Confessions of a shopaholic
I racked up £32,000 on four credit cards.. ..the only cure was to go cold turkey for a year
By Kate Jackson 7/01/2008
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With the January sales in full swing, imagine how hard it must be for a hopeless shopaholic to resist the lure of those massive discounts.
But clothes-mad Alexis Hall now knows how to resist temptation. She has not frittered away any money for a whole year, after deciding that 12 months of cold turkey was the only way to clear her debts.
For the 39-year-old from Glasgow, shopping was an all-consuming addiction. Whether it was another pair of Gina shoes, the season's must have skirt or a trendy designer bag, she just had to have it - no matter what it cost.
But when she realised her habit had landed her with a total debt of £31,637.84, she knew something drastic had to be done. So on May 15, 2006, she quit shopping.
"Until I sat down with all the bills and added them up, I had no idea I owed as much as I did," says Alexis, a media relations officer for Strathclyde police. "It was quite a shock to see it was nearly £32,000 - more than my yearly salary."
Alexis had perfected the knack for justifying her daily splurging.
"Years ago, a friend of mine told me that you shouldn't look at the price, but work out how much it would cost per wear," she says.
"So if a coat cost £500 but you wore it for 500 days, it's £1 per wear. I wish she'd never told me that because that's what I would do.
"I'd go shopping almost every day. It could be anything from a new mascara to a handbag costing several hundred pounds. My attitude was, 'Why shouldn't I have it?'"
Her despairing boyfriend of 15 years, Kevin Burns, 41, had already paid off two of her credit cards, amounting to several thousand pounds, and cut the plastic up.
"He told me if I did it again he'd leave me, but I still didn't stop," she says. "I just got replacement cards.
"If I was caught wearing something new I'd insist I'd had it for ages. I wasn't very good at lying, though. I once bought a North Face jacket to wear for walking our dog Hobbs, which was £200 - I told Kevin it was £190. What's the point in lying about £10?
"And I'd tell my friends I couldn't go out for dinner because I didn't have the money, but then I'd fork out for an extortionate pair of shoes. It was little lies like that."
When she decided to clear her debts, Alexis knew she had to be strict with herself.
She says: "I'd tried to give up smoking for three years. Every Monday I'd say, 'That's it, I won't smoke any more.'
Sometimes I'd last till Wednesday, and sometimes I would only last an hour. If I'd been that bad at stopping smoking, I knew I had to face this head on.
"The rules were: no shopping at all and no new clothes, unless it was an emergency... I was only allowed to spend money on food, transport, bills and the occasional coffee or meal out with friends."
She only took a fiver to work every day to pay for her transport and lunch. At the start, she was so fearful she would overspend she asked the bank for £200 all in £5 notes.
Alexis also kept a diary, charting her efforts and the rollercoaster of emotions that came with battling her addiction. It is now being published as In The Red: The Diary Of A Recovering Shopaholic.
In it, she talks about stroking the covers of clothes catalogues before dumping them, and throwing a tantrum in a mall when she tested her willpower.
"Kevin has had to physically remove me from a shopping centre because I was having a tantrum - I'm not joking," she says.
"Everything was difficult. From going shopping or browsing the internet every day to not buying anything at all, that was very hard. There were some moments when I thought, 'This is horrendous,' and others when it was easy.
"I've had highs and lows. Before, when I was having a bad day I'd go shopping to cheer myself up. During the experiment, there was nothing I could do about it."
An indulged only child, she reckons her spending habits were formed at an early age.
"We'd go to the newsagents every day and I would stand there crying because I wanted something," she says. "I was probably spoiled but my parents always told me that things didn't come out of thin air and they had to work to pay for them."
Her experiment didn't stop her going into shops completely. She says: "To a point, I avoided going near shops but there was always that little devil in me that would tempt me in to test my willpower."
Along the way Alexis has learned some valuable lessons. As she says in her book: "I've realised there is no reason to own every possible scent of shower gel or six types of shampoo. Life is too short to spend 10 minutes deliberating over that day's choice of deodorant."
Wise words, indeed.
Sail through the sales..
Here, Alexis gives her tips on how not to splurge at the January sales...
Ask yourself, "Do I really need this?"
Don't get caught up in the whole rush of adrenalin and end up buying something just because it's the last one in your size. Think whether you actually like it first.
If you've gone off an item by the time you get home, don't do what I do and leave it in the wardrobe with the label on - take it back to the shop.
Does it really go with everything you think it's going to go with? Or are you just trying to convince yourself it's a good buy?
Are you just buying it because it's cheap? Face it, just because that boob tube is £5, it doesn't mean you'll ever wear it.
Would you have paid full price for it? If not, don't buy it.
DIARY OFF HIGHS & LOWS
Day 14: Sunday, May 28
I log on and there's an invite to an LK Bennett fashion evening. I adore their impractical kitten heels in the palest pastel shade, so soft you'd swear they were made from real kittens.
It's like being tortured and tested all at once. I delete it immediately and rush to the kitchen to find solace in a jar of Nutella.
Day 20: Saturday, June 3
I've spent 48 hours sulking and making Kevin's life a misery - obviously it's his fault I'm in this situation.
A trip to the shopping centre doesn't exactly send my spirits soaring. It's huge, soulless and full of things I can't buy. Never have I wanted to shop more!
Day 138: Friday, Sept 29
Today I opened the door to Jo Malone, Johnnie Boden, Charles Tyrwhitt, Bombay Duck, Mulberry, Toast and The White Company - all crammed on a doormat, all begging me to run away with them on a shopping spree.
When did they decide to gang up on me en masse?!
Day 221: Friday, Dec 22
I'm struggling - really struggling. I'm in town after work and the sights, sounds and smells are enough to make me call off the experiment and run naked through the streets wearing nothing but a strategically placed credit card.
Day 257: Saturday, Jan 27
Kevin suggested I go on a TV show for people who need help to stop spending. I know he's trying to be supportive but I was hoping he'd noticed I'd stopped spending eight months ago!
Day 309: Tuesday, March 20
My bank statement arrives with a mysterious credit of £37. It's like a small lottery win for someone in my financial state. That's 12 lunches, one Chanel moisturiser, a haircut or one tenth of a pair of Jimmy Choos.
In The Red by Alexis Hall (Icon Books, £10.99) is out on Thursday at all good bookshops. For a copy at the special price of £8.99, including free P&P in UK, call 01206 255800 quoting "In The Red Mirror offer".
From:
http://www.mirror.co.uk/news/topstories/2008/01/07/confessions-of-a-shopaholic-89520-20277287/
Sunday, 25 May 2008
How to stop living like a shopaholic
How to stop living like a shopaholic
By ALEXIS HALL
Last updated at 09:23 24 January 2008
-1. Comments (4) Add to My Stories
If you can't get through your lunch hour without buying something (anything!) ... if your wardrobe is full of unworn clothes, some with the price tags attached ... if you own ten pairs of identical black trousers ... YOU could be a shopaholic.
Here, Alexis Hall - who reduced the £31,637.84 she owed in credit card debts and loans by buying only necessities - tells you how to take control of your spending while still looking great.
DETOX YOUR WARDROBE
Empty your wardrobe, drawers and upend your ironing basket to take a good look at your clothes and accessories.
Sort everything into four piles: clothes that need to go in the bin; those that can be sold; items for the charity shop; and outfits you want to keep.
It's a good idea to enlist the help of a brutally honest friend, as most shopaholics tend to be hoarders. She should take away the "bin" and "charity" items, so you aren't tempted to sneak any of those items back into your wardrobe.
When you see what is left, you'll realise you don't have to go clothes shopping for a long time.
Scroll down for more ...
RESTORE ORDER
Split your clothes into autumn/winter and spring/summer. Put away the season you don't need in a box that slides under the bed (ensure they are clean and add moth repellent sachets).
Hang up or fold this season's clothes so you can see exactly what you have.
Once I started wearing my rediscovered, unworn old clothes, it was surprising just how many compliments I got for quite lovely things that had been screwed up in a ball at the back of a drawer for years.
SELL, SELL, SELL
Hold a clothes sale at home for friends and neighbours, sell them to a dress agency (look in Yellow Pages for your nearest one) or photograph each item and advertise on an internet auction site such as eBay.
Bigwardrobe.com is a free-to-join website where members can swap clothes or sell them for cash. Use any money you make to pay off your debts.
MAKE DO AND MEND
Getting clothes and accessories altered or repaired can save a fortune.
Julia Dee, founder of tailoring and alterations service Designer Alterations (www.designeralterations.com) has clients including Elle Macpherson, Kelly Hoppen and David Furnish.
From darning a cashmere jumper to tailoring an unworn pair of trousers into fashionable shorts and putting new buttons on a tired-looking coat, it can be relatively cheap to give old favourites a new lease of life.
In the past, I'd have bought a new pair of shoes when the old ones started to look worn.
Instead, for less than £10 I found I could get my footwear repaired and buffed into a state of near newness instead of adding a couple of hundred quid to a credit card. Many cobblers are also able to repair leather handbags.
DON'T SCRIMP ON HAIR
I found a good haircut was worth the expense, even when I was sticking to a strict budget. Many stylists will trim your fringe for free between cuts.
DOS & DON'TS OF ONLINE SHOPPING
Online supermarket shopping is a good idea for the recovering shopaholic, as you tend to buy only what you need.
You don't end up with those magazines, candles, bottles of champagne or an on-sale flatscreen TV that can tempt you when you browse the aisles. But online shopping for fashion, beauty products, homeware or gifts can be a bad idea, as it's all too easy not to see it as 'real' spending.
You can also get caught out by expensive postage and packing.
Beware of the "it-doesn't-fit-but-I-can't-be-bothered-to-post-it-back-for-a-refund" laziness.
If your e-mail inbox is bombarded with special offers from online stores, unsubscribe immediately to avoid temptation.
And if you're bored and feel like a quick online shopping browse, go to the gym, take the dog out for a walk or phone a friend instead.
SCORE POINTS
Shopaholics almost never read their credit card bills and till receipts. If you're on a budget for the first time, you may notice you have racked up useful loyalty points. These can be spent on the things you want, but can't afford.
Make sure you take full advantage of Nectar and Boots cards when you shop for your weekly necessities so you can save money or buy yourself an occasional treat.
DON'T GO TO THE SALES
Come on, be honest - have you ever bought something really lovely and useful in a sale?
There's something about sales that makes us lose all our common sense. You may not be able to tell if it's a boob tube or a skirt, but, hey, it's only £5, so you'll end up buying it anyway.
But you'll never wear it and it'll just end up at the back of the wardrobe still in the bag, so you might as well have set light to a £5 note.
Just because something is cheap or greatly reduced doesn't mean it's a bargain.
BUDGET ON BEAUTY
As someone who used to buy every new fragrance going - and the matching shower gel and deodorant - I was amazed when the first time my boyfriend told me I smelled lovely I was using nothing but Nivea.
