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Publication type: news

Vedantam S.
Some Psychiatrists See 'Shopaholic' As a Diagnosis
The Washington Post 2006 Oct 13
http://www.washingtonpost.com/wp-dyn/content/article/2006/10/12/AR2006101201812_pf.html

Full text:

Some Psychiatrists See ‘Shopaholic’ As a Diagnosis

By Shankar Vedantam
Washington Post Staff Writer
Friday, October 13, 2006; A01

Lucille Schenk bought $20,000 worth of jewelry a year ago, plunging herself into debt and despair. She knew something was wrong but couldn’t help herself: For hours each day, she watched a jewelry channel and the Home Shopping Network, until the salespeople felt like family.

She did most of her binge buying late at night. Often, after her purchases arrived, she returned them, knowing she could not afford them. Then she would see the same items on TV and buy them again.

When Schenk finally sought help, New York psychologist April Lane Benson advised her to have a “conversation” with the jewelry before she made her next purchase, as a way to put some distance between herself and her compulsion.

“I would say, ‘You are so beautiful, I can’t live without you; I love the way you sparkle,’ “ recalled Schenk, 62, in an interview. “The jewelry would say back, ‘You need me. You look pretty when you wear me.’ I would say, ‘I do need you. I can’t possibly think of being without you. But something has to change. I need to stop this. I can’t afford a penny more.’ “

There may be more than 10 million people like Schenk in the United States, according to a study published this month in the American Journal of Psychiatry. They shop compulsively, buy things they do not need and often cannot afford, and place their work, their families and their mental health in jeopardy.

The problem is widespread and serious enough that the American Psychiatric Association, which is updating its influential “bible” of mental disorders, is weighing whether to list compulsive buying as a disorder.

That proposal is sure to stir a long-running debate about whether psychiatry is turning every troubling aspect of human behavior into a disease. Some researchers argue that categorizing binge buying as a medical problem takes the focus away from social factors such as the impact of advertising, easy credit and commercialization.

Avis Mysyk, an anthropologist at Cape Breton University in Nova Scotia, said therapists should not be advised to “throw the person out of your office” but added: “One thing with the holistic perspective is we don’t isolate the individual from the wider context, or just look at the wider context to the exclusion of the individual.”

There are no historical data to show whether the number of people affected is growing, but experts agree that the easy access to shopping provided by the Internet, 24-hour cable networks and malls has probably had an impact.

Most people can use shopping networks and credit cards without losing control, experts note. But for people who cannot control themselves, as with addictions to alcohol or gambling, easy availability of the thing they crave aggravates the problem. Like other addicts, binge buyers usually want to stop but find they cannot.

The new study in the American Journal of Psychiatry was conducted by a team led by Lorrin M. Koran, a psychiatrist at Stanford University.

Besides the sheer number of people, Koran said what surprised him was that men were just as likely as women to be binge buyers. The study also found that compulsive buyers were likely to earn less than $50,000.

Classifying compulsive buying as a disorder could have legal implications. Koran and other psychiatrists believe that at least some people who end up in bankruptcy are binge buyers, suffering from a disease similar to alcoholism, and that this should mitigate their personal responsibility for their debts.

Koran said it is a mistake to think that compulsive buyers are the same as people who occasionally overextend themselves financially, or to suggest that anyone who runs up debt is afflicted.

“This is persistent, compulsive behavior that gets them into trouble financially, at work, with their families or their friends,” he said. “They buy things they can’t afford. At work, they will be shopping on the Internet instead of doing work, or take a three-hour lunch break because they get lost at the mall.”

Instead of getting home in time to make dinner for their children, Koran said, binge buyers may stay at malls until closing, disrupting their family life. And binge buyers almost always shop alone. Unlike people who often shop with friends because it is enjoyable, compulsive shoppers usually say they are ashamed to tell other people about their behavior, much like people with other addictions, Koran said.

“It doesn’t become a disorder until it becomes very time-consuming, causes substantial strains on a marriage, interferes with job-related activities,” said Eric Hollander, a psychiatrist at the Mount Sinai School of Medicine who wrote a commentary on Koran’s study. “You have to realize at that point there are substantial consequences.”

Compared with the general population, the study found, binge buyers were far more likely to report that buying things made them happy and that they buy things simply because they are on sale.

Both Hollander and Koran said binge buyers who seek help report being aided by a variety of treatments; both physicians have treated the problem.

Hollander said those who shop because they are suffering from anxiety problems can be helped by antidepressants such as Prozac or Paxil. If the problem is caused by mood imbalances, mood stabilizers such as lithium can help, he said.

Binge buyers who also have other addictions, such as alcoholism, may be helped by opioid antagonists, drugs that block receptors that channel pleasure messages in the brain, Hollander said. And people who shop because they are restless or hyperactive can be helped by stimulant medications used to treat attention-deficit disorder.

For the study, Koran administered a questionnaire to 2,513 adults. Koran and Hollander said the questionnaire, known as the Compulsive Buying Scale, was developed several years ago and has been shown to be 90 percent accurate in identifying people with the problem and in determining when they are cured.

Benson, the New York psychologist, said she empathizes with binge buyers because she went through a similar “compulsive buy-return cycle.”

She believes that making compulsive shopping an official psychiatric disorder would draw attention to it, but she agrees with Mysyk that there are many societal aspects to the problem. She cited credit card marketing that encourages people to stay in debt, and said there ought to be regulations against it.

Schenk, who lives in Sandusky, Ohio, said she came to realize in therapy that her compulsions were related to her relationship with her mother — a Freudian insight that helped her. With Schenk and other patients, Benson said, she has successfully used cognitive behavioral therapy, which encourages people to systematically question their false beliefs.

Another patient Benson treated was a businesswoman in New York who believed that unless she bought a certain attaché case, she would be looked down on at work. Benson said that after treatment, the woman was able to go to a store, see the case and, when the impulse to buy swept over her, make a calculated decision.

“What predisposes someone to being a compulsive buyer is a materialistic value orientation and low self-esteem,” Benson concluded. “The materialistic orientation is very much cultural. This disorder exists along a continuum — there are excessive shoppers and there are compulsive shoppers.”

© 2006 The Washington Post Company