The American Journal of Drug and Alcohol Abuse, 36:248–253, 2010

Copyright © Informa Healthcare USA, Inc.

ISSN: 0095-2990 print / 1097-9891 online
DOI: 10.3109/00952990.2010.493590

Compulsive Buying

Michel Lejoyeux, Ph.D.

Paris 7 University, Department of Psychiatry, Paris, France, and Hospital Bichat Claude Bernard,
AP-HP and Maison Blanche Hospital, Paris, France

Aviv Weinstein, Ph.D.

Hadassah Medical Organization, Jerusalem, Israel

with a strong urge and feeling of pleasure and excitement. When

Background: Compulsive buying is a chronic, repetitive pur- it is repetitive and associated with adverse consequences (usu-
chasing that becomes a primary response to negative events and ally psychological and financial), this kind of buying is known as
feelings, and may include symptoms equivalent to craving and compulsive buying (1). Compulsive buying was first described
withdrawal. Objectives: This article describes the addictive char-
in the early 20th century by Emil Kraepplin (2) and Eugen
acteristics of compulsive buying, the psychiatric comorbidity, and
the possibilities of treatment. Methods: Using PubMed and Med- Bleuler (3). Diagnostic criteria for compulsive or addictive buy-
Line search engines, we performed a review of published litera- ing were first proposed in 1994 (4) and later refined (5). These
ture over the period 1990–2010 using the keyword “compulsive criteria describe symptoms equivalent of craving and withdrawal
buying”. Results: A key feature distinguishing compulsive buyers applied to buying behavior (6). However, compulsive buying is
from normal consumers, collectors, and hoarders is that the for-
not yet represented in the Diagnostic and Statistical Manual
mer focuses on the buying process itself, rather than the items
bought. In this instance, the purchased items are usually never (DSM) or International Classification of Diseases (ICD) clas-
used, but tend to be hidden or thrown away. A recent screening sifications. The Diagnostic and Statistical Manual Fifth Edi-
study found that up to 5% of adult Americans appear to be af- tion (DSM-V) task force proposed two important changes re-
flicted with this compulsion. Compulsive buying results in adverse lated to compulsive buying: separating obsessive-compulsive
consequences, including financial and legal problems, psychologi-
cal distress (depression, guilt), and interpersonal conflict. The most
disorder from the anxiety disorders and placing it in a separate
commonly associated comorbidities are depression and eating dis- category—the obsessive-compulsive disorder spectrum disor-
orders. Nothing is known about the neurobiology and genetics of ders; and creating several new autonomous disorders from those
compulsive buying and relatively little about its treatment. Cogni- currently described as impulse control disorders not otherwise
tive behavioral therapy has some efficacy, but no medication has specified. The task force suggested including in this group of
been effective in controlled trials. Conclusions: Compulsive buying
can be described as a behavioral dependence. A great deal of future
disorders compulsive-impulsive (C-I) shopping, C-I internet use
research is needed to improve our understanding of compulsive disorder, C-I sexual behavior, and C-I skin-picking. Compulsive
buying. buying (C-I shopping) has much in common with the other dis-
orders in the proposed DSM-V C-I disorder category, and little
Keywords behavioral addiction, compulsive buying, compulsive in common with the anxiety disorders in that proposed DSM-V
shopping grouping.

INTRODUCTION EPIDEMIOLOGY
The purpose of this article is to perform a review of recent
works on compulsive buying and to evaluate whether compul- Prevalence
sive buying should be regarded as an impulsive-compulsive dis- Population-based surveys in the United States suggest that
order or also as behavioral addiction. Buying is a routine part up to 5% of adults may have compulsive buying (7–9). The vast
of everyday life. However, in specific situations, buying may majority (up to 92%) of compulsive buyers are women (10) in
be unplanned and sudden, initiated on the spot, and associated clinical samples. Koran et al. (9), however, did not find a signif-
icant gender effect in their study which included 2,513 adults
Address correspondence to Professor Michel Lejoyeux, M.D., from the general population. The mean age of onset is 30 years
Ph.D., Bichat Hospital AP HP, Psychiatry, Rue Henri Huchard, Paris, (8). A study of 200 women who shopped at a renowned Parisian
75018, France. E-mail: [email protected] department store found that 32.5% met McElroy’s diagnostic