If you have sensitive skin and can use only certain expensive brands, budget for that item.
Otherwise, cheaper, non-designer nail varnishes, body lotions, cleansers, shampoos and conditioners do the job just as well.
SAVOUR THE WAIT
Cutting back on your spending to get yourself out of debt doesn't mean you can't enjoy luxuries.
Instead of buying a handbag and shoes or going on a spa visit, keep a list of the things you'd love and give it to people when they ask what you want for your birthday or Christmas.
Once I started living on a minimal budget, I had to wait almost six months until my birthday. Opening my presents after buying nothing but necessities for all that time, I felt like a child again.
Lovely things are so much more exciting and better appreciated when you've waited for them - and there's no credit card bill.
GETTING OUT OF DEBT
• FACE THE FACTS: Stop just looking at the minimum payment on your bills. Take a deep breath and open all your credit, store card and loan bills - then add up the total.
"Prepare a plan of action, such as cutting up your cards or taking some steps, however small, towards settling your debts," says Benjamin Fry, self-help author and presenter on BBC 3's Spendaholics. "It will help you feel a bit more in control of the situation."
• GO COLD TURKEY: If you've got yourself into serious debt, stop spending - now. Be firm. After you've cut up your credit and store cards, don't keep one in a !"safe" place for "emergencies" - it'll be too tempting to get it out again.
• LIVE ON A STRICT DAILY CASH BUDGET: At one stage, I took just £5 to work with me every day. That was just enough to get me to the office and buy lunch.
It stopped me making needless, spontaneous purchases and made me realise that within an hour of thinking I really wanted the latest must-have hair product, for example, I'd changed my mind or even forgotten about it.
• MANAGE YOUR DEBTS: First, pay off the debts with the highest interest rates and switch others to a lower rate of interest.The Consumer Credit Counselling Service (cccs.co.uk) can help.
• THE ROOT OF THE PROBLEM: Like most addictions, there's usually an emotional trigger behind shopaholism. You need to uncover what this might be and address it.
• Adapted from In The Red by Alexis Hall (Icon Books, £10.99). Copyright Alexis Hall 2008. To order a copy (P&P free), call 0845 606 4206.
From:
http://www.dailymail.co.uk/femail/article-510070/How-stop-living-like-shopaholic.html
By ALEXIS HALL
Last updated at 09:23 24 January 2008
-1. Comments (4) Add to My Stories
If you can't get through your lunch hour without buying something (anything!) ... if your wardrobe is full of unworn clothes, some with the price tags attached ... if you own ten pairs of identical black trousers ... YOU could be a shopaholic.
Here, Alexis Hall - who reduced the £31,637.84 she owed in credit card debts and loans by buying only necessities - tells you how to take control of your spending while still looking great.
DETOX YOUR WARDROBE
Empty your wardrobe, drawers and upend your ironing basket to take a good look at your clothes and accessories.
Sort everything into four piles: clothes that need to go in the bin; those that can be sold; items for the charity shop; and outfits you want to keep.
It's a good idea to enlist the help of a brutally honest friend, as most shopaholics tend to be hoarders. She should take away the "bin" and "charity" items, so you aren't tempted to sneak any of those items back into your wardrobe.
When you see what is left, you'll realise you don't have to go clothes shopping for a long time.
Scroll down for more ...
RESTORE ORDER
Split your clothes into autumn/winter and spring/summer. Put away the season you don't need in a box that slides under the bed (ensure they are clean and add moth repellent sachets).
Hang up or fold this season's clothes so you can see exactly what you have.
Once I started wearing my rediscovered, unworn old clothes, it was surprising just how many compliments I got for quite lovely things that had been screwed up in a ball at the back of a drawer for years.
SELL, SELL, SELL
Hold a clothes sale at home for friends and neighbours, sell them to a dress agency (look in Yellow Pages for your nearest one) or photograph each item and advertise on an internet auction site such as eBay.
Bigwardrobe.com is a free-to-join website where members can swap clothes or sell them for cash. Use any money you make to pay off your debts.
MAKE DO AND MEND
Getting clothes and accessories altered or repaired can save a fortune.
Julia Dee, founder of tailoring and alterations service Designer Alterations (www.designeralterations.com) has clients including Elle Macpherson, Kelly Hoppen and David Furnish.
From darning a cashmere jumper to tailoring an unworn pair of trousers into fashionable shorts and putting new buttons on a tired-looking coat, it can be relatively cheap to give old favourites a new lease of life.
In the past, I'd have bought a new pair of shoes when the old ones started to look worn.
Instead, for less than £10 I found I could get my footwear repaired and buffed into a state of near newness instead of adding a couple of hundred quid to a credit card. Many cobblers are also able to repair leather handbags.
DON'T SCRIMP ON HAIR
I found a good haircut was worth the expense, even when I was sticking to a strict budget. Many stylists will trim your fringe for free between cuts.
DOS & DON'TS OF ONLINE SHOPPING
Online supermarket shopping is a good idea for the recovering shopaholic, as you tend to buy only what you need.
You don't end up with those magazines, candles, bottles of champagne or an on-sale flatscreen TV that can tempt you when you browse the aisles. But online shopping for fashion, beauty products, homeware or gifts can be a bad idea, as it's all too easy not to see it as 'real' spending.
You can also get caught out by expensive postage and packing.
Beware of the "it-doesn't-fit-but-I-can't-be-bothered-to-post-it-back-for-a-refund" laziness.
If your e-mail inbox is bombarded with special offers from online stores, unsubscribe immediately to avoid temptation.
And if you're bored and feel like a quick online shopping browse, go to the gym, take the dog out for a walk or phone a friend instead.
SCORE POINTS
Shopaholics almost never read their credit card bills and till receipts. If you're on a budget for the first time, you may notice you have racked up useful loyalty points. These can be spent on the things you want, but can't afford.
Make sure you take full advantage of Nectar and Boots cards when you shop for your weekly necessities so you can save money or buy yourself an occasional treat.
DON'T GO TO THE SALES
Come on, be honest - have you ever bought something really lovely and useful in a sale?
There's something about sales that makes us lose all our common sense. You may not be able to tell if it's a boob tube or a skirt, but, hey, it's only £5, so you'll end up buying it anyway.
But you'll never wear it and it'll just end up at the back of the wardrobe still in the bag, so you might as well have set light to a £5 note.
Just because something is cheap or greatly reduced doesn't mean it's a bargain.
BUDGET ON BEAUTY
As someone who used to buy every new fragrance going - and the matching shower gel and deodorant - I was amazed when the first time my boyfriend told me I smelled lovely I was using nothing but Nivea.
If you have sensitive skin and can use only certain expensive brands, budget for that item.
Otherwise, cheaper, non-designer nail varnishes, body lotions, cleansers, shampoos and conditioners do the job just as well.
SAVOUR THE WAIT
Cutting back on your spending to get yourself out of debt doesn't mean you can't enjoy luxuries.
Instead of buying a handbag and shoes or going on a spa visit, keep a list of the things you'd love and give it to people when they ask what you want for your birthday or Christmas.
Once I started living on a minimal budget, I had to wait almost six months until my birthday. Opening my presents after buying nothing but necessities for all that time, I felt like a child again.
Lovely things are so much more exciting and better appreciated when you've waited for them - and there's no credit card bill.
GETTING OUT OF DEBT
• FACE THE FACTS: Stop just looking at the minimum payment on your bills. Take a deep breath and open all your credit, store card and loan bills - then add up the total.
"Prepare a plan of action, such as cutting up your cards or taking some steps, however small, towards settling your debts," says Benjamin Fry, self-help author and presenter on BBC 3's Spendaholics. "It will help you feel a bit more in control of the situation."
• GO COLD TURKEY: If you've got yourself into serious debt, stop spending - now. Be firm. After you've cut up your credit and store cards, don't keep one in a !"safe" place for "emergencies" - it'll be too tempting to get it out again.
• LIVE ON A STRICT DAILY CASH BUDGET: At one stage, I took just £5 to work with me every day. That was just enough to get me to the office and buy lunch.
It stopped me making needless, spontaneous purchases and made me realise that within an hour of thinking I really wanted the latest must-have hair product, for example, I'd changed my mind or even forgotten about it.
• MANAGE YOUR DEBTS: First, pay off the debts with the highest interest rates and switch others to a lower rate of interest.The Consumer Credit Counselling Service (cccs.co.uk) can help.
• THE ROOT OF THE PROBLEM: Like most addictions, there's usually an emotional trigger behind shopaholism. You need to uncover what this might be and address it.
• Adapted from In The Red by Alexis Hall (Icon Books, £10.99). Copyright Alexis Hall 2008. To order a copy (P&P free), call 0845 606 4206.
From:
http://www.dailymail.co.uk/femail/article-510070/How-stop-living-like-shopaholic.html
Design council
http://www.designcouncil.org.uk/en/About-Design/Design-Disciplines/Experience-design/
Encycopedia of Psychology
Environment Behavior Relationships : Consumer
http://www.psychology.org/links/Environment_Behavior_Relationships/Consumer/
http://www.psychology.org/links/Environment_Behavior_Relationships/Consumer/
Objects, Decision Considerations and Self-Image in Men's and Women's Impulse Purchases
Objects, Decision Considerations and Self-Image in Men's and Women's Impulse Purchases
Abstract
In this paper, we propose and examine a social psychological model of impulse buying, which predicts that people intend to acquire material symbols of personal and social identity. Current theories in economics (e.g., discounting models), marketing (e.g., information-processing models) and psychology (e.g., addiction models) fail to explain underlying reasons for impulse buying and, crucially, why particular goods (e.g., clothes) are bought impulsively more than others (e.g., tools). If impulse purchases are attempts to bolster self-image, then consumers should differ systematically in the goods they impulse-buy, and their reasons for doing so, along important social categories, such as gender. Specifically, our theoretical model - drawing on a social constructionist model of material possessions (e.g., Dittmar, 1992) and symbolic self-completion (e.g. Wicklund and Gollwitzer, 1982) - leads to three sets of hypotheses: (i) some consumer durables are more likely to be bought on impulse than others, and there may be gender differences in object choices, (ii) gender differences will emerge in the buying considerations they use (e.g., functional, emotional, symbolic), and (iii) impulse-buy objects and decision considerations will be related systematically to (actual and ideal) self-perception. In addition, we expect that all three sets of hypotheses hold more strongly for individuals with greater tendencies towards compulsive shopping habits. These predictions are examined in a preliminary questionnaire study with a sample of British consumers (n=61), who attended an Open University residential summer school in Southern England. The results from diverse multivariate statistical analyses (MANOVA, multiple regression) support all three sets of hypotheses to a considerable extent. The implications of these findings are discussed with respect to economic and consumer theory, and the treatment offered to the increasing number of "addicted" shoppers.
