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Assessment and Treatment of Compulsive Buying

Abstract and Keywords

Compulsive buying disorder (CBD) affects a significant percentage of those in the general population. However, CBD has not received as much attention with regard to research and training providers in its assessment and treatment as other psychiatric disorders. Formal diagnostic criteria have been put forth, and there are a variety of assessment instruments for evaluating buying behavior using both questionnaire and interview formats. Based on the literature to date, it appears that disorder-specific cognitive-behavioral therapy has been most successful in treating those with CBD. Treatment providers should also be aware that mood disorders, anxiety disorders, and compulsive hoarding often accompany CBD and complicate its treatment, and these disorders should be addressed within the treatment paradigm. Further research is needed to define barriers to motivation for change and treatment compliance among individuals with CBD, as well as factors associated with both positive and negative treatment outcomes.

Keywords: compulsive buying, Compulsive Buying Scale, impulse control disorder, compulsive hoarding, cognitive-behavioral therapy

Introduction

Compulsive buying disorder (CBD) is characterized by shopping and buying behavior that results in marked psychological distress as well as financial and interpersonal problems (Faber & O’Guinn, 1992; O’Guinn & Faber, 1989). Although CBD may seem to have emerged only recently, Kraepelin (1909) and Bleuler (1983) originally described onionmania, or the urge to buy, a century ago. More recently, research has examined the prevalence of CBD as well as ways to classify its symptoms (Black, 2007). Using the Compulsive Buying Scale (CBS; Faber & O’Guinn, 1992), Koran and colleagues (2006) estimated the prevalence of CBD to be 5.8% within a large general population sample in the United States. Compared with other participants, those with CBD were younger and reported lower incomes but did not differ as to gender.

Compulsive buying disorder is not specifically described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; APA, 1994) or in the International Classification of Mental and Behavioral Disorders (ICD-10; World Health Organization, 1994) but is currently conceptualized as an “impulse control disorder not otherwise specified.” In treatment-seeking individuals, the problematic buying behavior is associated with high rates of psychiatric comorbidity, especially mood and anxiety disorders, personality disorders, impulse control disorders (Black et al., 2000; Mitchell et al., 2002; Ninan et al., 2000; Schlosser et al., 1994), and compulsive hoarding (Frost et al., 2009; Mueller et al., 2007). Although research on this disorder has increased over the past 20 years, CBD remains frequently overlooked in clinical practice and many therapists lack specific information on its assessment and treatment.

Assessment

Compulsive buying disorder can be assessed by precise exploration of buying behavior and the (p. 399) thoughts and feelings associated with buying and shopping. According to McElroy and colleagues (1994), who proposed diagnostic criteria, the disorder is characterized by frequent buying episodes or impulses to buy that are experienced as irresistible or senseless. The spending behaviors and impulses lead to personal distress, social, marital, or occupational dysfunction, and financial or legal problems. The excessive buying behavior does not occur exclusively during episodes of mania or hypomania. Individuals should be asked about these symptoms during the course of a general clinical interview. A variety of other interviews and assessment techniques may then be implemented if indicated.

Several interviews and questionnaires have been developed to assess CBD specifically or within the context of other impulse control disorders.

Questionnaires

Compulsive buying scale (cbs)

The most widely used screening instrument in empirical research on CBD is the CBS (Faber & O’Guinn, 1992). This screening instrument consists of seven items utilizing a 5-point Likert scale for responses. Two items explore emotional reactions to shopping and five items ask about financial consequences of buying. The unidimensional scale reflects such characteristics as lack of impulse control, distress at the thought of others’ knowledge of the person’s purchasing habits, irrational use of credit cards, tension when not shopping, and the use of spending to feel better. Lower scores on the scale indicate higher levels of compulsive buying. The authors recommended a cut-off score of two standard deviations below the general population mean (–1.34) to identify those with compulsive buying. In the original study, the CBS correctly classified 89.9% of a general population sample and 85.3% of a compulsive buying group (Faber & O’Guinn, 1992)

