Tejaswini Doifode, M.D., Raja Mogallapu, M.D., Steven Lippmann, M.D.

Introduction

Do you have patients addicted to shopping?  Is it an addiction? Compulsive buying exists in nearly 6% of our population, predominantly among women (~80%) (1). Oniomania is the term that clinically describes compulsive shopping; it originates from Greek and comes from ṓnios- for “sale”, and mania- for “insanity”.

Oniomania refers to obsessive-compulsive behaviors preoccupied with buying or intrusive, irresistible impulses to shop, and includes prolonged purchasing of unneeded items. These cause distress, dysfunction, and maybe financial or social problems. There are many similar other compulsive behaviors, like gambling addiction, gaming addiction, etc.

The term “addiction” controversially may apply better to physiological dependence on a drug, rather than to a human behavior; yet, some experts report that this psychopathology is more of a dependency disorder (2). Diagnostic coding, at ICD-10 (F63.8), is “impulse control disorder, not otherwise classified”. Compulsive buyers and their families often evidence co-morbid depression, anxiety, substance abuse, eating disorders, and/or other obsessive-compulsive behaviors.

Vignette

A middle-aged, employed married woman complained about compulsive shopping for many years.  She obsessively spent her income to the distress of family and accumulated unneeded materials. When unable to shop, she experienced anxiety; she also endorsed depression and guilt with obsessive-compulsive traits.

Treatment began by excluding credit cards, shopping only when accompanied by family, and eliminating hoarded possessions. After psychotherapy and antidepressant pharmacotherapy, she experienced improvement in a few months.

Clinical

Chronic buying disorder usually begins in adolescence to early adulthood, corresponding often to emancipation from home and/or upon credit card access. Some people shop alone or with friends sharing this interest. They describe urges that can only diminish once a purchase is completed.

The compulsion includes anticipation, preparation, shopping, and spending. During anticipation, they experience urges to shop. That is followed by the actions necessary. Plans might include research about items, fashions, or stores. The actual shopping experience may be exhilarating.

After the purchase, the person feels less anxious, but often experiences personal disappointment. A complete evaluation is expected before making a diagnosis and treatment plan. The shopping version of the Yale-Brown Obsessive-Compulsive Scale is available to aid at confirming the diagnosis (3).

Treatment

Psychopharmacologic treatment studies evidence mixed results.  Selective serotonin reuptake inhibitor pharmaceuticals might have efficacy similar to that induced in patients with other obsessive-compulsive disorders. An open-label trial prescribing fluvoxamine was effective (4), but two controlled investigations reported no improvement (5,6). Open-label citalopram research documented improvement (7). An interventional consensus is not evident; yet, antidepressant medications are frequently prescribed.

Psychotherapy including behavioral methods and/or cognitive strategies are the initially recommended treatments (8,9). A combination of psychotherapy, pharmacotherapy, and peer support have the highest efficacy, while also addressing any co-morbid conditions.

Support groups such as Debtors Anonymous can be effective; peer counseling is often helpful (10). Patient intervention focuses on recognizing the problem behavior, removing financial access, shopping only with supervision, and finding alternative ways to enjoy life.

References

1. Black DW. A review of compulsive buying disorder. World Psychiatry. 2007;6(1):14-18
2. Croissant B, Croissant D. Shopping addiction – Current considerations on classification and therapy. 2007;78(5):575-579
3. Faber RJ, O’Guinn TC. A clinical screener for compulsive buying. J Consumer Res. 1992; 19:459-469
4. Black DW, Monahan P, Gabel J. Fluvoxamine in the treatment of compulsive buying. J Clin Psych. 1997;58:159-163
5. 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 Psych. 2000;12: 205-211
6. 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
7. Aboujaoude E, Gamel N, Koran LM. A 1-year naturalistic following of patients with compulsive shopping disorder. J Clin Psych. 2003;64:946-950
8. Lejoyeux M, Weinstein A. Compulsive Buying. Am J Drug and Alc Abuse. 2010;36(5): 248-253
9. Wood H. In the News: Retail therapy. Nature Reviews Neuroscience. 2003;4(9):700
10. Hartston HJ, Koran LM. Impulsive behavior in a consumer culture. Internat J Psych Clin Pract. 2002;6(2):65-68