Some Psychiatrists See 'Shopaholic' As a Diagnosis

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."