Canadian compulsive buying measurement scale

This scale was originally written in French because the study was done with French-speaking consumers (Valence et al., 1988). The items have since been translated from French to English. The Canadian Compulsive Buying Measurement Scale consists of 13 items distributed among three dimensions: (1) tendency to spend (6 items); (2) reactive aspect (4 items); and (3) postpurchase guilt (3 items). Participants are required to express the extent to which they agree with each item on a 5-point Likert scale. The measure demonstrated adequate internal consistency in the original study with 38 respondents with CBD and an equal number of noncompulsive buying individuals, with a Cronbach’s alpha of .88 (Valence et al., 1988).

Edwards compulsive buying scale

Viewing compulsive buying as lying on a continuum from healthy to unhealthy buying behavior, Edwards (1993) developed the Edwards Compulsive Buying Scale to determine how compulsive or addictive subjects are in their spending behavior. The scale includes 13 items that load on five different factors: (1) tendency to spend (5 items); (2) compulsion/drive to spend (2 items); (3) feelings about shopping and spending (2 items); (4) dysfunctional spending (2 items); and (5) postpurchase guilt (2 items). Cronbach’s alpha in a sample of 105 individuals with CBD and 101 subjects of a convenience sample for the entire scale was .91 (Edwards, 1993).

Executive personal finance scale

Spinella and colleagues (2007) developed the Executive Personal Finance Scale as a specific self-rating measure of executive aspects of personal money management regarding impulse control over spending, conceptualization of finances, and financial planning. The 20-item scale has four factors: (1) impulse control; (2) organization; (3) planning; and (4) motivational drive. Cronbach’s alpha for the total score was found to be .86 in a sample of 225 participants (Spinella et al., 2007).

Ridgway compulsive buying scale

Ridgway and colleagues (2008) developed a six-item scale that includes dimensions of both obsessive-compulsive and impulse control disorders while excluding negative financial consequences and income-related items. The instrument is based on a definition of compulsive buying in terms of proposed underlying consumer behavior tendencies, separating consequence effects of the spending behavior. Cronbach’s alpha in a sample of 551 university staff members was .81 (Ridgway et al., 2008).

Interviews

Minnesota impulsive disorder interview (midi)

The MIDI was developed by Christenson and colleagues (1994) for a descriptive study of compulsive buying. This semistructured interview consists of six separate screening modules examining criteria for the DSM-III-R impulse control disorders not elsewhere classified: trichotillomania, pyromania, (p. 400) intermittent explosive disorder, kleptomania, and pathological gambling, as well as compulsive buying. Grant et al. (2005) reported that the MIDI had sensitivity of 100% and specificity of 96.2% for compulsive buying when comparing the instrument to the proposed diagnostic criteria of McElroy and colleagues (1994).

Yale-brown obsessive-compulsive scale–shopping version (ybocs-sv)

Monahan and colleagues (2006) modified the YBOCS (Goodman et al., 1989) to measure symptom severity and change in persons with compulsive buying. The Shopping Version (YBOCS-SV) includes 10 questions, 5 exploring cognitions and 5 rating behaviors associated with uncontrolled buying. Consumers are asked about time involved, interference due to the preoccupations or the shopping, resistance to the thoughts or behaviors, and degree of control over the shopping and buying cognitions/behaviors. The authors compared a group of individuals clinically identified as having compulsive buying and control subjects and reported good interrater reliability for those with compulsive buying (r = .81), for control subjects (r = 0.96), and for both groups combined (r = 0.99). Cronbach’s alpha was moderately high for treatment-seeking individuals with compulsive buying (.65) and for comparison subjects (.70; Monahan et al., 2006). The YBOCS-SV was sensitive to clinical change and was able to detect improvement during a clinical trial. Thus, this instrument is best used as a severity measure rather than as a screening measure of compulsive buying.

