Compulsive buying behaviour in the United States

Monday 20 August 2007 8:31AM (view full episode)

A study in the U.S. has investigated the frequency of a condition called compulsive buying behaviour.


Norman Swan: Welcome to the program. This morning on the Health Report exercise guidelines toughen up, you can't count getting up off the settee to change the channel on the telly as part of your quota anymore or putting out the rubbish for the bin men, and your GP's off the hook as well.

Plus retail therapy. A study in the United States, the epicentre of excess consumption, has tried to discover the frequency of a condition called Compulsive Buying Disorder which probably needs no description because it's probably already infected someone you know.

Lorrin Koran is Professor of Psychiatry at Stanford University School of Medicine in California and Director of their Obsessive Compulsive Disorder Clinic.

Lorrin Koran: The compulsive buyer would be someone who's preoccupied with shopping or buying at times they don't want to be, can't get the thought out of their minds and then goes out shopping and buys things that they don't use, they don't need and frequently they can't afford and gets into trouble, either financially or family conflict, or job conflict because they are off in the shopping mall when they should be at work. And of course they usually feel guilty or regretful afterwards so it's causing dysfunction and it's causing distress and that's what makes it a disorder.

Norman Swan: And you did a study to find out how common it is?

Lorrin Koran: We recently did a study, a random sample study of 2500 people in the United States representative of the US by geography and more or less representative by age and ethnicity and we found surprisingly that men were about as likely to be compulsive buyers as women. And this was surprising because in treatment studies, or descriptive studies women come forward and volunteer and men don't. So everybody thought this was a problem of women and what we found was it was about 6% of women and about five and a half percent of men.

Norman Swan: So effectively the same percentage?

Lorrin Koran: Effectively the same percentage.

Norman Swan: So what are the men going out and buying - brake linings and carburettors and things like that?

Lorrin Koran: Well in fact you're right. Men and women buy different things, women buy clothes, jewellery, items for the home decoration, craft items, makeup, shoes, purses and men buy tech items, or books, or CDs, for example one fellow had 50 cameras, didn't take pictures. Another fellow had to buy every wrench on the market, he had 2000 wrenches and another fellow had thousands of books that he didn't read. So men buy different items than women but they're both having this problem of buying things they don't use, need or can't afford.

Norman Swan: And what sort of people are they in terms of where they sit on the income scale, education scale, that sort of thing?

Lorrin Koran: They span the entire income scale although in our study the rate of compulsive buying was somewhat higher in people who had incomes of $50,000 or less as compared to people who had incomes of more than $50,000.

Norman Swan: So those who could least afford it were buying most?

Lorrin Koran: Those who could least afford it and in every income group the people who were doing this have higher credit card debt than the people who are not doing this at the end of the month. And they are much less likely to be paying off their credit cards and so this is a real financial problem for them.

Norman Swan: And does the scale of buying go up according to their affordability so they are buying you know three Mercedes when you can afford to buy them rather than everything in the op shop?

Lorrin Koran: I couldn't say that because we didn't ask people what they're buying in this particular study.

Norman Swan: What questions did you ask them to elicit this response?

Lorrin Koran: We used something called the compulsive buying scale, a seven item scale that's been validated by asking these same questions to people who are clinically identified as compulsive buyers and they are questions like if I have any money left at the end of the pay period, I just have to spend it. Or, I bought things even though I couldn't afford them. Or, I wrote a cheque when I knew I didn't have enough money in the bank to cover it. Or, I bought myself something in order to make myself feel better. So there's a series of questions that are scored.

Norman Swan: And you're graded according to whether you never do that, rarely do it, or often do it?

Lorrin Koran: Exactly.

Norman Swan: Now is this an all or nothing phenomenon because we all know somebody who just can't help shopping?

Lorrin Koran: No it's not all or nothing and to some degree the place where you draw the line is arbitrary just like it's arbitrary where we draw the line to call people diabetic or hypertensive. But clinically the line that we drew has been found to match people who are suffering and having dysfunction as a result of this behaviour.

Norman Swan: And is it brought on by living near to malls and so on, in other words are people who live in the countryside, rural Montana, less likely to have that because they are just not exposed to the shops?

Lorrin Koran: Probably, although no one -

Norman Swan: Might migrate to the shops.

Lorrin Koran: Probably, however this is thought by some to be related not only to characteristics of the individual like are you depressed, or anxious, or doing this to relieve a mood disorder, or are you impulsive but to social characteristics like easy availability of credit, shopping malls, advertising telling you that you are what you own rather than you are what you act. So there may be social factors as well as individual but no one could say for sure.

Norman Swan: Is this an obsessive compulsive disorder, in other words like washing the hands obsessively and so on and so forth?

Lorrin Koran: No, compulsive buying is not the same or even probably related to obsessive compulsive disorder and the big difference is in compulsive buying just as in gambling, or kleptomania, or even skin picking it's pleasurable in the moment, even though you regret it afterwards. Whereas in obsessive compulsive disorder if you're washing your hands or checking the stove knobs to make sure they're off.

Norman Swan: There's no reward.

Lorrin Koran: There's no reward, it just makes you feel less anxious.

Norman Swan: So what's going on when you've treated people like this, what do they tell you is going on in their heads at that time? Because the classic situation where people over-buy is manic depression, what's called bipolar disorder where people just go out on a spree and it's part of their high.

Lorrin Koran: People have different explanations for what they're experiencing at the time. Some people say well I do it in order to get away from depressed feelings, or angry feelings, or bored feelings. Other people say I do it because when I'm doing it I feel good, I really am enjoying myself even though I know I shouldn't be doing this and I know I'm going to feel guilty afterwards.

Norman Swan: Which could explain the low income phenomenon.

Lorrin Koran: Indeed.

Norman Swan: So given that this doesn't fit into a neat biological or psychiatric category in a sense, is it just talking therapies that get people out of it?

Lorrin Koran: Well so far there's no well-proven treatment for this behaviour but there's some evidence from small studies that something called cognitive behavioural therapy may be helpful for some individuals.

Norman Swan: This is where you try to reframe people's thinking?

Lorrin Koran: Exactly. Even something so simple as asking them to keep a list of everything they buy and how they felt before, during and after they bought it and bring that list to you for review can help people get control of their behaviour. And there are also small studies that suggest that for some people anti-depressant medications called Serotonin Re-uptake Inhibitors may be helpful even if they're not depressed.

Norman Swan: Given that it represents a fair percentage of the population, it's unknown what it might be in Australia, this is a reasonable social issue.

Lorrin Koran: I think it's an issue that should be paid more attention. It tends to be trivialised because people think about retail therapy as a way of making yourself feel good and don't pay attention to the fact that this may have very serious consequences. Some of the people in our studies have been divorced because they couldn't stop, others had had to declare bankruptcy, many were actually quite miserable because they were not able to meet ordinary expenses. One woman was within weeks of losing her house.

Norman Swan: It's quite common when people have mental health problems for things to go together. It's quite unusual for somebody to have depression to only have depression, they're smoking, they may be drinking too much, they might have other things going on. What other things go along with compulsive buying disorder?

Lorrin Koran: Well it's interesting, in the studies that have been done in the treatment studies anywhere from a third to two thirds of the people who come into those studies have either depression, an anxiety disorder such as generalised anxiety or social anxiety, or another impulse control disorder including drinking, or hair pulling, or skin picking.

Norman Swan: Or ADHD?

Lorrin Koran: ADHD is not that common but it's also interesting that a third to a half of the people don't have any other disorder so this behaviour may be its own disorder in a least some fraction of the people who come in for treatment.

Norman Swan: Lorrin Koran is Professor of Psychiatry at Stanford University School of Medicine in California and Director of their Obsessive Compulsive Disorder Clinic. And you're listening to the Health Report here on ABC Radio National.


Koran LM et al. Estimated Prevalence of Compulsive Buying Behavior in the United States. Am J Psychiatry, 10 October, 2006;163:1806-1812

Koran LM et al. Citalopram for Compulsive Shopping Disorder: An Open-Label Study Followed by Double-Blind Discontinuation. J Clin Psychiatry, 7 July, 2003;64:793-798

Aboujaoude E et al. A 1-Year Naturalistic Follow-Up of Patients With Compulsive Shopping Disorder. J Clin Psychiatry, 8 August, 2003;64:946-950


Dr Lorrin Koran
Professor of Psychiatry
Stanford University School of Medicine
and Director of their Obsessive Compulsive Disorder Clinic


Dr Norman Swan
Brigitte Seega