Ms. A has been compulsively shopping and spending since age 19 when she first obtained credit cards. After years of intense urges to shop and remorse over the financial consequences, she seeks psychiatric help. Now age 37 and divorced, she has controlled her spending only for two 1- to 2-year periods that coincided with bankruptcy proceedings.
With easy access to credit, many persons such as Ms. A develop what is variously called compulsive buying, compulsive shopping, addictive shopping, or shopaholism. Although “medicalizing” excessive shopping may seem to obscure its broader cultural and social causes,1 increasing evidence points to a discrete shopping disorder.
Our group has contributed to compulsive buying research and continues to evaluate potential treatments. We offer evidence and practical advice to help you:
- identify compulsive shopping disorder using the patient’s history and three screening questions
- differentiate compulsive shopping from manic or hypomanic shopping sprees
- educate patients about four steps to control compulsive shopping.
Compulsive shopping disorder’s clinical signs
|Onset in late adolescence to early adulthood|
|Female-to-male ratio may be 9:1|
|Behaviors include shopping frequently, spending inappropriately, and fantasizing about future purchases|
|Psychiatric comorbidity—mood disorders, substance abuse, eating disorders—is common among patients and first-degree relatives|
|Chronic symptoms wax and wane, with widely varying severity|
|Irresistible urges prompt spending by some patients|
|Shopping is intensely exciting, with transitory feelings of happiness and power|
|Feelings of distress and guilt develop after shopping; patients often hide purchases|
|Patients may be in denial or feel embarrassed to disclose symptoms|
An Evolving Picture
Ms. A says shopping is her primary social activity and entertainment. Though she works full time, she shops three or more times a week, cruising expensive department stores and discount outlets on evenings and weekends. She buys clothing, shoes, makeup, jewelry, antiques, household electronics, and other items.
She says her shopping is spontaneous and impulsive. Shopping gives her an emotional “rush” that is frequently followed by periods of guilt, and she often returns or gives away purchased items. She is disappointed at her inability to control her shopping behavior and ashamed of the financial crises she has caused.
Compulsive buying is characterized by persistent or poorly controlled preoccupations, urges, or behaviors regarding shopping or spending, leading to adverse consequences.2 Onset in late adolescence to early adulthood is the usual pattern, and the disorder is thought to be chronic or recurrent. It is not listed in DSM-IV-TR but is considered an example of an impulse control disorder not otherwise specified. For this paper, we use the terms compulsive shopping and compulsive buying interchangeably.
The disorder’s tentative classification reflects debate about its conceptualization. Some clinicians and researchers consider compulsive buying an addiction similar to drug or alcohol misuse; others have linked it to depression or anxiety. Hollander3 and others have commented on its similarities with obsessive-compulsive disorder (OCD), and a recent study noted that compulsive buying is more common in patients with OCD than in matched controls.4 Still others—drawing on Kraepelin’s and Bleuler’s early work—consider compulsive buying an impulse control disorder, having features in common with pathological gambling and kleptomania.5
Prevalence. One survey estimates 2% to 8% of U.S. adults meet criteria for a compulsive shopping disorder, and community-based and clinical surveys suggest that 86% to 95% of them are women.5 The reported gender difference may be artifactual; women readily acknowledge that they enjoy shopping, whereas men are more likely to report that they “collect.”
Behavior patterns. No careful, longitudinal studies have examined compulsive buying disorder, but case reports suggest the condition is chronic, with a waxing and waning course and wide variance in symptom severity. In 20 consecutive patients with compulsive buying symptoms, one-half reported that irresistible urges prompted spending and three-quarters preferred to shop alone.6
Compulsive shoppers tend to shop frequently and spend inappropriately:
- at department and discount stores, specialty shops, and boutiques
- from mail order, television, and online merchants.
While shopping, compulsive shoppers may report feeling intensely excited, happy, and powerful. These emotions are frequently followed by distress or guilt. They may return purchases or hide them in closets or attics, never to be used.
Low-income persons who shop compulsively may do so at consignment shops or garage sales. In one of our studies, the most severe compulsive buyers had the lowest incomes,6 suggesting that: