more than one psychiatric disorder’. Lejoyeux et al.[27] compared individuals who were depressed and had compulsive buying disorder with depressed patients who did not have compulsive buying disorder. They reported that the group with compulsive buying disorder had significantly more recurrent depression, bipolar disorder, bulimia, kleptomania, benzodiazepine abuse and suicide attempts.

Faber et al.[31] have found a close relationship between binge eating disorder and compulsive buying. A group with compulsive buying disorder were more likely to have engaged in binge eating disorder and bulimia nervosa than a control group. Frequency of Axis II disorders was assessed by Schlosser et al.[17] using a self-report instrument and a structured interview. Nearly 60% of the sample met criteria for at least one personality disorder type through a consensus of both instruments, most commonly obsessive compulsive (22%), borderline (15%) and avoidant types (15%) [table IV]. Kruger[7] observed in 4 cases that all demonstrated aspects of narcissistic personality: ‘They rely on other people for affirmation and esteem regulation . . .’. Individuals with compulsive buying disorder also differ from comparison samples when dimensional assessments are used. Christenson et al.[18] report that individuals with compulsive buying disorder scored significantly higher than those who exhibited normal buying on the Beck Depression Inventory, the state and trait scales of the Spielberg Trait Anxiety Inventory, and on the checking, washing, obsessional slowness, and total scales of the Maudsley Obsessive-Compulsive Inventory. Lejoyeux et al.[27] found that individuals with depression and compulsive buying had significantly higher scores than individuals who were depressed but exhibited noncompulsive buying on the experience seeking scale of the Zuckerman Sensation Seeking Scale, as well as the cognitive impulsivity, motor impulsivity, nonplanning activity and total scores for the Barrat Impulsivity Scale. In a study of individuals who self-identified as compulsive buyers, O’Guinn and Faber[14] identified higher levels of compulsivity, materialism and fantasy, but lower levels of self-esteem than in individuals who engaged in normal buying behavior.

Family History
McElroy et al.[16] report that of 18 individuals with compulsive buying disorder, 17 had one or more first-degree relatives (FDRs) with major depression, 11 with alcohol or substance abuse, and 3 with an anxiety disorder. Three had relatives also with a compulsive buying disorder.

Black et al.[26] used the family history method to assess the 137 FDRs of 31 individuals with compulsive buying disorder (table V). In this study, the FDRs of individuals with compulsive buying disorder were significantly more likely than FDR comparators to have depression, alcoholism, drug use disorder and ‘more than one psychiatric disorder’. Compulsive buying was identified in 13 (9.5%) of the FDRs of those with compulsive buying disorder. In the only molecular genetic study of compulsive buying to be reported, Devor et al.[33] failed to find an association between two serotonin transporter gene polymorphisms and the disorder.

Clinical Symptoms
Christenson et al.[18] and Schlosser et al.[17] used the MIDI to assess buying behaviors and cognitions in their samples. Their data indicate that compulsive buying disorder is chronic for most individuals with few periods of remission, but episodic for the rest. Shopping experiences are frequent, and not confined to special holidays or birthdays. Patients report having irresistible urges to buy, and most have tried unsuccessfully to control themselves, usually through willpower.

Christenson et al.[18] noted that for 47% of patients, shopping experiences are associated with irresistible urges that prompt buying. Urgeswere episodic, typically lasting an hour and varied from daily to weekly in occurrence. In a few individuals, urges were reported to occur hourly.

For those with compulsive buying disorder, shopping is associated with a variety of emotions. Christenson et al.[18] note that many patients feel happy (83%) or powerful (71%) while shopping, although this may be followed by a feeling of ‘letdown’. Schlosser et al.[17] reported that many individuals with compulsive buying disorder buy for themselves (39%), but also buy for family members and friends. They prefer to shop alone (74%). Shoppers often describe their experiences as being enhanced by the colors, sounds, lighting and odor of stores, as well as the textures of clothing. Some shoppers (11%) even describe the experience as sexually exciting. Many feel guilt or remorse when faced with the consequences of their buying, and may even fail to unwrap their packages, return items, or give them away.

Clothes, shoes, jewelery and make-up were the most common items purchased by women. The items were generally not large and expensive and, individually, would not have led to any problems, but typically they are bought in quantity, leading spending to get out-of-hand. Men were typically interested in the same items, but tended to have a greater interest than women in electronic, automotive or hardware goods.

Additionally, individuals with compulsive buying disorder rely more on credit cards than individuals who buy normally, tend to have more of them, but are less likely to pay them off monthly. In one study, individuals who exhibited normal buying behavior reported that 22% of take-home pay was used to pay off debts (excluding home and car payments), but for those with compulsive buying disorder the figure was 46%.

Our group[34] recently introduced the concept of compulsive buying severity. By dividing a sample of 44 individuals into quartiles from most to least severe depending upon CBS score, we found that greater severity was associated with lower gross income, less likelihood of having an income above the median, and spending a lower percentage of income on sale items. Those with more severe compulsive buying were also more likely to have Axis I or Axis II comorbidity. The picture that emerges of persons with the most severe compulsive buying problem is of individuals with significant psychiatric comorbidity whose spending is both more impulsive and less well controlled than those with better finances.

In a comparison of depressed patients with and without compulsive buying,[25] those with compulsive buying disorder were significantly more likely to shop alone, and to buy gifts for themselves or others (as opposed to buying necessary goods) than the depressed patients who did not have compulsive buying behavior. The purchases made by those with compulsive buying disorder were also more likely to be made because the individual believed their social status required the item. Most purchases represented gifts for oneself or others, and were used significantly less often than expected.
- Black, DW; Compulsive buying disorder: definition, assessment, epidemiology; and clinical management; CNS Drugs; 2001; Vol. 15; Issue 1.

Personal Reflection Exercise #3
The preceding section contained information about the epidemiology of compulsive buying disorder.  Write three case study examples regarding how you might use the content of this section in your practice.

Online Continuing Education QUESTION 10
For those with compulsive buying disorder, what sensory factors often enhance their shopping experience? To select and enter your answer go to CEU Test

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