http://www.kent.ac.uk/ESRC/impulse.html
Abstract
In this paper, we propose and examine a social psychological model of impulse buying, which predicts that people intend to acquire material symbols of personal and social identity. Current theories in economics (e.g., discounting models), marketing (e.g., information-processing models) and psychology (e.g., addiction models) fail to explain underlying reasons for impulse buying and, crucially, why particular goods (e.g., clothes) are bought impulsively more than others (e.g., tools). If impulse purchases are attempts to bolster self-image, then consumers should differ systematically in the goods they impulse-buy, and their reasons for doing so, along important social categories, such as gender. Specifically, our theoretical model - drawing on a social constructionist model of material possessions (e.g., Dittmar, 1992) and symbolic self-completion (e.g. Wicklund and Gollwitzer, 1982) - leads to three sets of hypotheses: (i) some consumer durables are more likely to be bought on impulse than others, and there may be gender differences in object choices, (ii) gender differences will emerge in the buying considerations they use (e.g., functional, emotional, symbolic), and (iii) impulse-buy objects and decision considerations will be related systematically to (actual and ideal) self-perception. In addition, we expect that all three sets of hypotheses hold more strongly for individuals with greater tendencies towards compulsive shopping habits. These predictions are examined in a preliminary questionnaire study with a sample of British consumers (n=61), who attended an Open University residential summer school in Southern England. The results from diverse multivariate statistical analyses (MANOVA, multiple regression) support all three sets of hypotheses to a considerable extent. The implications of these findings are discussed with respect to economic and consumer theory, and the treatment offered to the increasing number of "addicted" shoppers.
http://www.kent.ac.uk/ESRC/impulse.html
You might be a shopaholic
The Basics
You might be a shopaholic
Turns out 1 in 20 of us -- women and men alike -- can't control the urge to spend. Learn what drives this destructive behavior.
By Bankrate.com
Is your closet overflowing with never-worn clothing, the price tags still waving in the breeze? Is your attic bulging with boxes and boxes of shoes that have never touched pavement? Do you buy new makeup weekly or compact discs by the fistful?
You might be a shopaholic.
Studies estimate that as many as 17 million Americans, better than one in 20 of us, can't control our urge to shop, even at the expense of our job, our marriage, our family and our finances.
In the land of conspicuous consumption, compulsive shopping is the smiled-upon addiction, the butt of countless sitcoms and Sunday comics, one of the few disorders that it's still OK to laugh at. Shop 'til you drop. The one who dies with the most toys wins. Heck, President Bush even called it patriotic to splurge. Where's the harm?
Real consequences
Manhattan psychologist April Benson, author of "I Shop Therefore I Am: Compulsive Buying and the Search for Self," has seen firsthand how destructive compulsive shopping can be.
"One patient of mine got fired because she was compulsively shopping on the Internet all day. There are other people who neglect their children and park them in the mall constantly because that is what they need to feed their habit. Lots of marriages break up over compulsive buying. In fact, we don't call it compulsive buying unless there is some significant impairment in some aspect of your life."
Not only is compulsive shopping tacitly condoned by our materialistic society, it is just as widely misunderstood.
For starters, according to Donald Black, M.D., a University of Iowa psychiatry professor who specializes in obsessive-compulsive disorder, compulsive shopping isn't a true compulsion at all, but instead an impulse control disorder.
"A compulsion is a behavior that is produced to counteract an upsetting thought; for example, I'm contaminated or dirty, therefore I will deal with that anxiety by washing my hands more," he says.
"There is no upsetting thought prompting compulsive shopping. It is a very pleasurable impulse, and people act on those impulses."
Famous shopaholics
Nor is compulsive shopping a modern-day "designer disease." According to Black, a German psychiatrist published the first clinical description of the disorder in 1915.
Famous shopaholics in history include Marie Antoinette, Mary Todd Lincoln, William Randolph Hearst, Jacqueline Kennedy Onassis, Imelda Marcos and Princess Diana. Their addictions ranged from clothing (Jackie O, Diana) to art and antiques (Hearst) to shoes (the heralded Marcos collection) to gloves (Mrs. Lincoln owned 84 pairs of them).
"Now maybe it's more prevalent now because you clearly need available goods, a market economy and disposable income, and those elements haven't always been around," he notes.
Men are 'collectors,' women are 'shopaholics'
While research suggests that nine in 10 shopaholics are women, Benson says it's a common misnomer to tag this as a female disorder.
"People who are part of their studies are psychiatric in- or outpatients, and women self-refer for these problems much more so than men. Recent studies coming out of Europe suggest that more men are beginning to have these problems. In addition to the fact that they don't self-refer for the types of studies on which these statistics are based is the fact that society often calls men who are compulsive buyers 'collectors.' It gives it a refined and slightly highbrow image."
The same is true of the misconception that compulsive shopping is a malady of the privileged class.
"We say that money is an equal opportunity mood changer," says Benson. "There have been a few studies linking socioeconomic class with compulsive buying and no significant results have been found. I had a colleague who had a guy on welfare who compulsively bought."
Black suggests we discard the notion that shopaholics are unaware of their problem.
"They are perfectly aware of what they're doing. Intellectually, they know that their closets and maybe their attic is full, but then they will be in the store and think, well, maybe I do need this one blouse or this will come in handy or I don't have one in this particular shade so I'll buy it. They usually hide it from their husbands. They do have feelings of guilt."
When it becomes a problem
What do women want? In order of preference, most female compulsive shoppers buy clothes, shoes, jewelry, makeup and compact discs.
Men? Clothing, shoes, electronics (TVs, stereos, computers, etc.), hardware and CDs.
Sounds normal enough, right? So how does compulsive shopping differ from your last trip to the mall?
"Well, they don't buy one CD, they buy 10 CDs at a time," says Black. "They might buy five skirts, all the same, perhaps in different shades or slightly different styles, where a normal buyer would identify a need for something new or attend a sale and buy one item."
Benson notes that shopaholics overspend on services as well as goods.
"I had one patient who had her hair blown dry maybe two or three times a week. Between the color, the cut and the blow-dry, she was spending at least $200 if not $250 a week on her hair, and that didn't include all the hair products," she says.
Some shopaholics have more eccentric tastes, though they are by far the minority. Black had one patient who was addicted to Beanie Babies, another who compulsively bought garden figurines; Benson treated a man who only bought compulsively for his camper.
Similarities to compulsive gambling
Black says the typical shopaholic cycle is not unlike that of the compulsive gambler -- or even the serial killer.
"What the patients will typically describe is they have a baseline preoccupation with shopping, they're always thinking about it, and a tension builds and they have to satisfy that tension by going out and shopping. That relieves the tension, at least for the time being," he says.
Some shop out of loneliness, others for the rush of it, still others to fill some inner need. Some seek greater self-esteem, others use it to battle depression. Some shop to return to a happy childhood, others to escape a bad one.
But few shopaholics consider it a debilitating disorder until the spiral of debt or marital discord leaves them no other choice.
All of which makes compulsive shopping especially difficult to treat.
Black says drug studies using serotonin uptake inhibitors (Prozac, Zoloft, Paxil, etc.) have met with mixed results, as the disorder seems to respond equally well to drugs and placebos.
Benson hopes to start her own 12-step-style therapy program this fall, focusing on group techniques to change cognitive behavior. The only other group program treating compulsive shopping in this way is in Fargo, N.D.
"Frankly, there is so little research done that I'm not sure you can talk about success rate," Black admits. "Very few people are studying this or writing about it. There are no standards for treatment, so there are no good definitions of what constitutes recovery. Is their buying down to your level or my level? Or should they abstain from shopping like they tell alcoholics? You can't do that realistically. Maybe if you go shopping, at least have someone with you so you don't go overboard."
from:
http://moneycentral.msn.com/content/SavingandDebt/P58684.asp
You might be a shopaholic
Turns out 1 in 20 of us -- women and men alike -- can't control the urge to spend. Learn what drives this destructive behavior.
By Bankrate.com
Is your closet overflowing with never-worn clothing, the price tags still waving in the breeze? Is your attic bulging with boxes and boxes of shoes that have never touched pavement? Do you buy new makeup weekly or compact discs by the fistful?
You might be a shopaholic.
Studies estimate that as many as 17 million Americans, better than one in 20 of us, can't control our urge to shop, even at the expense of our job, our marriage, our family and our finances.
In the land of conspicuous consumption, compulsive shopping is the smiled-upon addiction, the butt of countless sitcoms and Sunday comics, one of the few disorders that it's still OK to laugh at. Shop 'til you drop. The one who dies with the most toys wins. Heck, President Bush even called it patriotic to splurge. Where's the harm?
Real consequences
Manhattan psychologist April Benson, author of "I Shop Therefore I Am: Compulsive Buying and the Search for Self," has seen firsthand how destructive compulsive shopping can be.
"One patient of mine got fired because she was compulsively shopping on the Internet all day. There are other people who neglect their children and park them in the mall constantly because that is what they need to feed their habit. Lots of marriages break up over compulsive buying. In fact, we don't call it compulsive buying unless there is some significant impairment in some aspect of your life."
Not only is compulsive shopping tacitly condoned by our materialistic society, it is just as widely misunderstood.
For starters, according to Donald Black, M.D., a University of Iowa psychiatry professor who specializes in obsessive-compulsive disorder, compulsive shopping isn't a true compulsion at all, but instead an impulse control disorder.
"A compulsion is a behavior that is produced to counteract an upsetting thought; for example, I'm contaminated or dirty, therefore I will deal with that anxiety by washing my hands more," he says.
"There is no upsetting thought prompting compulsive shopping. It is a very pleasurable impulse, and people act on those impulses."
Famous shopaholics
Nor is compulsive shopping a modern-day "designer disease." According to Black, a German psychiatrist published the first clinical description of the disorder in 1915.
Famous shopaholics in history include Marie Antoinette, Mary Todd Lincoln, William Randolph Hearst, Jacqueline Kennedy Onassis, Imelda Marcos and Princess Diana. Their addictions ranged from clothing (Jackie O, Diana) to art and antiques (Hearst) to shoes (the heralded Marcos collection) to gloves (Mrs. Lincoln owned 84 pairs of them).
"Now maybe it's more prevalent now because you clearly need available goods, a market economy and disposable income, and those elements haven't always been around," he notes.
Men are 'collectors,' women are 'shopaholics'
While research suggests that nine in 10 shopaholics are women, Benson says it's a common misnomer to tag this as a female disorder.
"People who are part of their studies are psychiatric in- or outpatients, and women self-refer for these problems much more so than men. Recent studies coming out of Europe suggest that more men are beginning to have these problems. In addition to the fact that they don't self-refer for the types of studies on which these statistics are based is the fact that society often calls men who are compulsive buyers 'collectors.' It gives it a refined and slightly highbrow image."
