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Section 8
Compulsive Buying Disorder Part I: Definition & Classification

Question 8 | Test | Table of Contents

Compulsive buying disorder is characterized by excessive or poorly controlled preoccupations, urges or behaviors regarding shopping and spending, which lead to adverse consequences.

Compulsive buying disorder has been estimated to affect from 2 to 8% of the general adult population in the US; 80 to 95% of those affected are female. Onset occurs in the late teens or early twenties, and the disorder is generally chronic. Psychiatric comorbidity is frequent, particularly mood, anxiety, substance use, eating and personality disorders. Treatment has not been well delineated, but individual and group psychotherapy, cognitive-behavioral therapy and 12-step programs may be helpful. Debt consolidation and credit counseling will be appropriate for many individuals who have compulsive buying disorder. Serotonin (5-hydroxytryptamine; 5-HT) re- uptake inhibitors may help some patients regulate their buying impulses. Self-help books are also available.

Compulsive buying disorder has been the subject of growing interest in the professional and lay literature, much of it prompted by the recent interest in ‘compulsive’ behaviors.[1-3] Although many believe compulsive buying disorder to be a new phenomenon, German psychiatrist Emil Kraepelin[4] described ‘oniomania’ 85 years ago, and is quoted by Eugen Bleuler[5] in his 1924 Textbook of Psychiatry: ‘The particular element is compulsiveness; they cannot help it, which sometimes even expresses itself in the fact that… the patients are absolutely incapable to think differently, and to conceive the senseless consequences of their act and the possibilities of not doing it’. Kraepelin[4] and Bleuler[5] both classified compulsive buying as one of the ‘impulsive insanities’, alongside kleptomania and pyromania.

In the past decade, there has been a renewed interest in disorders characterized by behavioral excess. The effectiveness of serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors in relieving obsessive-compulsive symptoms has led psychiatrists and researchers to use these drugs to treat other disorders that may lie along a continuum with obsessive-compulsive disorder (OCD), including body dysmorphic disorder, compulsive sexual behavior, pathological gambling and compulsive buying.[1-3] Although it is unclear whether compulsive buying disorder is in any way related to OCD, renewed interest in this disorder can be traced directly to the emergence of the ‘obsessive-compulsive spectrum’ concept.[6]

Apart from the early interest in compulsive buying shown by Kraepelin[4] and Bleuler,[5] professional interest was essentially limited to occasional in-depth case reports authored by psychoanalysts,[ 7-9] or reports in the consumer behavior literature.[ 10-14] The situation changed when McElroy et al.[15] published a report describing the improvement observed in 3 individuals with compulsive buying disorder who were administered antidepressants. On the heels of this report came 3 independent case series[16-18] reporting on a total of 90 persons with compulsive buying disorder.

Definition and Classification
Faber and O’Guinn[12] have defined compulsive buying from their perspective as consumer behavior researchers; they define it as ‘chronic, repetitive purchasing that became a primary response to negative events or feelings [which]… becomes very difficult to stop and ultimately results in harmful consequences’.

As an alternative, McElroy and her colleagues[16] offered an operational definition for clinical and research use (see table I). The definition recognizes that compulsive buying has both cognitive and behavioral components, each potentially causing impairment. Impairment can be manifested through personal distress; social, marital or occupational dysfunction; or financial or legal problems. The DSM-IV[19] has no category for compulsive buying disorder, individuals with the condition are relegated to the residual category ‘Disorder of Impulse Control Not Otherwise Specified’. According to the
DSM-IV,[19] impulse control disorders share an inability to ‘resist an impulse, drive or temptation to perform an act that is harmful to the person or others’.

The definition of compulsive buying disorder developed by McElroy et al.[16] has achieved wide acceptance among psychiatric researchers. Although the appropriate classification of compulsive buying disorder is unclear, biologically oriented researchers have focused on the similarity of compulsive buying disorder to OCD, other impulse control disorders such as pathological gambling, and to the mood and anxiety disorders.[1,2,16,20] Other investigators[21,22] have suggested that compulsive buying is similar, in many respects, to alcohol and drug addiction.

