Introduction

Kraepelin and Bleuler first identified oniomania, or the urge to buy, in the early 1900s. Today, compulsive buying is likely a much different phenomenon from what it was when Kraepelin and Bleuler first conceptualized the disorder. In the United States, and likely in all industrialized nations, consumer spending takes place in both public places such as shopping centers, discount stores, or rummage sales and in private homes through the use of online shopping and television shopping networks. The set of symptoms known as compulsive buying, pathological buying, or buying disorder has recently received increased attention in both the consumer and mental health literatures, although data on the topic remain limited.

Diagnosis and Classification

Characteristics of compulsive buying include disinhibition or limited control over buying behavior. Compulsive buying is not included in the Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition, Text Revision (DSM-IV-TR); however, McElroy and colleagues have outlined criteria that are consistent with the DSM-IV-TR format, and these have been widely adopted in defining and studying compulsive buying ( Table 35.1 ).

Some have suggested that compulsive buying fits into the grouping of addictive and impulsive behaviors. An individual with compulsive buying behavior may experience a cycle of urges and impulses, followed by pleasure or euphoria while shopping, and guilt after purchasing items, along with a drive to continue the behavior. Impulse control disorders involve impulses or drives that the individual cannot resist, and these urges are harmful to oneself or another person.

According to its current classification, compulsive buying is a “disorder of impulsive control-not otherwise specified” due, in part, to the limited research on this topic. Some researchers have hypothesized that compulsive buying falls onto a spectrum, since the urge to buy may be variable in some individuals, or increasing and decreasing in certain situations, and the onset of compulsive buying behavior may be gradual.

However, research has yet to determine whether compulsive buying fits better with obsessive-compulsive, addictive, or impulse control disorders. Black conceptualized compulsive buying as obsessive thoughts followed by the compulsion to buy, and Frost and colleagues found that compulsive buyers had higher scores on an obsessive-compulsive symptomatology scale when compared with controls. Christenson and colleagues also suggested that compulsive buying might have features of both impulsive and compulsive disorders. Further research needs to delineate the relationship of compulsive buying to each of these theories.

Common factors among compulsive buying behavior are the desire, relief, and feeling of well-being that come from purchasing. Compulsive buyers may believe that their material possessions, not necessarily their personal characteristics, determine their identity. By purchasing, such individuals may feel that they are presenting a more desirable self to the world while hiding their shame over their debt and ongoing purchases. In addition, some research has suggested that a better conceptualization of compulsive buying may include compulsive acquisition, meaning that some individuals who exhibit compulsive buying behavior may feel the need to pick up or gather free items such as brochures or fliers.

Individuals who exhibit compulsive buying behavior often appear to be upset over their own lying, such as hiding new packages from a spouse. For many compulsive buyers, the act of purchasing, rather than what they buy, is what leads to gratification. Many who suffer from compulsive buying do not use the items that they purchase. Some individuals may return or sell the item, although many keep the items. This collection of items can lead to clutter or result in hoarding behavior. Some individuals with compulsive buying disorder spend their money on themselves, while others buy gifts. Some have reported that their urge to shop has led them to seek out and rummage trash cans and dumpsters.

Prevalence Rates and Subject Characteristics

The available data on prevalence rates of compulsive buying have proved to be variable. Koran and colleagues, after conducting phone surveys, found a point prevalence of 5.8% in the United States, with female prevalence rates somewhat higher than males, at 6.0% and 5.5%, respectively. These numbers decreased to a 1.4% point prevalence when the Compulsive Buying Scale cut-off score was increased. Other studies have reported rates of compulsive buying of 1.9% among university students (n = 791) and 9.3% in psychiatric inpatients (n = 204).

The age at onset for compulsive buying appears to typically be during late adolescence or early adulthood, although it may take several years to reach peak intensity. Compulsive buying respondents tend to have incomes below $50,000, to be more likely to make minimum payments on credit cards, and to be within $500 of maximum credit limits. Individuals with compulsive buying behavior also usually spend over $100 during compulsive buying episodes. Christenson and colleagues found that most individuals who exhibited compulsive buying behavior were experiencing indebtedness and that an average of almost half of the household’s income went toward attempts to resolve debt caused by compulsive buying behavior. Differences in shopping tendencies between genders, among individuals of varying incomes, and during special events (e.g., holidays, birthdays, or anniversaries) are important considerations in studying compulsive buying behavior.