Scid-i impulse control disorders

The impulse control disorders section of the Structured Clinical Interview (SCID; First et al., 2002) includes questions about DSM-IV impulse control disorders not otherwise specified including intermittent explosive disorder, pathological gambling, pyromania, trichotillomania, compulsive buying, and kleptomania. A more recent version that has not been formally field tested yet includes a number of questions for CBD, as well as for proposed impulse control disorders such as impulsive-compulsive nonparaphilic sexual behavior disorder, impulsive-compulsive Internet use disorder, and impulsive-compulsive skin picking disorder.

It is important to note that self-ratings and semistructured interviews should not replace the clinical evaluation. Clinicians ought to inquire in detail about shopping and spending, particularly buying attitudes, the extent of preoccupation with buying and shopping, buying behaviors, urges to buy, feelings and thoughts associated with buying, and interference with social, financial, and occupational functioning. Assessment further should include one of the self-ratings presented above. For example, Faber and O’Guinn’s CBS (Faber & O’Guinn, 1992) is a useful instrument to screen for clinically significant compulsive buying. To measure the severity and interference caused by buying behaviors and cognitions, the YBOCS-SV (Monahan et al., 2006) should be administered; this instrument also allows for the measurement of clinical change within treatment.

Treatment

Pharmacological Treatment

Guidelines for the pharmacological treatment of CBD are lacking, and treatment research on this topic is limited. With regard to the high comorbidity with anxiety and affective disorders, individuals with CBD may benefit from medications that are successful in treating anxiety and depression. In 1991, McElroy and colleagues (McElroy et al., 1991) described the successful treatment of three individuals with CBD and comorbid mood disorder with antidepressants (buproprion, nortriptyline, and fluoxetine). Lejoyeux and colleagues (1995) reported two cases in which treatment of comorbid depression led to improvement of CBD. Until now, the best-studied class of drugs for CBD have been the selective serotonin reuptake inhibitors.

Selective serotonin reuptake inhibitors (ssris)

The results of open-label trials suggested that SSRIs could reduce compulsive buying (Black et al., 1997; Koran et al., 2002; McElroy et al., 1991). For example, Black and colleagues (1997) treated 10 nondepressed subjects with CBD with fluvoxamine in a dose of up to 300 mg daily for 9 weeks. Nine of the 10 patients improved and were less preoccupied with shopping. Koran and colleagues (2002) enrolled 24 subjects with CBD in an open-label citalopram treatment trial. Exclusion criteria were obsessive-compulsive disorder, bipolar disorder, substance abuse/dependence disorders, or psychotic disorders. Seventeen subjects showed a substantial response and significant improvement in compulsive buying behavior. However, small randomized, controlled trials failed to confirm the optimistic results of open-label trials. Table 30.1 summarizes the results of the controlled psychopharmacological trials.

Table 30.1 xxx

(p. 401) Two subsequent double-blind, placebo-controlled studies (Black et al., 2000; Ninan et al., 2000) did not find a significant difference in efficacy between fluvoxamine and placebo. In the study of Black and colleagues (2000), primary outcome measures included the YBOCS-SV, the National Institute of Mental Health Obsessive-Compulsive Scale (NIMHOCS), and three Clinical Global Impression (CGI) ratings. The improvement experienced by fluvoxamine recipients was similar to that of the placebo group, suggesting a high placebo response rate. Likewise, Ninan and colleagues (2000) failed to demonstrate significant differences between fluvoxamine-treated and placebo-treated group using the YBOCS-SV, the Hamilton Rating Scale for Depression (HAM-D), and the Global Assessment of Functioning (GAF) as outcome measures. Investigators in both studies assumed that shopping diaries, reviews of shopping behaviors at study visits, and nonspecific support during these visits may have contributed to the positive response.