The same is true of the misconception that compulsive shopping is a malady of the privileged class.
"We say that money is an equal opportunity mood changer," says Benson. "There have been a few studies linking socioeconomic class with compulsive buying and no significant results have been found. I had a colleague who had a guy on welfare who compulsively bought."
Black suggests we discard the notion that shopaholics are unaware of their problem.
"They are perfectly aware of what they're doing. Intellectually, they know that their closets and maybe their attic is full, but then they will be in the store and think, well, maybe I do need this one blouse or this will come in handy or I don't have one in this particular shade so I'll buy it. They usually hide it from their husbands. They do have feelings of guilt."
When it becomes a problem
What do women want? In order of preference, most female compulsive shoppers buy clothes, shoes, jewelry, makeup and compact discs.
Men? Clothing, shoes, electronics (TVs, stereos, computers, etc.), hardware and CDs.
Sounds normal enough, right? So how does compulsive shopping differ from your last trip to the mall?
"Well, they don't buy one CD, they buy 10 CDs at a time," says Black. "They might buy five skirts, all the same, perhaps in different shades or slightly different styles, where a normal buyer would identify a need for something new or attend a sale and buy one item."
Benson notes that shopaholics overspend on services as well as goods.
"I had one patient who had her hair blown dry maybe two or three times a week. Between the color, the cut and the blow-dry, she was spending at least $200 if not $250 a week on her hair, and that didn't include all the hair products," she says.
Some shopaholics have more eccentric tastes, though they are by far the minority. Black had one patient who was addicted to Beanie Babies, another who compulsively bought garden figurines; Benson treated a man who only bought compulsively for his camper.
Similarities to compulsive gambling
Black says the typical shopaholic cycle is not unlike that of the compulsive gambler -- or even the serial killer.
"What the patients will typically describe is they have a baseline preoccupation with shopping, they're always thinking about it, and a tension builds and they have to satisfy that tension by going out and shopping. That relieves the tension, at least for the time being," he says.
Some shop out of loneliness, others for the rush of it, still others to fill some inner need. Some seek greater self-esteem, others use it to battle depression. Some shop to return to a happy childhood, others to escape a bad one.
But few shopaholics consider it a debilitating disorder until the spiral of debt or marital discord leaves them no other choice.
All of which makes compulsive shopping especially difficult to treat.
Black says drug studies using serotonin uptake inhibitors (Prozac, Zoloft, Paxil, etc.) have met with mixed results, as the disorder seems to respond equally well to drugs and placebos.
Benson hopes to start her own 12-step-style therapy program this fall, focusing on group techniques to change cognitive behavior. The only other group program treating compulsive shopping in this way is in Fargo, N.D.
"Frankly, there is so little research done that I'm not sure you can talk about success rate," Black admits. "Very few people are studying this or writing about it. There are no standards for treatment, so there are no good definitions of what constitutes recovery. Is their buying down to your level or my level? Or should they abstain from shopping like they tell alcoholics? You can't do that realistically. Maybe if you go shopping, at least have someone with you so you don't go overboard."
from:
http://moneycentral.msn.com/content/SavingandDebt/P58684.asp
A review of compulsive buying disorder
A review of compulsive buying disorder
DONALD W BLACK11Department of Psychiatry, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA 52242, USA
ABSTRACT
Compulsive buying disorder (CBD) is characterized by excessive shopping cognitions and buying behavior that leads to distress or impairment. Found worldwide, the disorder has a lifetime prevalence of 5.8% in the US general population. Most subjects studied clinically are women (~80%), though this gender difference may be artifactual. Subjects with CBD report a preoccupation with shopping, prepurchase tension or anxiety, and a sense of relief following the purchase. CBD is associated with significant psychiatric comorbidity, particularly mood and anxiety disorders, substance use disorders, eating disorders, and other disorders of impulse control. The majority of persons with CBD appear to meet criteria for an Axis II disorder, although there is no special "shopping" personality. Compulsive shopping tends to run in families, and these families are filled with mood and substance use disorders. There are no standard treatments. Psychopharmacologic treatment studies are being actively pursued, and group cognitive-behavioral models have been developed and are promising. Debtors Anonymous, simplicity circles, bibliotherapy, financial counseling, and marital therapy may also play a role in the management of CBD.
Keywords: Compulsive shopping, compulsive buying, impulse control disorders
REFERENCES
Compulsive buying disorder (CBD) was first described clinically in the early 20th century by Bleuler (1) and Kraepelin (2), both of whom included CBD in their textbooks. Bleuler writes: "As a last category Kraepelin mentions the buying maniacs (oniomaniacs) in whom even buying is compulsive and leads to senseless contraction of debts with continuous delay of payment until a catastrophe clears the situation a little - a little bit never altogether because they never admit to their debts" (1). Bleuler described CBD as an example of a "reactive impulse", or "impulsive insanity", which he grouped alongside kleptomania and pyromania.
CBD attracted little attention throughout the 20th century except among consumer behaviorists (3-6) and psychoanalysts (7-9). Interest was revived in the early 1990s, when clinical case series from three independent research groups appeared (10-12). The disorder has been described worldwide, with reports coming from the US (10-12), Canada (5), England (4), Germany (6), France (13), and Brazil (14).
The appropriate classification of CBD continues to be debated. Some researchers have linked CBD to addictive disorders (15), while others have linked it to obsessive-compulsive disorder (16), and still others to mood disorders (17). While not included in DSM-IV (18), CBD was included in DSM-III-R (19) as an example of an "impulsecontrol disorder not otherwise specified". Research criteria have been developed that emphasize its cognitive and behavioral aspects (10). Some writers have criticized attempts to categorize CBD as an illness, which they see as part of a trend to "medicalize" behavioral problems (20). Yet, this approach ignores the reality of CBD, and both trivializes and stigmatizes attempts to understand or treat the disorder.
EPIDEMIOLOGY
Koran et al (21) recently estimated the point prevalence of CBD to be 5.8% of respondents, based on results from a random telephone survey of 2,513 adults conducted in the US. Earlier, Faber and O'Guinn (22) had estimated the prevalence of CBD to fall between 2% and 8% of the general population of Illinois. Both research groups had used the Compulsive Buying Scale (CBS) (23) to identify compulsive buyers. Other surveys have reported figures ranging from 12% to 16% (24,25). There is no evidence that CBD has increased in prevalence in the past few decades.
Community based and clinical surveys suggest that 80% to 95% of persons with CBD are women (10-12,23). The reported gender difference could be artifactual: women readily acknowledge that they enjoy shopping, whereas men are more likely to report that they "collect". The report of Koran et al (21) suggests that this may be the case: in their survey, a near equal percentage of men and women met criteria for CBD (5.5% and 6.0%, respectively). However, Dittmar (26) concluded from a general population survey in the United Kingdom, in which 92% of respondents considered compulsive shoppers were women, that the gender difference is real and is not an artifact of men being underrepresented in samples.
The age of onset of CBD appears to be in the late teens or early twenties (11,12,27), though McElroy et al (10) reported a mean age at onset of 30 years. It may be that the age of onset corresponds with emancipation from the home, and the age at which people first establish credit accounts.
There are no careful longitudinal studies of CBD, but the majority of subjects studied by Schlosser et al (12) and McElroy et al (10) describe their course as continuous. Aboujaoude et al (28) suggested that persons with CBD who responded to treatment with citalopram were likely to remain in remission during one-year follow-up, a finding that suggests that treatment could alter the natural history of the disorder. The authors' personal observation is that subjects with CBD typically report decades of compulsive shopping behavior at the time of presentation, although it might be argued that clinical samples are biased in favor of severity.
There is some evidence that CBD runs in families and that within these families mood, anxiety, and substance use disorders are excessive. McElroy et al (8) reported that, of 18 individuals with CBD, 17 had one or more first-degree relatives (FDRs) with major depression, 11 with an alcohol or drug use disorder, and three with an anxiety disorder. Three had relatives with CBD. Black et al (29) used the family history method to assess 137 FDRs of 33 persons with CBD. FDRs were significantly more likely than those in a comparison group to have depression, alcoholism, a drug use disorder, "any" psychiatric disorder, and "more than one psychiatric disorder". CBD was identified in 9.5% of the FDRs of the CBD probands (CBD was not assessed in the comparison group). In molecular genetic studies, Devor et al (30) failed to find an association between two serotonin transporter gene polymorphisms and CBD, while Comings (31) reported an association of CBD with the DRD1 receptor gene.
CLINICAL SYMPTOMS
Persons with CBD are preoccupied with shopping and spending, and devote significant time to these behaviors. While it might be argued that a person could be a compulsive shopper and not spend, and confine his or her interest to window shopping, this pattern is uncommon. The author's personal observation is that the two aspects - shopping and spending - are intertwined. Persons with CBD often describe an increasing level of urge or anxiety that can only lead to a sense of completion when a purchase is made.
The author has been able to identify four distinct phases of CBD: 1) anticipation; 2) preparation; 3) shopping; and 4) spending. In the first phase, the person with CBD develops thoughts, urges, or preoccupations with either having a specific item, or with the act of shopping. In the second phase, the person prepares for shopping and spending. This can include decisions on when and where to go, on how to dress, and even which credit cards to use. Considerable research may have taken place about sale items, new fashions, or new shops. The third phase involves the actual shopping experience, which many individuals with CBD describe as intensely exciting, and can even lead to a sexual feeling (12). Finally, the act is completed with a purchase, often followed by a sense of let down, or disappointment with oneself (21). In a study of the antecedents and consequences of CBD, Miltenberger et al (32) reported that negative emotions (e.g., depression, anxiety, boredom, self-critical thoughts, anger) were the most commonly cited antecedents to CBD, while euphoria or relief from the negative emotions were the most common consequence.
Individuals with CBD tend to shop by themselves, although some will shop with friends who may share their interest in shopping (11,12). In general, CBD is a private pleasure which could lead to embarrassment if someone not similarly interested in shopping accompanied them. Shopping may occur in just about any venue, ranging from high fashion department stores and boutiques to consignment shops or garage sales. Income has relatively little to do with the existence of CBD: persons with a low income can still be fully preoccupied by shopping and spending, although their level of income will lead them to shop at a consignment shop rather than a department store.
Typical items purchased by persons with CBD include (in descending order) clothing, shoes, compact discs, jewelry, cosmetics, and household items (11,12,32). Individually, the items purchased by compulsive shoppers tend not to be particularly expensive, but the author has observed that many compulsive shoppers buy in quantity resulting in out of control spending. Anecdotally, patients often report buying a product based on its attractiveness or because it was a bargain. In the study by Christenson et al (11), compulsive shoppers reported spending an average of $110 during a typical shopping episode compared with $92 reported in the study by Schlosser et al (12).
Although research has not identified gender specific buying patterns, in the author's experience men tend to have a greater interest than women in electronic, automotive, or hardware goods. Like women, they are also interested in clothing, shoes, and compact discs.
