Hristina K. Koleva, M.D. and Jess G. Fiedorowicz, M.D., M.S.

Over the last decade, online shopping has rapidly grown in popularity and continues to grow with the global base of online shoppers increasing 40% over a recent two year period (1). Convenience, selection, and ease of use may facilitate further growth. However, the availability and ease of online shopping may pose a liability for some vulnerable individuals.

Herein, we report three cases of excessive online spending in individuals with bipolar disorder. Spending sprees commonly occur in mania and hypomania and “unrestrained buying sprees” are even noted in the DSM-IV criteria for mania. Curiously, some reports have also associated uncontrolled buying with depression and antidepressant use (2,3). Compulsive buying in depression has previously been described as “compensatory buying” to alleviate depressive symptoms, often involving gifts to self or others (4). The Internet, with its availability and ease of use, can easily facilitate excessive buying. Market research suggests online shopping is perceived as riskier than conventional shopping (5). Mood states in bipolar disorder may impair assessment of the financial risks for online purchases.

In our clinical practice, several patients with bipolar disorder have engaged in unreasonable online spending with detrimental financial consequences. Commonly, the behavior occurs during a manic or hypomanic episode. One case involved a middle-aged male admitted for acute mania with psychosis, who spent online about $5,000 on car equipment within a day. His computer use on the ward subsequently had to be restricted. A young adult female admitted with mania also used a computer on the ward to shop for a new home, even making arrangements for several showings and contacting her bank. Despite inadequate finances as a self-indentified stressor, the patient lacked the insight to recognize the risk associated with such purchase. Another case involved a young woman with bipolar disorder and borderline personality disorder. Interestingly, her online shopping sprees, which mainly involved purchasing clothing for her children, tended to occur immediately upon recovery from a depressive episode without necessarily cycling into mania. As observed by other authors, this patient attributed the motivation for her behavior to the transient experience of happiness and a “rush” while buying (2).

Excessive online shopping in mood disorders should be differentiated from compulsive buying conceptualized as an impulse control disorder, reckless behavior associated with personality disorders, or the disinhibited behaviors that may present in neurodegenerative conditions. The presence of mood symptoms and the confinement of the behavior to within specific mood episodes suggest a contributing role for the mood disorder. Assertive management of mood episodes and monitoring for excessive spending are strongly recommended. Further, with many inpatient settings providing Internet access, close monitoring of use may be required for at risk patients, with restriction of access if indicated to prevent untoward consequences.

References:

1. Company TN. Trends in online shopping: a global Nielsen consumer report. 2008; http://th.nielsen.com/site/documents/GlobalOnlineShoppingReportFeb08.pdf. Accessed September 30, 2009.
2. Lejoyeux M, Ades J, Tassain V, Solomon J. Phenomenology and psychopathology of uncontrolled buying. Am J Psychiatry. Dec 1996;153(12):1524-1529.
3. McElroy SL, Keck PE, Jr., Pope HG, Jr., Smith JM, Strakowski SM. Compulsive buying: a report of 20 cases. J Clin Psychiatry. Jun 1994;55(6):242-248.
4. Lejoyeux M, Haberman N, Solomon J, Ades J. Comparison of buying behavior in depressed patients presenting with or without compulsive buying. Compr Psychiatry. Jan-Feb 1999;40(1):51-56.
5. Cho CH, Kang J, Cheon HJ. Online shopping hesitation. Cyberpsychol Behav. Jun 2006;9(3):261-274.