Two subsequent open-label trials by Koran and colleagues were followed by a double-blind, placebo-controlled discontinuation phase (Koran et al., 2003, 2007). These studies yielded mixed results. In the first study to test the effectiveness of citalopram (Koran et al., 2003), primary outcome measures were the relapse rate in the double-blind portion of the study and the change in YBOCS-SV from randomization baseline to endpoint. Investigators decided to omit shopping diaries to avoid their potential therapeutic effect. Results of the double-blind phase suggested a true drug effect. Subjects randomized to double-blind citalopram did not report relapses and showed significant lower YBOC-SV scores at endpoint. In the second study, Koran and colleagues (2007) used an identical study design to test escitalopram for CBD. The similar relapse rates in the drug and placebo groups during the double-blind phase contradicted the findings of the previous study conducted with citalopram (Koran et al., 2007).

Overall, it seems likely that the improvement in compulsive buying during open-label SSRI treatment was not a true drug effect. Similar medication and placebo rates suggest that the promising results of open-label medication trials may have largely been a placebo response. However, it cannot be excluded that the medication trials failed to show a drug effect due to the lack of power.

Opiate antagonists

Dopaminergic reward pathways may be involved in CBD, and opioid antagonists appear to reduce buying urges (Bullock & Koran, 2003). There have been several treatment studies involving opiate antagonists for the treatment of other impulse control disorders, particularly pathological gambling (Grant et al., 2006, 2008) and kleptomania (Grant et al., 2009). With regard to CBD, only case reports rather than controlled trials have been published. For example, Kim (1998) described the treatment response to the opiate antagonist naltrexone (100 mg/day) in a female patient with CBD and three other cases. Grant (2003) reported improvement of (p. 402) CBD in three patients treated with naltrexone using higher doses (100–200 mg/day).

In summary, pharmacological studies on compulsive buying are limited by small sample sizes, inadequate numbers of male subjects, and high placebo response rates. Larger controlled pharmacological studies are needed to determine whether or not medication may be effective in the treatment of CBD.

Psychotherapy Treatment

The earliest case reports illustrated psychodynamic considerations in therapeutic interventions for CBD (Krueger, 1988; Lawrence, 1990; Winestine, 1985). Winestine (1985), in his case report, described a woman in her late 30s who sought treatment because of uncontrollable shopping sprees. The psychoanalytical treatment focused on the role of her remembered childhood seduction and demonstrated the interdigitation of childhood abuse with the development of intrapsychic conflicts and adult compulsive buying symptoms. With regard to Krueger (1988), who reported four casuistics, CBD may occur as a reparative effort for a fragmented sense of self and the experience of emptiness. The author recommended as therapeutic interventions emphatic resonance, understanding, and development of a more cohesive sense of self. Lawrence (1990) suggested that castration anxiety could be the main motivation of female compulsive buying.

A letter to the editor by Bernik and colleagues (1996) reported on two women with CBD. Both women suffered from comorbid panic disorder that was successfully treated with clomipramine (150 mg/day), with no effect on compulsive buying. To treat CBD, behavioral therapy was conducted with exposure to external cues and response prevention techniques (i.e., walking around street markets where buying attacks used to occur, touching the objects but not buying anything, first accompanied, then alone). Bernik et al. reported that after 3 to 4 weeks of daily exercises, distress and compulsive buying disappeared.

In recent years, several group cognitive-behavioral therapy (CBT) manuals have been published in a variety of languages (Benson & Gengler, 2004; Damon, 1988; Mitchell, 2010; Müller et al., 2008). Although psychotherapy research on this topic remains limited, CBT has been shown to be helpful in two randomized, controlled studies comparing the efficacy of group CBT to that of a waiting list control (Mitchell et al., 2006; Mueller et al., 2008). Both studies have tested the efficacy of the CBT program described in detail by Mitchell (2010). This group therapy consists of 12 weekly sessions and specifically aims to interrupt and control the compulsive buying habits, to identify and restructure maladaptive thoughts and feelings associated with compulsive buying, and to establish healthy purchasing patterns. Treatment interventions focus on delineating factors that maintain the uncontrolled buying episodes and strategies for controlling shopping and buying. In addition, more general sessions on self-esteem, problem solving, and stress management are included.