Subjects generally are willing to acknowledge that CBD is problematic. Schlosser et al (10) reported that 85% of their subjects expressed concern with their CBD-related debts, and that 74% felt out of control while shopping. In the study by Miltenberger et al (32), 68% of persons with CBD reported that it negatively affected their relationships. Christenson et al (11) reported that nearly all of their subjects (92%) tried to resist their urges to buy, but were rarely successful. The subjects indicated that 74% of the time they experienced an urge to buy, the urge resulted in a purchase.
CBD tends to occur year round, although it may be more problematic during the Christmas or other important holidays, and around the birthdays of family members and friends (12). Schlosser et al (12) found that subjects reported a range of behaviors regarding the outcome of a purchase, including returning the item, failing to remove the item from the packaging, selling the item, or even giving it away.
In a study of 44 subjects with CBD, Black et al (33) reported that greater severity was associated with lower gross income, less likelihood of having an income above the median, and spending a lower percentage of income on sale items. Subjects with more severe CBD were also more likely to have comorbid Axis I or Axis II disorders. These data suggest that the most severe forms of CBD are found in persons with low incomes who have little ability to control or to delay their urge to make impulsive purchases.
PSYCHIATRIC COMORBIDITY
Persons with CBD frequently meet criteria for Axis I disorders, particularly mood disorders (21-100%) (27,34), anxiety disorders (41-80%) (10,12), substance use disorders (21-46%) (11,29), and eating disorders (8-35%) (10,27). Disorders of impulse control are also relatively common in these individuals (21-40%) (10,11).
Schlosser et al (12) found that nearly 60% of subjects with CBD met criteria for at least one Axis II disorder. While there was no special "shopping" personality, the most frequently identified personality disorders were the obsessive-compulsive (22%), avoidant (15%), and borderline (15%) types. Krueger (7), a psychoanalyst, described four patients who he observed to have aspects of narcissistic character pathology.
ETIOLOGY
The etiology of CBD is unknown, though speculation has settled on developmental, neurobiological, and cultural influences. Psychoanalysts (7-9) have suggested that early life events, such as sexual abuse, are causative factors. Yet, no special or unique family constellation or pattern of early life events has been identified in persons with CBD.
Neurobiological theories have centered on disturbed neurotransmission, particularly involving the serotonergic, dopaminergic, or opioid systems. Selective serotonin reuptake inhibitors (SSRIs) have been used to treat CBD (27,34- 38), in part because investigators have noted similarities between CBD and obsessive-compulsive disorder, a disorder known to respond to SSRIs. Dopamine has been theorized to play a role in "reward dependence", which has been claimed to foster "behavioral addictions" (e.g., CBD, pathological gambling) (39). Case reports suggesting benefit from the opiate antagonist naltrexone have led to speculation about the role of opiate receptors (40,41). There is currently no direct evidence to support the role of these neurotransmitter systems in the etiology of CBD.
Cultural mechanisms have been proposed to recognize the fact that CBD occurs mainly in developed countries (42). Elements which appear necessary for the development of CBD include the presence of a market-based economy, the availability of a wide variety of goods, disposable income, and significant leisure time. For these reasons, CBD is unlikely to occur in poorly developed countries, except among the wealthy elite (Imelda Marcos and her many shoes come to mind).
ASSESSMENT
The goal of assessment is to identify CBD through inquiries regarding the person's attitudes and behaviors towards shopping and spending (43). Inquiries might include: "Do you feel overly preoccupied with shopping and spending?"; "Do you ever feel that your shopping behavior is excessive, inappropriate or uncontrolled?"; "Have your shopping desires, urges, fantasies, or behaviors ever been overly time consuming, caused you to feel upset or guilty, or lead to serious problems in your life such as financial or legal problems or the loss of a relationship?".
Clinicians should note past psychiatric treatment, including medications, hospitalizations, and psychotherapy. A history of physical illness, surgical procedures, drug allergies, or medical treatment is important to note, because it may help rule out medical explanations as a cause of the CBD (e.g., neurological disorders, brain tumors). Bipolar disorder needs to be ruled out as a cause of the excessive shopping and spending. Typically, the manic patient's unrestrained spending corresponds to manic episodes, and is accompanied by euphoric mood, grandiosity, unrealistic plans, and often a giddy, expansive affect. The pattern of shopping and spending in the person with CBD lacks the periodicity seen with bipolar patients, and suggests an ongoing preoccupation.
Normal buying behavior should also be ruled out. In the US and other developed countries, shopping is a major pastime, particularly for women, and frequent shopping does not necessarily constitute evidence in support of a diagnosis of CBD. Normal buying can sometimes take on a compulsive quality, particularly around special holidays or birthdays. Persons who receive an inheritance or win a lottery may experience shopping sprees as well.
Several instruments have been developed to either identify CBD or rate its severity. The CBS (23), already mentioned, consists of seven items representing specific behaviors, motivations, and feelings associated with compulsive buying, and reliably distinguishes normal buyers from those with CBD. Edwards (44) has developed a useful 13-item scale that assesses important experiences and feelings about shopping and spending. Monahan et al (45) modified the Yale Brown Obsessive-Compulsive Scale to create the YBOCS-Shopping Version (YBOCS-SV) to assess cognitions and behaviors associated with CBD. This 10-item scale rates time involved, interference, distress, resistance, and degree of control for both cognitions and behaviors. The instrument is designed to measure severity of CBD, and change during clinical trials.
TREATMENT
There are no evidence-based treatments for CBD. In recent years, treatment studies of CBD have focused on the use of psychotropic medication (mainly antidepressants) and cognitive-behavioral therapy (CBT).
Interest in CBT has largely replaced earlier interest in psychodynamic therapies. Several competing CBT models have been developed, the most successful involving the use of group treatment (46-49). The first use of group therapy was described by Damon (46). Subsequent group models were developed by Burgard and Mitchell (47), Villarino et al (48), and more recently by Benson and Gengler (49). Mitchell et al (50) reported that their group CBT model produced significant improvement compared to a wait list in a 12-week pilot study; improvement was maintained during a 6-months follow-up. Benson (51) has recently developed a comprehensive self-help program which combines cognitive- behavioral strategies with self-monitoring. A detailed workbook, a shopping diary, and a CD-ROM are included.
Several self-help books (bibliotherapy) are available (52- 54), and may be helpful to some persons with CBD. Debtors Anonymous, patterned after Alcoholics Anonymous, is a voluntary, lay-run group that provides an atmosphere of mutual support and encouragement for those with substantial debts. Simplicity circles are available in some US cities; these voluntary groups encourage people to adopt a simple lifestyle, and to abandon their CBD (55). Many subjects with CBD develop substantial financial problems, and may benefit from financial counseling (56). The author has seen cases in which a financial conservator has been appointed to control the patient's finances, and appears to have helped. While a conservator controls the person's spending, this approach does not reverse his or her preoccupation with shopping and spending. Marriage (or couples) counseling may be helpful, particularly when CBD in one member of the dyad has disrupted the relationship (57).
Psychopharmacologic treatment studies have yielded mixed results. An early case series suggested that antidepressants could curb CBD (58), and an early open-label trial using fluvoxamine showed benefit (34). Yet, two subsequent randomized controlled trials found that fluvoxamine did no better than placebo (35,36). In another open-label trial (28), citalopram produced substantial improvement. In this particular study, responders to open-label citalopram were then enrolled in a nine-week randomized placebo controlled trial (38). Compulsive shopping symptoms returned in five of eight subjects assigned to placebo compared with none of the seven who continued taking citalopram. By comparison, escitalopram showed little effect for CBD in an identically designed discontinuation trial by the same investigators (39). Grant (40) and Kim (41) have described cases in which persons with CBD improved with naltrexone, suggesting that opiate antagonists might play a role in the treatment of CBD. Interpretation of treatment studies is complicated by the high placebo response rate associated with CBD (ranging to 64%) (35).
The author has developed a set of recommendations (59). First, pharmacologic treatment trials provide little guidance, and patients should be informed that they cannot rely on medication. Further, patients should: a) admit that they have CBD; b) get rid of credit cards and checkbooks, because they are easy sources of funds that fuel the disorder; c) shop with a friend or relative; the presence of a person without CBD will help curb the tendency to overspend; and d) find meaningful ways to spend one's leisure time other than shopping.
REFERENCES
1.
Bleuler, E. New York: Macmillan; 1930. Textbook of psychiatry.
2.
Kraepelin, E. 8th ed. Leipzig: Barth; 1915. Psychiatrie.
3.
O'Guinn TC. Faber RJ. Compulsive buying: a phenomenological exploration. J Consumer Res. 1989;16:147–157.
4.
Elliott R. Addictive consumption: function and fragmentation in post-modernity. J Consumer Policy. 1994;17:159–179.
5.
Valence G. D'Astous A. Fortier L. Compulsive buying: concept and measurement. J Consum Policy. 1988;11:419–433.
6.
Scherhorn G. Reisch LA. Raab G. Addictive buying in West Germany: an empirical study. J Consum Policy. 1990;13:355–387.
7.
Krueger DW. On compulsive shopping and spending: a psychodynamic inquiry. Am J Psychother. 1988;42:574–584. [PubMed]
8.
Lawrence L. The psychodynamics of the compulsive female shopper. Am J Psychoanal. 1990;50:67–70. [PubMed]
9.
Winestine MC. Compulsive shopping as a derivative of childhood seduction. Psychoanal Q. 1985;54:70–72. [PubMed]
10.
McElroy S Jr. Keck PE Jr. Pope HG Jr, et al. Compulsive buying: a report of 20 cases. J Clin Psychiatry. 1994;55:242–248. [PubMed]
11.
Christenson GA. Faber JR. de Zwann M. Compulsive buying: descriptive characteristics and psychiatric comorbidity. J Clin Psychiatry. 1994;55:5–11. [PubMed]
12.
Schlosser S. Black DW. Repertinger S, et al. Compulsive buying: demography, phenomenology, and comorbidity in 46 subjects. Gen Hosp Psychiatry. 1994;16:205–212. [PubMed]
13.
Lejoyeux M. Tassain V. Solomon J, et al. Study of compulsive buying in depressed patients. J Clin Psychiatry. 1997;58:169–173. [PubMed]
14.
Bernik MA. Akerman D. Amaral JAMS, et al. Cue exposure in compulsive buying. J Clin Psychiatry. 1996;57:90. [PubMed]
15.
Krych R. Abnormal consumer behavior: a model of addictive behaviors. Adv Consum Res. 1989;16:745–748.
16.
Hollander E. , editor. Obsessive-compulsive related disorders. Washington: American Psychiatric Press; 1993.
17.
Lejoyeux M. Andes J. Tassian V, et al. Phenomenology and psychopathology of uncontrolled buying. Am J Psychiatry. 1996;152:1524–9. [PubMed]
18.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed, revised. Washington: American Psychiatric Press; 1987.