248
 COMPULSIVE BUYING 249

criteria for compulsive buying (11). There was no difference Differential Diagnosis
from a control group in age, education level, or professional Collectors
status. Among 1,490 customers of an Internet women’s clothing Both collectors and compulsive buyers spend time, money,
retailer, 17.7% were compulsive buyers (12). and energy in the hunt for “precious” goods, but the attitude
towards and fate of the purchases are different. For collectors,
the focus is the item acquired, so they keep their purchases and
CLINICAL CHARACTERISTICS often display them with pride. For compulsive buyers, the focus
is the buying process, not the item, so they usually lose interest
Phenomenology of Compulsive Buying in their purchase and keep it hidden (e.g., in a closet) or give it
According to our clinical experience as a psychiatrist and or throw it away.
psychologist specializing in the treatment of substance and be-
havioral addictions, compulsive buyers experience repetitive, Compulsive Hoarding
irresistible, and overpowering urges to purchase goods, per- Compulsive hoarding has been defined as the acquisition of,
haps similar to the attitude of substance addicts towards their and failure to discard, possessions which appear to be useless
substance of choice. These goods are frequently useless and/or or of limited value (16). Hoarding involves not only buying,
unused items (6). Availability of the Internet retail environment but also acquiring “free things,” “freebies,” and things other
may promote compulsive buying because it permits avoidance people have discarded. Compulsive buying may be associated
of direct, face-to-face social contact, allows the transactions to with compulsive hoarding. Compulsive buying is more frequent
be kept private (e.g., hidden from family), and provides con- among people who hoard than among controls (17). Among
tinuous electronic feedback about product offerings and prices. patients (18) who met criteria for clinically significant hoard-
Compulsive buyers strongly focus on the buying process itself, ing, 61% presented compulsive buying and 85% reported ex-
i.e., are more interested in the acquisition than in possession or cessive acquisition. Those who acquired excessively had more
use of the item purchased (6). All these clinical characteristics severe hoarding; their hoarding had an earlier onset and re-
may suggest similarities between compulsive buying and addic- sulted in more psychiatric work impairment days, and they ex-
tion. Research on addiction could help to identify compulsive perienced more symptoms of obsessive compulsive disorder,
buying as behavioral addiction. depression, and anxiety. Two forms of excessive acquisition
(buying and accumulation of free things) each contributed in-
dependent variance in the prediction of hoarding severity and
Intoxication related symptoms.
Mc Elroy et al. (4) noted that 70% of patients presenting with
compulsive buying described buying as “a high,” “a buzz,” “a Buying during Manic Episodes
rush,” the positive feeling (e.g., pleasure, excitement) experi-
Excessive or inappropriate buying is a common symptom
enced while buying.
of manic episodes. This behavior, which disappears during eu-
thymic periods, is driven by grandiosity and loss of impulse
control, rather than any focus on the buying process itself (6,
Equivalent of Withdrawal
14). All diagnostic criteria for compulsive buying (15, 5) ex-
Compulsive buyers consider that they miss important occa- clude buying sprees related to mania.
sions to buy items that will not be again available (13).
Buying Related to Psychosis
Patients with schizophrenia may engage in excessive buying.
Adverse Consequences
Such buying is often discordant or bizarre and may reflect delu-
Compulsive buying regularly results in adverse conse-
sions or other thought disorder, e.g., buying high-tech electron-
quences, including substantial financial debts (14), legal prob-
ics goods to contact aliens from another planet. In most cases,
lems, psychological distress (e.g., depression, feelings of guilt),
compulsive buyers do not suffer from psychotic symptoms, and
interpersonal conflict, and marital conflict (15). For compulsive
their buying is not the result of a delusion (14).
buyers, money and possibility to buy could be considered as an
equivalent of a drug.
Compulsive buyers, according to a study conducted in de- Psychiatric Comorbidity
pressed patients, are no more sensitive than others to advertis- Mood Disorders
ing and marketing (13). They do not seek sales, use loans, or Depression and bipolar disorder are present among compul-
change their purchase choices significantly more than others. sive buyers (4, 7, 14). Furthermore, some patients report that
These observations have not been replicated in non-depressed buying increases during depressive episodes and that shopping
compulsive buyers. made them feel good.
250 M. LEJOYEUX AND A. WEINSTEIN