One additional key feature of compulsive buying is the use of credit cards. O’Guinn and Faber found that individuals who exhibited compulsive buying behavior, on average, tended to have more credit cards than general consumers and that more compulsive buyers’ credit cards were within $100 of their limit. Access to credit cards is abundant in the United States, and cognitions associated with the use of credit cards (e.g., “I’m not paying for this right now,” “I can afford this next month,” or “I can pay off this credit card with another card”) can often lead to the cycle of overspending. In addition, the desire for and value placed on the need to attain and have the most items possible are likely key aspects for many compulsive buyers. Others diagnosed with compulsive buying disorder may feel driven to purchase items because they have a collection of specific items. Still others feel the allure of the sense of saving when they see a sales rack, even when they spend money on an item that they do not need.

Economics and Consumerism

Economists have long studied the behavior of buyers. Some believe that it is best to conceptualize compulsive buying on a continuum with normal spending. However, compulsive buying is a disorder involving more than just indebtedness. Whereas individuals with compulsive buying behavior do have control over their spending, there are other factors influencing and sustaining the impulse to buy that make those with compulsive buying disorder feel that they can no longer control their buying.

External forces may have etiological importance in the development of compulsive buying. For example, in the United States, there appears to be a sense of importance attached to having higher end goods such as new, expensive cars and designer fashions. Others may feel pressures from the American culture’s pursuit of youth. Individuals may experience a sense of psychological well-being when purchasing objects that fall into these categories and may think that these objects will make others perceive them as successful. Nevertheless, each individual may feel driven by a different factor or factors, and the concept of success may be different among individuals in different socioeconomic strata. Indeed, compulsive buying appears to affect individuals in varying socioeconomic categories.

Shopping in the United States is a somewhat gender-specific leisure activity. Black suggested that compulsive buying behavior and compulsive gambling behavior might be gender-specific variants of the same underlying pathology, with compulsive buying behavior manifesting itself in women and compulsive gambling behavior being more prevalent among men. Those with compulsive buying disorder often find themselves drawn to shopping for clothing, shoes, music CDs, jewelry, makeup, groceries, and décor for the home. Larger items such as cars are also possible purchases, and for this reason, purchases differ depending on access to disposable income.

Etiology and Course

No one has extensively examined the possible etiologies of compulsive buying, although it will likely fit into a biopsychosocial etiological model. ^. The course for compulsive buying is probably chronic, with one study finding the mean age at onset in late adolescence. Identification of buying as a problem tends to occur later, in one’s late twenties or early thirties. In many cases, the main thing that identifies compulsive buying is the large debt that subjects have accrued, followed by feedback from friends or family, legal problems, or guilt.

Levels of materialism and youth are predictors of compulsive buying tendencies. Women are more likely to be diagnosed with compulsive buying disorder, perhaps because women predominantly hold the shopping role in families. Indeed, women are more likely to carry a diagnosis of compulsive buying. In addition, women have had higher scores on compulsive buying inventories, suggesting that compulsive buying may be more severe in females. Compulsive buying is also related to low self-esteem and to problem credit-card use.

Several variables may be important in determining etiological factors for compulsive buying behavior as well as differences in compulsive buying among younger individuals. Survey results of adolescents suggest a positive relationship between hours of television viewed per day and compulsive buying behavior. This may be due to the influence of materialism viewed on television. There is also a significant correlation between compulsive buying behavior in adolescence and perceptions of parental compulsive buying behavior, possibly suggesting that compulsive buying is a learned behavior identified through modeling. Adolescent girls appear to have higher compulsive buying scores than boys, which speaks to gender differences in diagnosis. Predictive modeling of adolescent compulsive buying behavior suggests that gender, younger age, peer influence, parents’ compulsive buying behavior, tangible family resources, family stressors, and lesser family communication may predict compulsive buying. Others have found significant relationships between compulsive buying behavior and risk-taking behaviors such as smoking, alcohol and drug use, and unsafe sexual practices, which may speak to the relationship between impulsivity and compulsive buying behavior.

Developmental learning may also affect the formation of compulsive buying. In examining retrospective recall of childhood buying behavior, d’Astous found that the likelihood of compulsive buying increased in individuals who reported a history of being likely to spend money quickly after receiving it in childhood, as well as when they reported their parents buying “everything” they wanted. In addition, susceptibility of influences from friends or social situations (e.g., feeling important when making a purchase, frustration when having fewer things than others do) was related to compulsive buying behavior. Further research could better assess similarities in childhood experiences or modeling that may be precursors to compulsive buying.

