It had become a tradition in my family. After we dropped our kids at camp near Augusta, Maine, we stopped in Freeport on our drive back to Boston.
Freeport is the home of clothing retailer L.L. Bean, which is open 24 hours a day, 365 days a year. It was a magnet for around-the-clock shoppers decades before the Internet. Freeport is now thick with outlet stores — a perfect place to do "retail therapy" in the hours after you leave your beloved children.
There's no denying the pleasure in purchasing. And advertisers only get more skilled at parting us from our cash. But for some — maybe as many as 1 in 20 according to a 2006 study — shopping is a compulsion or an addiction. Compulsive shoppers may get some pleasure, but they are also trapped in a terrible cycle. As shopping becomes an irresistible and sometimes senseless impulse, they buy things they don't need and can't afford. And the shopping leads to guilt, conflict in key relationships, trouble at work, and financial difficulty, if not ruin. In some cases, the compulsion leads to criminal activity.
At worst, an individual may commit suicide in response to feeling depressed or humiliated. That is an extreme and rare outcome. But experts have learned that compulsive buying can cause as much distress as very common mental disorders such as depression and anxiety.
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Is Compulsive Buying an Illness?
Compulsive buying is not currently listed in the manual used in American psychiatry to diagnose mental health disorders. It has been discussed for inclusion in the next edition, but it is not part of the proposed revision.
Experts disagree about how to classify this problem. Some see it as a problem of impulse control — the inability to resist an impulse or temptation. There's an increasing sense of arousal or tension before acting and a sense of relief afterwards. Other practitioners see compulsive buying as a variant of obsessive-compulsive disorder. A third position is that it as an addiction. It's possible that it's not a compulsion or an addiction at all, but a way to soothe painful feelings of depression or loneliness or part of the intense high or euphoria of mania.
Some experts even criticize the idea that we should call compulsive buying a medical or mental disorder. They suggest that the problem is primarily a social one. Advertisers are too clever at selling us things. And modern shopping opportunities are always available.
The social influence is great, no doubt. But there is evidence of a biological component, too: Compulsive buyers are more likely than average to have a mood disorder or some other psychiatric disorder. And their close relatives are more likely than average to have psychiatric disorders like depression, alcoholism, or drug abuse. This suggests a genetic, and therefore a biological link.
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How Common Is It?
In a study published in the American Journal of Psychiatry in 2006, researchers interviewed about 2,500 adults selected at random across the United States. They were asked questions from a standardized "compulsive buying scale." Subjects were asked to describe their spending habits and say whether they thought their spending was unusual, if they were spending to improve their mood, if they felt they were losing control and if they had developed money troubles.
The authors found that almost 6% of the people who responded had significant problems with compulsive buying. This is two to four times higher than rates for anxiety and depression. (A 2010 survey conducted in Germany found a slightly higher rate, closer to 7%.) When they used the strictest definition of compulsive buying, the rate in the U.S. study dropped to between 1% and 2% — similar to rates of major depression. Either way, it adds up to too many people spending too much money, getting too little pleasure and feeling too much pain.
Women and men are equally affected by this problem. So society's bias that women are more likely to be shopaholics, is wrong. Women are, however, more likely to seek treatment.
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Figuring Out the Cause
There are probably multiple causes of compulsive buying just as there are numerous causes of depression and anxiety. Getting the right treatment depends on the answers to these questions:
- Is the person depressed? Does he or she have mood swings that alternate between manic and depressed periods, suggesting bipolar disorder?
- Does the person have other problems with impulse control?
- Does the person's buying habits fall into an "addictive" pattern? Does he or she feel guilty or remorseful after shopping? Are there other addictions, such as alcohol, drugs or gambling?
- Are there other obsessions and compulsions the person has such as a tendency to collect things obsessively, or to hoard?
- Is shopping a way to combat loneliness or to deal with feelings of emptiness or aimlessness in life?
- Will overspending make the person vulnerable to financial hardships?
- Does the excess spending create conflict at home?
- Has the person's work or career suffered?
- Does the person shop in a mall or online?
- Does the person recognize the problem?
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Getting the Right Treatment
Compulsive buying is almost certainly not a single illness with one best treatment. Here are possible treatment options:
- There is very little research on treatment, but psychotherapies rooted in cognitive behavior therapy have been studied more than other treatments. Patients receiving these treatments have done better than patients in comparison groups on a waiting list.
- Antidepressants, which are often used to treat obsessive-compulsive symptoms, have not been proven specifically successful for compulsive buying. But they can help if the person also is depressed.
- A very small pilot study (9 patients) tested memantine, a drug used for impulsive behavior. The majority of patients reduced their shopping on this drug.
- If a person has another addiction, it should be treated because other addictions can make matters worse.
- As with most psychiatric disorders, education and family support are key elements of treatment, especially as the problem becomes more severe.
If life is unraveling — the money is gone, relationships have been destroyed, work life is damaged, and there are high levels of distress — it may be necessary to try all of these approaches at once. And someone else may have to intervene, for example, by taking away the credit card or shutting off Internet access.
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Pleasure Without the Guilt
Social scientists are probably right that compulsive buying is fostered by an economy that benefits some people when others over-spend. Compulsive shoppers are not buyers who can beware. They need tools to combat the relentless temptation of advertisements and packaging. Part of the treatment process may include buying a sensible book on managing finances (and not one that promises a get-rich quick scheme). Read it! Find a financial advisor you can trust, or someone to hold your paycheck. It's tough to give up control to others, but it's probably a good idea if you've lost control yourself. It is best if that person does not shame you for having the problem.
The aim is not to stop spending completely, but to turn what has become a compulsive and joyless activity into one that reliably brings pleasure without guilt. When that goal is reached, we'll meet at the outlet store.
Koran LM, Faber RJ, Aboujaoude E, Large MD, Serpe RT. "Estimated prevalence of compulsive buying behavior in the United States." American Journal of Psychiatry. Oct 2006;163(10):1806-1812.
Grant JE, Odlaug BL, Mooney M, O'Brien R, Kim SW. "Open-label pilot study of memantine in the treatment of compulsive buying." Annals of Clinical Psychiatry. May 2012;24(2):119-126.
Mueller A, Mitchell JE, Crosby RD, et al. "Estimated prevalence of compulsive buying in Germany and its association with sociodemographic characteristics and depressive symptoms." Psychiatry Research. Dec 30 2010;180(2-3):137-142.
Michael Craig Miller, M.D. is Editor in Chief of the Harvard Mental Health Letter. He is also associate physician at Beth Israel Deaconess Medical Center and assistant professor at Harvard Medical School. He has been practicing psychiatry for more than 25 years and teaches in the Harvard Longwood Psychiatry Residency Program.