Among 119 inpatients with a major depressive episode Di- Assessment of Compulsive Buying
agnostic and Statistical Manual Third Edition Revised (DSM- The Compulsive Buying Scale (28) is a validated 7-item
III-R criteria), 31.9% were compulsive buyers (19). This group screening instrument developed to measure compulsive buy-
was younger and more likely female and single than the pa- ing behavior. Lower scores on this scale indicate greater level of
tients without compulsive buying. They were also more likely compulsive buying. A score less than or equal to −1.34 classifies
to have recurrent depression (relative risk [RR] = 1.4), im- a compulsive buyer. The Yale–Brown Obsessive Compulsive
pulse control disorders such as kleptomania (RR = 8.5) or Scale-Shopping Version (Y-BOCS-SV) (29) was modelled on
bulimia (RR = 2.8), or benzodiazepine abuse or dependence the Y-BOCS (30) and assesses severity and interference caused
(RR = 4.68). by buying thoughts and behavior, rather than assessing obses-
sions and compulsions. The instrument is reliable and valid
Obsessive-Compulsive Disorder (OCD) in measuring severity and change in persons with compulsive
Compulsive buying has been considered part of the OCD buying.
spectrum (15), but most OCD patients spend less money than The Questionnaire about Buying Behavior (QABB) (19)
compulsive buyers and are less impulsive in their buying be- consists of 19 yes–no items representing major basic features
havior (20). Assessment of 1,500 consecutive general medical of compulsive buying (e.g., urges to shop and buy, negative
outpatients in Paris identified 60 patients with OCD, of whom feedback from family and friends, post-purchase guilt) based
14 (23%) also had compulsive buying (21). The prevalence of on the McElroy et al. (4) criteria. The QABB is usually self-
compulsive buying among patients without OCD was 0.3%. Pa- administered.
tients with OCD + compulsive buying met a higher number Other clinical instruments are the Canadian Compulsive Buy-
of Diagnostic and Statistical Manual Fourth Edition Revised ing Measurement Scale (31), the Edwards Compulsive Buying
(DSM-IV-R) criteria for OCD than patients with OCD only, Scale (32), the Minnesota Impulsive Disorder Interview (14),
were more likely depressed and had higher scores on the CAGE and the Ridgway’s Compulsive Buying Scale (33).
questionnaire (assessing alcoholism). The Canadian Compulsive Buying Measurement Scale (31)
is a 13-item-scale exploring three basic dimensions: the ten-
dency to spend, a reactive aspect to triggers which may lead to
Eating Disorders
shopping, and post-purchase guilt. Valence et al. (31) found a
Compulsive buying and eating disorders frequently co-occur.
statistically significant difference between the addictive buying
One study found that 20% of compulsive buyers also had an eat-
averages of a general pool of consumers and a second pool of
ing disorder; conversely, 17.6% of binge eaters had compulsive
compulsive consumers. Edwards (32) has developed a 13-item
buying (22). Among a group of 373 patients with a variety of eat-
scale that assesses experiences and feelings about shopping and
ing disorders, the lifetime prevalence of compulsive buying was
spending. Ridgway’scale (33) consists of nine questions identi-
11.8% (23). Compulsive buyers were three times more likely to
fying consumers who have a strong urge to buy, regularly spend
have comorbid borderline personality disorder. Another study
a lot of money, and have difficulty resisting the impulse to buy.
found that compulsive buying commonly appeared prior to the
These self-reported ratings and semistructured interviews
onset of eating disorder (24).
cannot replace clinical evaluation. Clinicians must inquire in
detail about buying attitudes, the extent of preoccupation with
Substance Use Disorders and Impulse Control Disorders buying and shopping, urges to buy, feeling and thoughts asso-
Little is known about the comorbidity of compulsive buying ciated with buying, and the interference with social, financial,
and substance use disorders. Lejoyeux et al. (25) noted that and occupational functioning.
45.6% of women with nicotine dependence have compulsive
buying. Compulsive buying is significantly more frequent in
smokers than in non-smokers (25). Impulse control disorders
are also relatively common in patients with compulsive buying PSYCHOLOGICAL FACTORS
(21–40%) (4, 14). Compulsive Buying as a Way to Escape Negative Emotions
Although factors promoting positive mood state (e.g., nice
Personality Disorders scents, pretty colors, or pleasant music) may elicit an impulse
Schlosser et al. [26] found that nearly 60% of subjects with purchase, compulsive buying more frequently occurs in the con-
compulsive buying met criteria for at least one Axis II disorder. text of negative affects (1). Compulsive buying occurs in re-
While there was no special “shopping” personality, the most sponse to negative emotions and results in a decrease in the
frequently identified personality disorders were the obsessive- intensity of negative emotions. Euphoria or relief from nega-
compulsive (22%), avoidant (15%), and borderline (15%) types. tive emotions is the most common psychological consequence
Krueger (27), a psychoanalyst, described four patients who he of compulsive buying (34–36). This relief is transient and fol-
observed to have aspects of narcissistic character pathology. lowed by an increase in anxiety.
 COMPULSIVE BUYING 251

Sad mood, Thought: "I am Buying

feeling less sad when I something Craving
blue have bought will make me
something happy
pleasant"

Money hunting, Thoughts:

Purchase action of going into a "I’m entitled to a
shop little treat."
"I am full of
desires."
"I am worth it."

