Compulsive Buying Deserves Greater Consideration

It's not surprising that compulsive buying disorder is considered a relatively recent psychiatric condition and one that merits little consideration among mental health professionals.

After all, most people see compulsive buyers as "shopaholics," individuals not with a serious disorder but rather as minor casualties in today's consumer-driven society. For some people, "shop 'til you drop" is even considered a badge of honor.

But compulsive buying disorder has been around for decades, if not centuries, and often leads to financial difficulties and severe family and personal distress. Moreover, it warrants serious consideration among mental health professionals and the public, according to a University of Iowa psychiatrist.

"People do tend to trivialize this condition, and say it doesn't exist, that it's a minor behavioral problem or that it doesn't affect many people," said Donald Black, M.D., professor of psychiatry in the University of Iowa Roy J. and Lucille A. Carver College of Medicine. "But this is a distinct, definable syndrome that affects many people and causes a lot of problems."

Black, who first began researching compulsive buying in the early 1990s, published a review article on compulsive buying in the February 2007 issue of CNS Spectrums (the International Journal of Neuropsychiatric Medicine). In the article, he notes that examples of excessive spending have been well documented throughout modern history as in the cases of Marie Antoinette, Mary Todd Lincoln, Jacqueline Kennedy Onassis and Princess Diana.

Compulsive buying disorder is best classified as a disorder of impulse control, Black writes. It occurs in as many as 6 percent of American adults and probably affects women more than men. The condition is chronic -- people with the disorder tend to exhibit overspending behavior in their late teens or early twenties, and the problem continues for years. Black noted that most compulsive shoppers have a history of depression or anxiety disorder. It also is linked to other conditions such as eating disorders, problem gambling and Internet addiction.

There are no standard treatments for compulsive buying disorder. Cognitive behavioral therapy, especially group therapy, seems to help some people, but such programs are rare, Black said. He added that studies on medications to treat compulsive shopping have been disappointing.

"Basically, it comes down to this: get rid of your credit cards, do not shop by yourself and find other ways to spend your time." Black said. "Unfortunately, for most compulsive buyers, this is their pastime. If they want to succeed at eliminating this problem, they need to find something else to fill that time."

Black would like to see compulsive buying disorder included in the next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the manual for mental health professionals published by the American Psychiatric Association. The association establishes a series of committees who review and revise diagnostic criteria for mental illnesses and make recommendations for new disorders to be added. The current fourth edition of the DSM was published in 1994; the next edition is still several years away, said Black, who is not a member of any of the DSM review committees.

Including compulsive buying in the next edition of the DSM would lead to greater understanding and acceptance in the mental health profession, which in turn could lead to better treatments and opportunities for more research on the disorder, Black noted. He cited compulsive gambling as an example of a disorder that was first met with skepticism by health professionals but has been included in the DSM for years.

"The research I and others have done over the past 15 years has shown that compulsive buying is not simply a product of another condition. Its symptom patterns are practically identical from patient to patient, and it affects people in a substantial way," Black said. "It's been around, and it's going to stay around."