Considered by some to fall within an ‘obsessive-compulsive spectrum’, there are few data other than those provided by McElroy et al.[16] to suggest that the two disorders overlap, nor are there any data from family history studies showing an excess of OCD among the relatives of individuals who have compulsive buying disorder, and vice versa. Compulsive buying appears to overlap with other impulse control disorders, particularly pathological gambling.[17] Pathological gambling is primarily a disorder of men, but the two disorders are similar in terms of cognitive and behavioral symptoms; each could represent gender-specific manifestations of an underlying impulsive tendency.

Table I. Diagnostic criteria for compulsive buying
Maladaptive preoccupation with buying or shopping, or maladaptive buying or shopping impulses or behavior, as indicated by at least one of the following:

- frequent preoccupation with buying or impulses to buy that is/are experienced as irresistible, intrusive and/or senseless
- frequent buying of more than can be afforded, frequent buying of items that are not needed, or shopping for longer periods of time than intended
- The buying preoccupations, impulses or behaviors cause marked distress, are time consuming, significantly interfere with social or occupational functioning, or result in financial problems (e.g. indebtedness or bankruptcy)
- The excessive buying or shopping behavior does not occur exclusively during periods of hypomania or mania
- Black, DW; Compulsive buying disorder: definition, assessment, epidemiology; and clinical management; CNS Drugs; 2001; Vol. 15; Issue 1.

Personal Reflection Exercise Explanation
The Goal of this Home Study Course is to create a learning experience that enhances your clinical skills. We encourage you to discuss the Personal Reflection Journaling Activities, found at the end of each Section, with your colleagues. Thus, you are provided with an opportunity for a Group Discussion experience. Case Study examples might include: family background, socio-economic status, education, occupation, social/emotional issues, legal/financial issues, death/dying/health, home management, parenting, etc. as you deem appropriate. A Case Study is to be approximately 150 words in length. However, since the content of these “Personal Reflection” Journaling Exercises is intended for your future reference, they may contain confidential information and are to be applied as a “work in progress.” You will not be required to provide us with these Journaling Activities.

Personal Reflection Exercise #1
The preceding section contained information about the definition and classification of compulsive buying disorder. Write three case study examples regarding how you might use the content of this section in your practice.

Update
Compulsive Buying Disorder (CBD)
among Medical Students in Colleges
of Medicine, Dentistry and Pharmacy
at King Saud University in Riyadh

- Amin, H. S., Binobaid, A. A., Nagshabandi, K. N., Alammari, O. B., Alshunaybir, O. H., Alhammad, S. A., & Almezaini, A. I. (2022). Compulsive buying disorder (CBD) among medical students in colleges of medicine, dentistry and pharmacy at King Saud University in Riyadh. Journal of family medicine and primary care, 11(11), 6876–6884. https://doi.org/10.4103/jfmpc.jfmpc_769_22

Peer-Reviewed Journal Article References:
Allom, V., Mullan, B. A., Monds, L., Orbell, S., Hamilton, K., Rebar, A. L., & Hagger, M. S. (2018). Reflective and impulsive processes underlying saving behavior and the additional roles of self-control and habit. Journal of Neuroscience, Psychology, and Economics, 11(3), 135–146.

Fradkin, I., Adams, R. A., Parr, T., Roiser, J. P., & Huppert, J. D. (2020). Searching for an anchor in an unpredictable world: A computational model of obsessive compulsive disorder. Psychological Review. Advance online publication.

Ladd, B. O., Murphy, J. G., & Borsari, B. (2020). Integration of motivational interviewing and behavioral economic theories to enhance brief alcohol interventions: Rationale and preliminary examination of client language. Experimental and Clinical Psychopharmacology. Advance online publication.

QUESTION 8
What is the diagnostic criteria for compulsive buying? To select and enter your answer go to Test.

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