19.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed, text revision. Washington: American Psychiatric Press; 2004.
20.
Lee S. Mysyk A. The medicalization of compulsive buying. Soc Sci Med. 2004;58:1709–1718. [PubMed]
21.
Koran LM. Faber RJ. Aboujaoude E, et al. Estimated prevalence of compulsive buying in the United States. Am J Psychiatry. 2006;163:1806–1812. [PubMed]
22.
Faber RJ. O'Guinn TC. Classifying compulsive consumers: advances in the development of a diagnostic tool. Adv Consum Res. 1989;16:147–157.
23.
Faber RJ. O'Guinn TC. A clinical screener for compulsive buying. J Consumer Res. 1992;19:459–469.
24.
Magee A. Compulsive buying tendency as a predictor of attitudes and perceptions. Adv Consum Res. 1994;21:590–594.
25.
Hassay DN. Smith CL. Compulsive buying: an examination of consumption motive. Psychol Marketing. 1996;13:741–752.
26.
Dittmar, H. Understanding and diagnosing compulsive buying. In: Coombs R. , editor. Addictive disorders: a practical handbook. New York: Wiley; 2004. pp. 411–450.
27.
Koran LM. Bullock KD. Hartston HJ, et al. Citalopram treatment of compulsive shopping: an open-label study. J Clin Psychiatry. 2002;63:704–708. [PubMed]
28.
Aboujaoude E. Gamel N. Koran LM. A 1-year naturalistic following of patients with compulsive shopping disorder. J Clin Psychiatry. 2003;64:946–950. [PubMed]
29.
Black DW. Repertinger S. Gaffney GR, et al. Family history and psychiatric comorbidity in persons with compulsive buying: preliminary findings. Am J Psychiatry. 1998;155:960–963. [PubMed]
30.
Devor EJ. Magee HJ. Dill-Devor RM, et al. Serotonin transporter gene (5-HTT) polymorphisms and compulsive buying. Am J Med Genet. 1999;88:123–125. [PubMed]
31.
Comings DE. The molecular genetics of pathological gambling. CNS Spectrums. 1998;6:20–37.
32.
Miltenberger RG. Redlin J. Crosby R, et al. Direct and retrospective assessment of factors contributing to compulsive buying. J Behav Ther Exp Psychiatry. 2003;34:1–9. [PubMed]
33.
Black DW. Monahan P. Schlosser S, et al. Compulsive buying severity: an analysis of compulsive buying scale results in 44 subjects. J Nerv Ment Dis. 2001;189:123–127. [PubMed]
34.
Black DW. Monahan P. Gabel J. Fluvoxamine in the treatment of compulsive buying. J Clin Psychiatry. 1997;58:159–163. [PubMed]
35.
Black DW. Gabel J. Hansen J, et al. A double-blind comparison of fluvoxamine versus placebo in the treatment of compulsive buying disorder. Ann Clin Psychiatry. 2000;12:205–211. [PubMed]
36.
Ninan PT. McElroy SL. Kane CP, et al. Placebo-controlled study of fluvoxamine in the treatment of patients with compulsive buying. J Clin Psychopharmacol. 2000;20:362–366. [PubMed]
37.
Koran LM. Chuang HW. Bullock KD, et al. Citalopram for compulsive shopping disorder: an open-label study followed by a double- blind discontinuation. J Clin Psychiatry. 2003;64:793–798. [PubMed]
38.
Koran LM. Escitalopram treatment evaluated in patients with compulsive shopping disorder. Primary Psychiatry. 2005;12:13.
39.
Holden C. Behavioral addictions; do they exist? Science. 2001;294:980–982. [PubMed]
40.
Grant JE. Three cases of compulsive buying treated with naltrexone. Int J Psychiatry Clin Pract. 2003;7:223–225.
41.
Kim SW. Opioid antagonists in the treatment of impulse-control disorders. J Clin Psychiatry. 1998;59:159–164. [PubMed]
42.
Black DW. Compulsive buying disorder: definition, assessment, epidemiology and clinical management. CNS Drugs. 2001;15:17–27. [PubMed]
43.
Black, DW. Assessment of compulsive buying. In: Benson A. , editor. I shop, therefore I am - compulsive buying and the search for self. New York: Aronson; 2000. pp. 191–216.
44.
Edwards EA. Development of a new scale to measure compulsive buying behavior. Fin Counsel Plan. 1993;4:67–84.
45.
Monahan P. Black DW. Gabel J. Reliability and validity of a scale to measure change in persons with compulsive buying. Psychiatry Res. 1995;64:59–67. [PubMed]
46.
Damon, JE. Los Angeles: Price Stein Sloan; 1988. Shopaholics: serious help for addicted spenders.
47.
Burgard, M. Mitchell, JE. Group cognitive-behavioral therapy for buying disorders. In: Benson A. , editor. I shop, therefore I am - compulsive buying and the search for self. New York: Aronson; 2000. pp. 367–397.
48.
Villarino, R. Otero-Lopez, JL. Casto, R. Madrid: Ediciones Piramide; 2001. Adicion a la compra: analysis, evaluaction y tratamiento.
49.
Benson, A. Gengler, M. Treating compulsive buying. In: Coombs R. , editor. Addictive disorders: a practical handbook. New York: Wiley; 2004. pp. 451–491.
50.
Mitchell JE. Burgard M. Faber R, et al. Cognitive behavioral therapy for compulsive buying disorder. Behav Res Ther. 2006;44:1859–1865. [PubMed]
51.
Benson A. Stopping overshopping - A comprehensive program to help eliminate overshopping. New York: April Benson, 2006 www.stoppingovershopping.com.
52.
Arenson, G. Blue Ridge Summit: Tab Books; 1991. Born to spend: how to overcome compulsive spending.
53.
Catalano, EM. Sonenberg, N. Oakland: New Harbinger Publications; 1993. Consuming passions - help for compulsive shoppers.
54.
Wesson, C. New York: St. Martin's Press; 1991. Women who shop too much: overcoming the urge to splurge.
55.
Andrews, C. Simplicity circles and the compulsive shopper. In: Benson A. , editor. I shop, therefore I am - compulsive buying and the search for self. New York: Aronson; 2000. pp. 484–496.
56.
McCall, K. Financial recovery counseling. In: Benson A. , editor. I shop, therefore I am - compulsive buying and the search for self. New York: Aronson; 2000. pp. 457–483.
57.
Mellan, O. Overcoming overspending in couples. In: Benson A. , editor. I shop, therefore I am - compulsive buying and the search for self. New York: Aronson; 2000. pp. 341–366.
58.
McElroy S. Satlin A. Pope HG, et al. Treatment of compulsive shopping with antidepressants: a report of three cases. Ann Clin Psychiatry. 1991;3:199–204.
59.
Kuzma J. Black DW. Compulsive shopping - when spending begins to consume the consumer. Current Psychiatry. 2006;7:27–40.
From
http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=17342214
DONALD W BLACK11Department of Psychiatry, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA 52242, USA
ABSTRACT
Compulsive buying disorder (CBD) is characterized by excessive shopping cognitions and buying behavior that leads to distress or impairment. Found worldwide, the disorder has a lifetime prevalence of 5.8% in the US general population. Most subjects studied clinically are women (~80%), though this gender difference may be artifactual. Subjects with CBD report a preoccupation with shopping, prepurchase tension or anxiety, and a sense of relief following the purchase. CBD is associated with significant psychiatric comorbidity, particularly mood and anxiety disorders, substance use disorders, eating disorders, and other disorders of impulse control. The majority of persons with CBD appear to meet criteria for an Axis II disorder, although there is no special "shopping" personality. Compulsive shopping tends to run in families, and these families are filled with mood and substance use disorders. There are no standard treatments. Psychopharmacologic treatment studies are being actively pursued, and group cognitive-behavioral models have been developed and are promising. Debtors Anonymous, simplicity circles, bibliotherapy, financial counseling, and marital therapy may also play a role in the management of CBD.
Keywords: Compulsive shopping, compulsive buying, impulse control disorders
REFERENCES
Compulsive buying disorder (CBD) was first described clinically in the early 20th century by Bleuler (1) and Kraepelin (2), both of whom included CBD in their textbooks. Bleuler writes: "As a last category Kraepelin mentions the buying maniacs (oniomaniacs) in whom even buying is compulsive and leads to senseless contraction of debts with continuous delay of payment until a catastrophe clears the situation a little - a little bit never altogether because they never admit to their debts" (1). Bleuler described CBD as an example of a "reactive impulse", or "impulsive insanity", which he grouped alongside kleptomania and pyromania.
CBD attracted little attention throughout the 20th century except among consumer behaviorists (3-6) and psychoanalysts (7-9). Interest was revived in the early 1990s, when clinical case series from three independent research groups appeared (10-12). The disorder has been described worldwide, with reports coming from the US (10-12), Canada (5), England (4), Germany (6), France (13), and Brazil (14).
The appropriate classification of CBD continues to be debated. Some researchers have linked CBD to addictive disorders (15), while others have linked it to obsessive-compulsive disorder (16), and still others to mood disorders (17). While not included in DSM-IV (18), CBD was included in DSM-III-R (19) as an example of an "impulsecontrol disorder not otherwise specified". Research criteria have been developed that emphasize its cognitive and behavioral aspects (10). Some writers have criticized attempts to categorize CBD as an illness, which they see as part of a trend to "medicalize" behavioral problems (20). Yet, this approach ignores the reality of CBD, and both trivializes and stigmatizes attempts to understand or treat the disorder.
EPIDEMIOLOGY
Koran et al (21) recently estimated the point prevalence of CBD to be 5.8% of respondents, based on results from a random telephone survey of 2,513 adults conducted in the US. Earlier, Faber and O'Guinn (22) had estimated the prevalence of CBD to fall between 2% and 8% of the general population of Illinois. Both research groups had used the Compulsive Buying Scale (CBS) (23) to identify compulsive buyers. Other surveys have reported figures ranging from 12% to 16% (24,25). There is no evidence that CBD has increased in prevalence in the past few decades.
Community based and clinical surveys suggest that 80% to 95% of persons with CBD are women (10-12,23). The reported gender difference could be artifactual: women readily acknowledge that they enjoy shopping, whereas men are more likely to report that they "collect". The report of Koran et al (21) suggests that this may be the case: in their survey, a near equal percentage of men and women met criteria for CBD (5.5% and 6.0%, respectively). However, Dittmar (26) concluded from a general population survey in the United Kingdom, in which 92% of respondents considered compulsive shoppers were women, that the gender difference is real and is not an artifact of men being underrepresented in samples.
The age of onset of CBD appears to be in the late teens or early twenties (11,12,27), though McElroy et al (10) reported a mean age at onset of 30 years. It may be that the age of onset corresponds with emancipation from the home, and the age at which people first establish credit accounts.
