Compulsive shopping: When spending begins to consume the consumer

• lack of money does not prevent compulsive shopping disorder from developing
  
• severe compulsive shoppers lack the ability to delay their shopping.
  

Psychiatric comorbidity

Compulsive buyers differ from matched controls when dimensional scales are used to measure psychopathology. One study found that compulsive buyers had elevated scores on the Beck Depression Inventory, the Spielberger Trait Anxiety Scale, and the Maudsley Obsessive Compulsive Inventory.²

Compulsive buyers and their first-degree relatives often have comorbid psychiatric disorders, particularly mood, anxiety, substance use, and eating disorders.⁵ Axis II disorders are also common; no particular type predominates, but the obsessive-compulsive, borderline, and avoidant personality types are seen most frequently.

McElroy et al⁷ defined compulsive buying disorder as:

• uncontrollable
  
• markedly distressing, time-consuming, and/or resulting in family, social, vocational, and/or financial difficulties
  
• not occurring only in the context of hypomanic or manic symptoms.
  

In a larger controlled study, our group⁸ compared 33 individuals who met the McElroy et al criteria for compulsive buying disorder and 22 control patients. The 137 first-degree relatives of the compulsive shoppers were significantly more likely than the controls’ relatives to have histories of depression, alcoholism, substance use, or multiple psychiatric diagnoses (as measured by the Family History Research Diagnostic Criteria).

Identifying a patient’s psychiatric comorbidities can help you develop:

• a biopsychosocial counseling plan—such as for a patient with borderline personality disorder who shops to relieve tension from relationship stress
  
• pharmacologic treatment strategies—such as prescribing a selective serotonin reuptake inhibitor (SSRI) for patients with comorbid major depression.
  

Manic versus compulsive behavior

Manic and hypomanic symptoms may be associated with impulsive and reckless spending. Thus, when evaluating excessive spending, always carefully evaluate patients for bipolar disorder.

Bipolar mania and excessive spending related to a compulsive buying disorder are relatively easy to differentiate:

• The manic patient’s unrestrained spending sprees correspond to manic episodes and are accompanied by euphoric mood, grandiosity, unrealistic plans, and often a giddy, overly bright affect.
  
• The compulsive shopper’s spending occurs year-round in a pattern suggesting ongoing preoccupation.
  

Not so for the manic, who may boast of his or her spending, display the evidence, and try to convince family and friends that the purchase is necessary or fits into some grandiose scheme. “Who doesn’t need two BMWs?” a manic patient said to one of the authors [DWB].

Screening and diagnosis

As with any psychiatric disorder, gathering an accurate history through a careful interview is important. This can be challenging with compulsive shopping disorder, however, because the patient may minimize symptoms out of embarrassment or denial. Your goal is to identify the shopping problem through nonjudgmental inquiries.

Diagnostic instruments. Researchers use assessment tools such as Faber and O’Guinn’s 7-item Compulsive Buying Scale⁹ to help diagnose this disorder. Our group developed a shopping version of the Yale-Brown Obsessive Compulsive Scale (YBOCS-SV) to help rate severity and change during clinical trials.¹⁰

Formal instruments may help in the clinical setting, but you can often elicit compulsive buying symptoms with a few screening questions (Table 2). If screening indicates a positive response, move to more detailed questions about:

• frequency of excessive shopping
  
• time spent shopping
  
• factors that trigger or worsen the shopping behavior
  
• amount of money spent.
  

Table 2

Is your patient a compulsive shopper? Ask these screening questions