Mitchell and colleagues (2006) conducted a pilot trial with female adults with current compulsive buying problems; 28 individuals were assigned to receive active treatment and 11 to the waiting list condition. The findings at the end of treatment showed a substantial reduction in the number of compulsive buying episodes and time spent buying, as well as improved scores on the YBOCS-SV and the CBS in the CBT group. The significant improvement was maintained at 6-month follow-up.

The results of the German replication study (Mueller et al., 2008) supported Mitchell and colleagues’ findings. In the German psychotherapy study, 51 women and 9 men with current CBD were enrolled. Thirty-one participants were subsequently randomly assigned to the CBT group and 29 to the waiting list condition. The analyses of the primary outcome variables on the CBS, the YBOCS-SV, and the German Compulsive Buying Measurement Scale found that CBT, compared with the waiting list condition, resulted in a reduction of compulsive buying behavior. Predictor analysis showed that poorer attendance at the group therapy sessions and higher pretreatment compulsive hoarding traits, as measured with the Saving Inventory-Revised (Frost et al., 2004), were significant predictors of a poor outcome (Mueller et al., 2008).

Although the principal disorder was CBD, in the U.S. as well as in the German study, a broad range of comorbid psychiatric disorders were found. The large number of concurrent Axis I disorders was consistent with previous findings (Black et al., 2000; Mitchell et al., 2002; Ninan et al., 2000; Schlosser et al., 1994). Since the typical treatment-seeking patient with CBD suffers from comorbid psychopathology, the inclusion of patients with concurrent psychopathology increased the external validity of these two psychotherapy studies (Rothwell, 2005). Further treatment research is needed to examine specific psychotherapeutic effects and to develop subtyping strategies to account for individual comorbid psychopathology (e.g. compulsive hoarding).

Table 30.2 xxx

(p. 403) In addition, self-help groups, financial counseling, and couples’ counseling may be helpful to individuals with CBD. Several self-help books for CBD are already available (Arenson, 1991; Benson, 2001, 2008; Catalono & Sonenberg, 1993; Wesson, 1991). In general, it should be noted that there is a need to evaluate the efficacy and effectiveness of bibliotherapy.

Cognitive-Behavioral Psychotherapy Strategies

Since there is evidence that CBT may be effective, the following sections describe the main cognitive-behavioral strategies that are helpful in the treatment of CBD.

Self-monitoring: purchasing records

Self-monitoring is considered essential in precisely describing the frequency of and situational circumstances involved in shopping episodes. Patients should be asked to complete daily purchasing records. The self-observation requires patients’ active cooperation and may represent the first step in changing excessive buying behavior. Purchasing records can help develop a clearer picture of compulsive buying antecedents and consequences and allow the clinician to track progress in terms of severity and frequency of buying/shopping episodes, as well as intensity of urges to buy. Sometimes simply the systematic filling out of purchasing records leads to a reduction of purchasing attacks, at least temporarily. Table 30.2 shows an example of a completed purchasing record.

It is important to note that for individuals with CBD, it can be difficult to differentiate between appropriate (normal) and inappropriate (compulsive/pathological) purchases. Most persons with CBD tend to minimize and justify their impulsive purchases. For example, one patient did not recognize that the monthly purchasing of completely new decorations for her apartment was inappropriate. Another patient justified the purchase of 10 gardening books with overlapping contents as necessary in that she might, in the future, want to begin an education in gardening.

Motivation

Therapeutic progress requires that clients are ready to change. To clarify the motivation to change, individuals with CBD should examine the benefits of normalizing their buying behavior. At the same time, it is important to consider personal resources and weaknesses. The pros and cons of normalizing the buying behavior must be discussed at the beginning of treatment. Often CBD has extremely negative social and financial consequences for the affected persons and their relatives. Treatment-seeking patients with CBD are mostly externally motivated to change (e.g. because of severe conflicts with their spouses and huge debts). Furthermore, (p. 404) compulsive buying can be used as a short-term coping strategy to avoid negative mood states and conflicts. Individuals with CBD should know what to expect to as they modify their buying habits and consider whether they want and are able to invest in this change. According to Miller and Rollnick (2000), the motivation to change can be influenced by the therapist’s behavior (e.g., supportive and empathetic styles of intervention combined with an emphasis on the personal responsibility of the client for change, active listening, and open-ended questions enhancing the patient’s perceived self-efficacy). Table 30.3 summarizes some reasons for and against changing unhealthy buying habits that were expressed by participants in a therapy group.