There are no careful longitudinal studies of CBD, but the majority of subjects studied by Schlosser et al (12) and McElroy et al (10) describe their course as continuous. Aboujaoude et al (28) suggested that persons with CBD who responded to treatment with citalopram were likely to remain in remission during one-year follow-up, a finding that suggests that treatment could alter the natural history of the disorder. The authors' personal observation is that subjects with CBD typically report decades of compulsive shopping behavior at the time of presentation, although it might be argued that clinical samples are biased in favor of severity.
There is some evidence that CBD runs in families and that within these families mood, anxiety, and substance use disorders are excessive. McElroy et al (8) reported that, of 18 individuals with CBD, 17 had one or more first-degree relatives (FDRs) with major depression, 11 with an alcohol or drug use disorder, and three with an anxiety disorder. Three had relatives with CBD. Black et al (29) used the family history method to assess 137 FDRs of 33 persons with CBD. FDRs were significantly more likely than those in a comparison group to have depression, alcoholism, a drug use disorder, "any" psychiatric disorder, and "more than one psychiatric disorder". CBD was identified in 9.5% of the FDRs of the CBD probands (CBD was not assessed in the comparison group). In molecular genetic studies, Devor et al (30) failed to find an association between two serotonin transporter gene polymorphisms and CBD, while Comings (31) reported an association of CBD with the DRD1 receptor gene.
CLINICAL SYMPTOMS
Persons with CBD are preoccupied with shopping and spending, and devote significant time to these behaviors. While it might be argued that a person could be a compulsive shopper and not spend, and confine his or her interest to window shopping, this pattern is uncommon. The author's personal observation is that the two aspects - shopping and spending - are intertwined. Persons with CBD often describe an increasing level of urge or anxiety that can only lead to a sense of completion when a purchase is made.
The author has been able to identify four distinct phases of CBD: 1) anticipation; 2) preparation; 3) shopping; and 4) spending. In the first phase, the person with CBD develops thoughts, urges, or preoccupations with either having a specific item, or with the act of shopping. In the second phase, the person prepares for shopping and spending. This can include decisions on when and where to go, on how to dress, and even which credit cards to use. Considerable research may have taken place about sale items, new fashions, or new shops. The third phase involves the actual shopping experience, which many individuals with CBD describe as intensely exciting, and can even lead to a sexual feeling (12). Finally, the act is completed with a purchase, often followed by a sense of let down, or disappointment with oneself (21). In a study of the antecedents and consequences of CBD, Miltenberger et al (32) reported that negative emotions (e.g., depression, anxiety, boredom, self-critical thoughts, anger) were the most commonly cited antecedents to CBD, while euphoria or relief from the negative emotions were the most common consequence.
Individuals with CBD tend to shop by themselves, although some will shop with friends who may share their interest in shopping (11,12). In general, CBD is a private pleasure which could lead to embarrassment if someone not similarly interested in shopping accompanied them. Shopping may occur in just about any venue, ranging from high fashion department stores and boutiques to consignment shops or garage sales. Income has relatively little to do with the existence of CBD: persons with a low income can still be fully preoccupied by shopping and spending, although their level of income will lead them to shop at a consignment shop rather than a department store.
Typical items purchased by persons with CBD include (in descending order) clothing, shoes, compact discs, jewelry, cosmetics, and household items (11,12,32). Individually, the items purchased by compulsive shoppers tend not to be particularly expensive, but the author has observed that many compulsive shoppers buy in quantity resulting in out of control spending. Anecdotally, patients often report buying a product based on its attractiveness or because it was a bargain. In the study by Christenson et al (11), compulsive shoppers reported spending an average of $110 during a typical shopping episode compared with $92 reported in the study by Schlosser et al (12).
Although research has not identified gender specific buying patterns, in the author's experience men tend to have a greater interest than women in electronic, automotive, or hardware goods. Like women, they are also interested in clothing, shoes, and compact discs.
Subjects generally are willing to acknowledge that CBD is problematic. Schlosser et al (10) reported that 85% of their subjects expressed concern with their CBD-related debts, and that 74% felt out of control while shopping. In the study by Miltenberger et al (32), 68% of persons with CBD reported that it negatively affected their relationships. Christenson et al (11) reported that nearly all of their subjects (92%) tried to resist their urges to buy, but were rarely successful. The subjects indicated that 74% of the time they experienced an urge to buy, the urge resulted in a purchase.
CBD tends to occur year round, although it may be more problematic during the Christmas or other important holidays, and around the birthdays of family members and friends (12). Schlosser et al (12) found that subjects reported a range of behaviors regarding the outcome of a purchase, including returning the item, failing to remove the item from the packaging, selling the item, or even giving it away.
In a study of 44 subjects with CBD, Black et al (33) reported that greater severity was associated with lower gross income, less likelihood of having an income above the median, and spending a lower percentage of income on sale items. Subjects with more severe CBD were also more likely to have comorbid Axis I or Axis II disorders. These data suggest that the most severe forms of CBD are found in persons with low incomes who have little ability to control or to delay their urge to make impulsive purchases.
PSYCHIATRIC COMORBIDITY
Persons with CBD frequently meet criteria for Axis I disorders, particularly mood disorders (21-100%) (27,34), anxiety disorders (41-80%) (10,12), substance use disorders (21-46%) (11,29), and eating disorders (8-35%) (10,27). Disorders of impulse control are also relatively common in these individuals (21-40%) (10,11).
Schlosser et al (12) found that nearly 60% of subjects with CBD met criteria for at least one Axis II disorder. While there was no special "shopping" personality, the most frequently identified personality disorders were the obsessive-compulsive (22%), avoidant (15%), and borderline (15%) types. Krueger (7), a psychoanalyst, described four patients who he observed to have aspects of narcissistic character pathology.
ETIOLOGY
The etiology of CBD is unknown, though speculation has settled on developmental, neurobiological, and cultural influences. Psychoanalysts (7-9) have suggested that early life events, such as sexual abuse, are causative factors. Yet, no special or unique family constellation or pattern of early life events has been identified in persons with CBD.
Neurobiological theories have centered on disturbed neurotransmission, particularly involving the serotonergic, dopaminergic, or opioid systems. Selective serotonin reuptake inhibitors (SSRIs) have been used to treat CBD (27,34- 38), in part because investigators have noted similarities between CBD and obsessive-compulsive disorder, a disorder known to respond to SSRIs. Dopamine has been theorized to play a role in "reward dependence", which has been claimed to foster "behavioral addictions" (e.g., CBD, pathological gambling) (39). Case reports suggesting benefit from the opiate antagonist naltrexone have led to speculation about the role of opiate receptors (40,41). There is currently no direct evidence to support the role of these neurotransmitter systems in the etiology of CBD.
Cultural mechanisms have been proposed to recognize the fact that CBD occurs mainly in developed countries (42). Elements which appear necessary for the development of CBD include the presence of a market-based economy, the availability of a wide variety of goods, disposable income, and significant leisure time. For these reasons, CBD is unlikely to occur in poorly developed countries, except among the wealthy elite (Imelda Marcos and her many shoes come to mind).
ASSESSMENT
The goal of assessment is to identify CBD through inquiries regarding the person's attitudes and behaviors towards shopping and spending (43). Inquiries might include: "Do you feel overly preoccupied with shopping and spending?"; "Do you ever feel that your shopping behavior is excessive, inappropriate or uncontrolled?"; "Have your shopping desires, urges, fantasies, or behaviors ever been overly time consuming, caused you to feel upset or guilty, or lead to serious problems in your life such as financial or legal problems or the loss of a relationship?".
Clinicians should note past psychiatric treatment, including medications, hospitalizations, and psychotherapy. A history of physical illness, surgical procedures, drug allergies, or medical treatment is important to note, because it may help rule out medical explanations as a cause of the CBD (e.g., neurological disorders, brain tumors). Bipolar disorder needs to be ruled out as a cause of the excessive shopping and spending. Typically, the manic patient's unrestrained spending corresponds to manic episodes, and is accompanied by euphoric mood, grandiosity, unrealistic plans, and often a giddy, expansive affect. The pattern of shopping and spending in the person with CBD lacks the periodicity seen with bipolar patients, and suggests an ongoing preoccupation.
Normal buying behavior should also be ruled out. In the US and other developed countries, shopping is a major pastime, particularly for women, and frequent shopping does not necessarily constitute evidence in support of a diagnosis of CBD. Normal buying can sometimes take on a compulsive quality, particularly around special holidays or birthdays. Persons who receive an inheritance or win a lottery may experience shopping sprees as well.
Several instruments have been developed to either identify CBD or rate its severity. The CBS (23), already mentioned, consists of seven items representing specific behaviors, motivations, and feelings associated with compulsive buying, and reliably distinguishes normal buyers from those with CBD. Edwards (44) has developed a useful 13-item scale that assesses important experiences and feelings about shopping and spending. Monahan et al (45) modified the Yale Brown Obsessive-Compulsive Scale to create the YBOCS-Shopping Version (YBOCS-SV) to assess cognitions and behaviors associated with CBD. This 10-item scale rates time involved, interference, distress, resistance, and degree of control for both cognitions and behaviors. The instrument is designed to measure severity of CBD, and change during clinical trials.
TREATMENT
There are no evidence-based treatments for CBD. In recent years, treatment studies of CBD have focused on the use of psychotropic medication (mainly antidepressants) and cognitive-behavioral therapy (CBT).
Interest in CBT has largely replaced earlier interest in psychodynamic therapies. Several competing CBT models have been developed, the most successful involving the use of group treatment (46-49). The first use of group therapy was described by Damon (46). Subsequent group models were developed by Burgard and Mitchell (47), Villarino et al (48), and more recently by Benson and Gengler (49). Mitchell et al (50) reported that their group CBT model produced significant improvement compared to a wait list in a 12-week pilot study; improvement was maintained during a 6-months follow-up. Benson (51) has recently developed a comprehensive self-help program which combines cognitive- behavioral strategies with self-monitoring. A detailed workbook, a shopping diary, and a CD-ROM are included.
Several self-help books (bibliotherapy) are available (52- 54), and may be helpful to some persons with CBD. Debtors Anonymous, patterned after Alcoholics Anonymous, is a voluntary, lay-run group that provides an atmosphere of mutual support and encouragement for those with substantial debts. Simplicity circles are available in some US cities; these voluntary groups encourage people to adopt a simple lifestyle, and to abandon their CBD (55). Many subjects with CBD develop substantial financial problems, and may benefit from financial counseling (56). The author has seen cases in which a financial conservator has been appointed to control the patient's finances, and appears to have helped. While a conservator controls the person's spending, this approach does not reverse his or her preoccupation with shopping and spending. Marriage (or couples) counseling may be helpful, particularly when CBD in one member of the dyad has disrupted the relationship (57).