There has been little research regarding the personal financial costs of compulsive buying. Miltenberger and colleagues found that debt ranged from $0 to $30,000 in a small sample of individuals who exhibited compulsive buying behavior. Compulsive buying episodes can vary in duration from less than an hour to hours of shopping.

A range of emotions can lead to compulsive buying episodes. Individuals with compulsive buying symptoms suggest that they often experience negative emotions before shopping, although some report elation, power, and joy beforehand. Miltenberger and colleagues also found that ratings of sadness or depressed mood were significantly higher before shopping when compared with mood during the shopping episode. Faber and Christenson also reported that boredom, depressed mood, and anxiousness were moods experienced prior to shopping. Euphoria and excitement ratings were significantly higher during shopping episodes than afterwards. These findings suggest that a negative mood state occurs before shopping and that shopping leads to a more positive change in an emotion. After shopping, a negative mood state is likely to emerge as individuals realize that they are unable to afford the purchased items. In most cases, negative emotion (e.g., tension/anxiousness, anger/irritation, self-criticalness, and boredom) scores were highest before shopping and decreased during and after the shopping episode. This model of negative reinforcement may sustain compulsive buying behavior.

Researchers have attempted to connect obsessive-compulsive spectrum disorders or impulse control disorder to compulsive buying, considering the possible role of serotonin in compulsive buying symptoms. In the only study directly examining this relationship, no differences emerged between compulsive buying participants and control participants in the rate of occurrence of two polymorphisms related to the serotonin transporter.

Research on the pathophysiology of compulsive buying remains limited. In the one available study assessing the neurobiology of compulsive buying, functional magnetic resonance imaging (fMRI) assessments showed greater activation in the nucleus accumbens in participants with compulsive buying, compared to controls, when shown various products. Consistent with these neurobiological findings, a study of neurocognition in compulsive buying found significant impairment in response inhibition, risk adjustment during decision making, and spatial working memory when compared to controls.

Comorbidity

A number of studies have examined the relationship of compulsive buying with other psychiatric disorders. The most commonly reported comorbidities include mood disorders, anxiety disorders, substance use disorders, impulse control disorders, and eating disorders. For example, when compared with control groups, it appears that persons with compulsive buying disorder are more likely to have a mood disorder or another psychiatric disorder than would be expected in the general population. In individuals with compulsive buying disorder and their family members, depression and anxiety appear to be common.

The relationship between compulsive buying and mood disorders is reasonably well established. In his examination of several case series, Black identified comorbidity rates for compulsive buying disorder and mood disorders ranging from 28% to 95%. It is important to note that compulsive buying behavior is distinct from the symptoms of a manic or hypomanic episode. Additional research on how spending and buying differ in manic episodes compared with compulsive buying episodes would be useful in understanding the distinction.

Researchers have drawn a strong link between compulsive buying disorder and binge eating disorder. Faber and colleagues performed two studies to assess the link between these two disorders. In the first study, they examined compulsive buying in women diagnosed with binge eating disorder. The authors found that the women diagnosed with binge eating disorder had significantly more symptoms of compulsive buying than did matched controls. In the second study, the authors compared a group of participants (mostly women) with compulsive buying behavior with a group of participants whose buying behavior was normal. The authors found that those with compulsive buying behavior were significantly more likely to engage in behaviors characteristic of binge eating disorder. In addition, McElroy and colleagues contributed a theoretical link between compulsive buying disorder and binge eating disorder, in that both disorders likely belong on the compulsive-impulsive behavior spectrum. Concerning other eating disorders, no one has shown a strong link between compulsive buying disorder and anorexia nervosa or bulimia nervosa.

As mentioned previously, some have suggested that compulsive buying disorder is part of the obsessive-compulsive spectrum. Interest in the obsessive-compulsive spectrum has increased over the last several years, and some have suggested that up to 10% of the population in the United States has an obsessive-compulsive spectrum problem that includes intrusive thoughts and/or repetitive behaviors. However, the relationship of compulsive buying disorder to obsessive-compulsive disorder and obsessive-compulsive spectrum disorders is unclear. For example, Bienvenu and colleagues examined a sample of individuals diagnosed with obsessive-compulsive disorder and their first-degree relatives. They identified only one case where compulsive buying disorder co-occurred with obsessive-compulsive disorder. In addition, Jaisoorya and colleagues examined a large sample of individuals with obsessive-compulsive disorder and found only one individual with comorbid compulsive buying disorder. Although compulsive buying disorder symptoms seem to relate to the general symptoms of obsessive-compulsive disorder, it appears that the relationship between compulsive buying disorder and obsessive-compulsive disorder may be unremarkable.