Functional analyses

Using a model of short-term positive and negative reinforcement, compulsive buying episodes are used to escape from conflicts, to relieve negative mood states, or simply to reduce boredom. Compulsive buying disorder is maintained by its short-term positive consequences, whereas the negative consequences are often not considered. It is important that patients identify specific individualized cues that trigger their buying episodes and the short- and long-term consequences of their problem buying behavior. Patients should be encouraged to recognize their behavioral patterns, thoughts, and feelings associated with compulsive buying.

Stimulus control

Patients can develop specific strategies to deal with environmental buying triggers identified in their functional analysis. Stimulus control strategies are designed to rearrange environmental cues for compulsive buying by encouraging the individual to avoid the buying cue entirely (e.g., discard catalogs/sale advertisements), restrict the stimulus field (e.g., shop only in specific stores), or strengthen cues for desired alternative behavior (e.g., spend more time with friends). It is also important that healthy buying behavior is increased and rewarded during treatment. Furthermore, techniques of internal stimulus control (e.g., internal monologues) are helpful. In addition to the physical avoidance of compulsive buying triggers, the responses to cues can be changed through the delay of response and the implementation of alternative behaviors.

Alternative behaviors

One way to decrease compulsive buying is to develop alternative behaviors in which to engage instead of going shopping. Patients should schedule realistic positive activities to engage in during future high-risk situations identified in their functional analysis (long-term plans) or plan alternative behaviors for moments when they feel shopping urges (short-term plans). It is important to establish an individualized list of alternative behaviors for both types of situations.

Table 30.3 xxx

(p. 405) Cognitive restructuring

Cognitive techniques are described in detail in many textbooks (Beck et al., 1987). Strategies for eliciting and testing dysfunctional thoughts that become associated with shopping and buying are an essential element in the psychotherapeutic treatment of individuals with CBD. Patients are encouraged to become aware of the maladaptive styles of thinking in which they engage that may lead to problematic shopping responses and to further question, test, and modify these thoughts. For example, patients are asked to keep records of dysfunctional thoughts in which they record the emotions and automatic thoughts that occur in buying/shopping situations. Patients are further taught to develop more rational responses to their maladaptive thoughts that trigger compulsive buying episodes and to record them in the appropriate column (see Table 30.4).

Behavioral chains

Most of the time, problem buying behavior consists of a series of components in which each aspect represents a link in a behavioral chain. Figure 30.1 presents an example of such a chain. It is important to obtain a description of the events co-occuring with the onset of the compulsive buying attack. Becoming aware of such events may be difficult. Specifying an initial prompting event and the series of cues, thoughts, and feelings that trigger the problematic buying episode creates an opportunity to break the chain early in the cycle and to avoid compulsive buying behavior.

Exposure

In learning to control urges to buy impulsively, it is important that individuals with CBD learn to expose themselves to high-risk buying situations and to avoid buying in those situations. This is important because they will periodically be in situations where urges and opportunities for compulsive buying arise. Exposure and ritual prevention techniques have been found to be quite effective in the treatment of other disorders and are described in many textbooks (Craske & Barlow, 2008; Foa & Kozak, 1996).

Money management

 Assessment and Treatment of Compulsive Buying

Fig. 30.1 Behavioral chain.