Psychopharmacologic treatment studies have yielded mixed results. An early case series suggested that antidepressants could curb CBD (58), and an early open-label trial using fluvoxamine showed benefit (34). Yet, two subsequent randomized controlled trials found that fluvoxamine did no better than placebo (35,36). In another open-label trial (28), citalopram produced substantial improvement. In this particular study, responders to open-label citalopram were then enrolled in a nine-week randomized placebo controlled trial (38). Compulsive shopping symptoms returned in five of eight subjects assigned to placebo compared with none of the seven who continued taking citalopram. By comparison, escitalopram showed little effect for CBD in an identically designed discontinuation trial by the same investigators (39). Grant (40) and Kim (41) have described cases in which persons with CBD improved with naltrexone, suggesting that opiate antagonists might play a role in the treatment of CBD. Interpretation of treatment studies is complicated by the high placebo response rate associated with CBD (ranging to 64%) (35).
The author has developed a set of recommendations (59). First, pharmacologic treatment trials provide little guidance, and patients should be informed that they cannot rely on medication. Further, patients should: a) admit that they have CBD; b) get rid of credit cards and checkbooks, because they are easy sources of funds that fuel the disorder; c) shop with a friend or relative; the presence of a person without CBD will help curb the tendency to overspend; and d) find meaningful ways to spend one's leisure time other than shopping.
REFERENCES
1.
Bleuler, E. New York: Macmillan; 1930. Textbook of psychiatry.
2.
Kraepelin, E. 8th ed. Leipzig: Barth; 1915. Psychiatrie.
3.
O'Guinn TC. Faber RJ. Compulsive buying: a phenomenological exploration. J Consumer Res. 1989;16:147–157.
4.
Elliott R. Addictive consumption: function and fragmentation in post-modernity. J Consumer Policy. 1994;17:159–179.
5.
Valence G. D'Astous A. Fortier L. Compulsive buying: concept and measurement. J Consum Policy. 1988;11:419–433.
6.
Scherhorn G. Reisch LA. Raab G. Addictive buying in West Germany: an empirical study. J Consum Policy. 1990;13:355–387.
7.
Krueger DW. On compulsive shopping and spending: a psychodynamic inquiry. Am J Psychother. 1988;42:574–584. [PubMed]
8.
Lawrence L. The psychodynamics of the compulsive female shopper. Am J Psychoanal. 1990;50:67–70. [PubMed]
9.
Winestine MC. Compulsive shopping as a derivative of childhood seduction. Psychoanal Q. 1985;54:70–72. [PubMed]
10.
McElroy S Jr. Keck PE Jr. Pope HG Jr, et al. Compulsive buying: a report of 20 cases. J Clin Psychiatry. 1994;55:242–248. [PubMed]
11.
Christenson GA. Faber JR. de Zwann M. Compulsive buying: descriptive characteristics and psychiatric comorbidity. J Clin Psychiatry. 1994;55:5–11. [PubMed]
12.
Schlosser S. Black DW. Repertinger S, et al. Compulsive buying: demography, phenomenology, and comorbidity in 46 subjects. Gen Hosp Psychiatry. 1994;16:205–212. [PubMed]
13.
Lejoyeux M. Tassain V. Solomon J, et al. Study of compulsive buying in depressed patients. J Clin Psychiatry. 1997;58:169–173. [PubMed]
14.
Bernik MA. Akerman D. Amaral JAMS, et al. Cue exposure in compulsive buying. J Clin Psychiatry. 1996;57:90. [PubMed]
15.
Krych R. Abnormal consumer behavior: a model of addictive behaviors. Adv Consum Res. 1989;16:745–748.
16.
Hollander E. , editor. Obsessive-compulsive related disorders. Washington: American Psychiatric Press; 1993.
17.
Lejoyeux M. Andes J. Tassian V, et al. Phenomenology and psychopathology of uncontrolled buying. Am J Psychiatry. 1996;152:1524–9. [PubMed]
18.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed, revised. Washington: American Psychiatric Press; 1987.
19.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed, text revision. Washington: American Psychiatric Press; 2004.
20.
Lee S. Mysyk A. The medicalization of compulsive buying. Soc Sci Med. 2004;58:1709–1718. [PubMed]
21.
Koran LM. Faber RJ. Aboujaoude E, et al. Estimated prevalence of compulsive buying in the United States. Am J Psychiatry. 2006;163:1806–1812. [PubMed]
22.
Faber RJ. O'Guinn TC. Classifying compulsive consumers: advances in the development of a diagnostic tool. Adv Consum Res. 1989;16:147–157.
23.
Faber RJ. O'Guinn TC. A clinical screener for compulsive buying. J Consumer Res. 1992;19:459–469.
24.
Magee A. Compulsive buying tendency as a predictor of attitudes and perceptions. Adv Consum Res. 1994;21:590–594.
25.
Hassay DN. Smith CL. Compulsive buying: an examination of consumption motive. Psychol Marketing. 1996;13:741–752.
26.
Dittmar, H. Understanding and diagnosing compulsive buying. In: Coombs R. , editor. Addictive disorders: a practical handbook. New York: Wiley; 2004. pp. 411–450.
27.
Koran LM. Bullock KD. Hartston HJ, et al. Citalopram treatment of compulsive shopping: an open-label study. J Clin Psychiatry. 2002;63:704–708. [PubMed]
28.
Aboujaoude E. Gamel N. Koran LM. A 1-year naturalistic following of patients with compulsive shopping disorder. J Clin Psychiatry. 2003;64:946–950. [PubMed]
29.
Black DW. Repertinger S. Gaffney GR, et al. Family history and psychiatric comorbidity in persons with compulsive buying: preliminary findings. Am J Psychiatry. 1998;155:960–963. [PubMed]
30.
Devor EJ. Magee HJ. Dill-Devor RM, et al. Serotonin transporter gene (5-HTT) polymorphisms and compulsive buying. Am J Med Genet. 1999;88:123–125. [PubMed]
31.
Comings DE. The molecular genetics of pathological gambling. CNS Spectrums. 1998;6:20–37.
32.
Miltenberger RG. Redlin J. Crosby R, et al. Direct and retrospective assessment of factors contributing to compulsive buying. J Behav Ther Exp Psychiatry. 2003;34:1–9. [PubMed]
33.
Black DW. Monahan P. Schlosser S, et al. Compulsive buying severity: an analysis of compulsive buying scale results in 44 subjects. J Nerv Ment Dis. 2001;189:123–127. [PubMed]
34.
Black DW. Monahan P. Gabel J. Fluvoxamine in the treatment of compulsive buying. J Clin Psychiatry. 1997;58:159–163. [PubMed]
35.
Black DW. Gabel J. Hansen J, et al. A double-blind comparison of fluvoxamine versus placebo in the treatment of compulsive buying disorder. Ann Clin Psychiatry. 2000;12:205–211. [PubMed]
36.
Ninan PT. McElroy SL. Kane CP, et al. Placebo-controlled study of fluvoxamine in the treatment of patients with compulsive buying. J Clin Psychopharmacol. 2000;20:362–366. [PubMed]
37.
Koran LM. Chuang HW. Bullock KD, et al. Citalopram for compulsive shopping disorder: an open-label study followed by a double- blind discontinuation. J Clin Psychiatry. 2003;64:793–798. [PubMed]
38.
Koran LM. Escitalopram treatment evaluated in patients with compulsive shopping disorder. Primary Psychiatry. 2005;12:13.
39.
Holden C. Behavioral addictions; do they exist? Science. 2001;294:980–982. [PubMed]
40.
Grant JE. Three cases of compulsive buying treated with naltrexone. Int J Psychiatry Clin Pract. 2003;7:223–225.
41.
Kim SW. Opioid antagonists in the treatment of impulse-control disorders. J Clin Psychiatry. 1998;59:159–164. [PubMed]
42.
Black DW. Compulsive buying disorder: definition, assessment, epidemiology and clinical management. CNS Drugs. 2001;15:17–27. [PubMed]
43.
Black, DW. Assessment of compulsive buying. In: Benson A. , editor. I shop, therefore I am - compulsive buying and the search for self. New York: Aronson; 2000. pp. 191–216.
44.
Edwards EA. Development of a new scale to measure compulsive buying behavior. Fin Counsel Plan. 1993;4:67–84.
45.
Monahan P. Black DW. Gabel J. Reliability and validity of a scale to measure change in persons with compulsive buying. Psychiatry Res. 1995;64:59–67. [PubMed]
46.
Damon, JE. Los Angeles: Price Stein Sloan; 1988. Shopaholics: serious help for addicted spenders.
47.
Burgard, M. Mitchell, JE. Group cognitive-behavioral therapy for buying disorders. In: Benson A. , editor. I shop, therefore I am - compulsive buying and the search for self. New York: Aronson; 2000. pp. 367–397.
48.
Villarino, R. Otero-Lopez, JL. Casto, R. Madrid: Ediciones Piramide; 2001. Adicion a la compra: analysis, evaluaction y tratamiento.
49.
Benson, A. Gengler, M. Treating compulsive buying. In: Coombs R. , editor. Addictive disorders: a practical handbook. New York: Wiley; 2004. pp. 451–491.
50.
Mitchell JE. Burgard M. Faber R, et al. Cognitive behavioral therapy for compulsive buying disorder. Behav Res Ther. 2006;44:1859–1865. [PubMed]
51.
Benson A. Stopping overshopping - A comprehensive program to help eliminate overshopping. New York: April Benson, 2006 www.stoppingovershopping.com.
52.
Arenson, G. Blue Ridge Summit: Tab Books; 1991. Born to spend: how to overcome compulsive spending.
53.
Catalano, EM. Sonenberg, N. Oakland: New Harbinger Publications; 1993. Consuming passions - help for compulsive shoppers.
54.
Wesson, C. New York: St. Martin's Press; 1991. Women who shop too much: overcoming the urge to splurge.
55.
Andrews, C. Simplicity circles and the compulsive shopper. In: Benson A. , editor. I shop, therefore I am - compulsive buying and the search for self. New York: Aronson; 2000. pp. 484–496.
56.
McCall, K. Financial recovery counseling. In: Benson A. , editor. I shop, therefore I am - compulsive buying and the search for self. New York: Aronson; 2000. pp. 457–483.
57.
Mellan, O. Overcoming overspending in couples. In: Benson A. , editor. I shop, therefore I am - compulsive buying and the search for self. New York: Aronson; 2000. pp. 341–366.
58.
McElroy S. Satlin A. Pope HG, et al. Treatment of compulsive shopping with antidepressants: a report of three cases. Ann Clin Psychiatry. 1991;3:199–204.
59.
Kuzma J. Black DW. Compulsive shopping - when spending begins to consume the consumer. Current Psychiatry. 2006;7:27–40.
From
http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=17342214
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