Some have identified a relationship between compulsive buying disorder and kleptomania. McElroy and colleagues presented a theoretical paper closely linking kleptomania and compulsive buying disorder. Lejoyeux and colleagues identified a relative risk of comorbid kleptomania of 8.5% for those with compulsive buying disorder. It also seems possible that behaviors associated with kleptomania (e.g., shoplifting) may become more common in those with compulsive buying disorder as their financial situations deteriorate and they are unable to purchase the goods that they are compelled to obtain. Another disorder that some have speculated is closely related to compulsive buying disorder is pathological gambling. As noted above, Black has conceptualized compulsive buying and pathological gambling as being gender-specific manifestations of a similar underlying psychopathology. In a sample of pathological gamblers, 23% had a lifetime history of compulsive buying disorder. Christenson and colleagues. found no difference between individuals who exhibited compulsive buying behavior and age-matched control subjects across trichotillomania, pyromania, kleptomania, intermittent explosive disorder, or pathological gambling. However, compulsive buying subjects were more likely to have any impulsive control disorder when compared with the age-matched control group. Further research about the comorbidity among compulsive buying, kleptomania, and pathological gambling could help to explain the complex relationship observed among these disorders.

Schlosser and colleagues reported on a sample of 46 individuals who met criteria for compulsive buying. Participants completed two assessments (Structured Interview for Diagnostic and Statistical Manual of Mental Disorders, Third Edition , Revised, Personality Disorders and Personality Diagnostic Questionnaire Revised), and the authors examined the extent to which the two instruments identified the same personality pathology. The most frequently identified personality disorder within the sample was obsessive-compulsive personality disorder. Twenty-two percent of the sample met the criteria for obsessive-compulsive personality disorder on both the Structured Interview for Diagnostic and Statistical Manual of Mental Disorders, Third Edition , Revised, Personality Disorders and Personality Diagnostic Questionnaire Revised. Avoidant personality disorder and borderline personality disorder were both present in 15% of the sample. Overall, 59% of the sample met criteria for a personality disorder on both the Structured Interview for Diagnostic and Statistical Manual of Mental Disorders, Third Edition , Revised, Personality Disorders and Personality Diagnostic Questionnaire Revised.

The literature on hoarding is too large to review in this chapter; however, the literature regarding compulsive buying and hoarding is worth mentioning. Frost and Hartl identified several important features of compulsive hoarding, including the acquisition of seemingly useless possessions and the inability to discard them, the negative effect of clutter created from compulsive hoarding on the activities of daily living, and the distress and impairment experienced because of compulsive hoarding. Others have suggested that those who compulsively hoard possessions attach sentimental meaning to items while others do not. Hoarding behavior is more likely in those with compulsive buying disorder compared with a noncompulsive buying group. No one thus far has proposed a diagnostic specifier for identifying hoarding behavior in compulsive buying; however, it may be that a hoarding specifier could help in differentiating compulsive buying disorder subtypes. That is, those with compulsive buying disorder who choose to give their items away may differ from those buyers who hoard items or see some sentimental value in the possession. Indeed, Mueller and colleagues suggested that compulsive buying behavior might be more severe in persons with compulsive buying who hoard compared with those who do not hoard items. Moreover, compulsive buying subjects with hoarding behavior are more likely to have an affective disorder, substance use disorder, eating disorder, or anxiety disorder than those subjects who only hoard, suggesting more comorbid psychopathology in those with both hoarding and compulsive buying behavior. Further research is needed to identify whether those individuals with hoarding traits are different from those with compulsive buying without hoarding behavior and to determine how treatment may differ between these two groups.

Almost half of one compulsive buying sample had a substance abuse problem, with most subjects abusing or dependent on alcohol. Researchers have shown that substance abuse is comorbid with compulsive buying behavior, although no research to the authors’ knowledge has directly examined the relationship between the two disorders.