Psychological factors of compulsive buying

Impulsivity garded as such. In our view, compulsive buying, similar to other

Impulsivity (i.e., a predisposition toward rapid, unplanned behavioral addictions, may be maintained by the brain’s reward
reactions to internal or external stimuli with diminished regard to system which can be predictive of purchasing behaviors, but
the negative consequences) contributes to uncontrolled buying. once negatively reinforced it may result in the return of negative
Compulsive buyers are significantly more impulsive than others affective states. This point, however, has not been confirmed by
(37, 38) and have higher subscores for experience seeking on specific experiments on neurocircuitry.
the Zuckerman Sensation-Seeking Scale (38). Devor et al. (41) raised the hypothesis that serotonergic dys-
Billieux et al. (1) found a significant correlation between function may be associated with compulsive buying. They con-
compulsive buying and three components of impulsivity as con- sidered that deficits in impulse control and reward-mediated
ceptualized by Whiteside and Lynam (39): urgency, lack of learning are mediated by serotonin. They examined 21 patients
premeditation, and lack of perseverance. They concluded that a diagnosed with compulsive buying for two DNA sequence poly-
high level of urgency is related to a poorer ability to deliberately morphisms found in the gene that encodes the serotonin trans-
suppress buying impulses. Due to their impulsivity, compulsive port (5-HTT). One polymorphism, found in the promoter region
buyers are not able to refrain from purchasing. This high level of the 5-HTT gene, involves a 44-base pair (bp) deletion, and
of impulsivity supports the suggestion of including compulsive the other, found in the second intron, is due to variable numbers
buying as a disorder as a behavioral addiction involving prob- of a repeat sequence. When compared to a control panel, no sig-
lems with impulse control, more than as a compulsive disorder. nificant differences were seen for either 5-HTT marker among
High tendency to impulsivity distinguishes compulsive buyers the compulsive buyers.
from patients with OCD, who are more often collectors and only
buy after a long period of hesitation or procrastination. In most
cases, however, both compulsivity and impulsivity may play a TREATMENT
role in compulsive buying.
Psychotherapy
Cognitive Behavioral Therapy
NEUROBIOLOGICAL FACTORS The false cognitions associated with compulsive buying (fear
The only work on neurobiology of buying was conducted of missing an exceptional occasion to buy, tendency to overesti-
by Knutson et al. (40) using event-related Functional Magnetic mate power, and importance of items to be bought) suggest that
Resonance Imaging (fMRI). They suggested that distinct cir- cognitive behavioral therapy (CBT) might be effective for this
cuits anticipate gain and loss. Product preference activated the disorder. The patient should first be evaluated for psychiatric
nucleus accumbens (NAcc), while excessive prices activated the comorbidity, especially depression, so that appropriate pharma-
insula and deactivated the mesial prefrontal cortex (MPFC) prior cological treatment can be instituted if indicated. For example,
to the purchase decision. Activity from each of these regions in- if depression is found, antidepressants should be used in treat-
dependently predicted immediately subsequent purchases above ment along with psychotherapy. Mitchell et al. (42) compared
and beyond self-report variables. 28 compulsive buyers receiving 12 sessions of CBT over 10
This evidence seems to suggest that compulsive buying is weeks to 11 patients remaining on a waiting list. At the end
similar in its neurocircuitry to other behavioral addictions such of treatment, patients receiving CBT showed significant reduc-
as gambling or internet addiction and, therefore, should be re- tions, compared to those on the waiting list, in the number of
252 M. LEJOYEUX AND A. WEINSTEIN

TABLE 1 are rarely used. Compulsive buying appears impulsive and

McElroy’s et al. diagnostic criteria for compulsive buying; significantly different from a compulsive disorder. Screening
adapted from (4). instruments and diagnostic criteria exist that parallel those for
substance addictions, pathological gambling, or other impulse
Inappropriate preoccupations with buying or shopping, or control disorders. Very little is known about the neurobiology
inappropriate buying or shopping impulses or behavior, as and genetics of compulsive buying, but the evidence points out to
indicated by at least one of the following: some similarity with behavioral addictions and lack of evidence
Frequent preoccupations with buying or impulses to buy that for serotonergic abnormality, which is a characteristic of OCD.
are experienced as irresistible, intrusive, and/or senseless Relatively little is known about its treatment. CBT has some ef-
Frequent buying of more than can be afforded, frequent ficacy, but no medication has been effective in controlled trials.
buying of items that are not needed, or shopping for longer Much future research is needed to improve our understanding
periods of time than intended of compulsive buying. It could also be useful to pursue research
The buying preoccupations, impulses, or behaviors cause works on pharmacological treatment of the disorder.
marked distress, are time-consuming, significantly interfere
with social or occupational functioning, or result in
Declaration of Interest
financial problems (e.g., indebtedness or bankruptcy)
The excessive buying or shopping behavior does not occur The authors report no conflict of interest. The authors alone
exclusively during periods of hypomania or mania are responsible for the content and writing of this paper.

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