Materialistic values, maladaptive patterns of beliefs about money, and deficits in money management are typical in individuals with CBD (Dittmar, 2005; Rose, 2007; Mueller et al., 2010). Due to the suggested importance of psychological and social factors, as well as consumerism and attitudes toward money, treatment should focus on the improvement of money management as appropriate. Noting that credit card use has a moderating effect on compulsive buying and can provoke excessive spending behavior (Raghubir, 2008; Roberts & Jones, 2001), (p. 406) the closing of credit card accounts may be helpful to limit excessive purchases. Patients with CBD should be encouraged to give up their credit cards and to use cash or debit cards instead. In addition, recommendations for appropriate money management should be discussed, including the operationalization of appropriate consumer habits.

Table 30.4 xxx (p. 410)

Compulsive hoarding

A strong association between compulsive hoarding and compulsive buying has been reported (Frost et al., 2002). The most visible symptom of compulsive hoarding is clutter. People with compulsive hoarding are unable to discard the purchased items. Acquisition has been defined as a pattern of compulsive hoarding including both the acquisition of free items and compulsive buying (Frost et al., 2009). Individuals with CBD often do not use the things they buy, and many of them do not even unwrap the items or remove the tags; instead, they store or hoard them. In a treatment-seeking sample of individuals with compulsive buying, the severity of hoarding symptoms was associated with the severity of compulsive buying (Mueller et al., 2007). Furthermore, a psychotherapy treatment study with patients with CBD has reported that those with hoarding symptoms were significantly less likely to respond to CBT than nonhoarding patients (Mueller et al., 2008). Because hoarding patients with CBD might be embarrassed to admit their hoarding behavior, especially the amount of clutter in their homes, there is a need for screening of compulsive hoarding and specific treatment interventions to reduce hoarding behavior that focus not only on acquisition but also on clutter and difficulty discarding items.

Group versus individual therapy

Based on our clinical experience with patients with CBD, group treatment may be as effective as or more effective than individual therapy. Individuals with compulsive buying are mostly embarrassed about their buying behavior and are used to hiding their spending patterns from friends, family members, and therapists. In the CBD specific group, many of them first have the heart to open up about their (p. 407) excessive shopping and buying, the extent of their preoccupation, and the consequences. Furthermore, many individuals with CBD are prone to rationalize their buying attacks. The understanding and feedback of other people with the same inappropriate behaviors and thoughts stimulate them to overcome this problem. The strict focus on normalization of spending patterns associated with group cohesion and support by other group members may motivate patients to modify their spending habits.

Summary

Compulsive buying disorder is defined as frequent buying of more than can be afforded and frequent buying of items that are not needed. The buying impulses and behaviors cause marked distress, significantly interfere with social or occupational functioning, and result in interpersonal difficulties and financial problems. Compulsive buying disorder is associated with significant psychiatric comorbidity, particularly mood and anxiety disorders, compulsive hoarding, and personality disorders. It is currently conceptualized as an “impulse control disorder not otherwise specified.” Compulsive buying disorder affects a significant percentage of the general population, but it has received much less attention with regard to research and training providers in its assessment and treatment compared to other psychiatric disorders with similar prevalence rates. Formal diagnostic criteria have been put forth, and there are a variety of assessment instruments for evaluating compulsive buying behavior with both questionnaire and interview formats.

Based on the literature to date, it appears that disorder-specific CBT has been most successful in treating CBD. Cognitive-behavioral treatment should include daily purchasing records, functional analysis, stimulus control strategies, increased use of alternative behaviors, identification of behavioral chains, cognitive restructuring, improvement of money management, and exposure practice. Treatment providers should also be aware that mood disorders, anxiety disorders, and compulsive hoarding often accompany CBD and complicate its treatment; these problems should be addressed within the treatment paradigm.

Future Directions

Further research is needed to test the efficacy of other methods of treatment, especially pharmaceutical approaches. With regard to psychotherapeutic treatment, psychiatric comorbidity should be taken into account in tailoring treatment strategies. A subtyping approach might be useful in determining treatment needs.

Further research should also focus on barriers to motivation for change and treatment compliance among individuals with compulsive buying, as well as factors associated with both positive and negative treatment outcomes.

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