Health warning: shopping is addictive

November's Black Friday for American retailers will soon turn into January's Red Friday for many shoppers. After lashing out on the Friday after Thanksgiving, the first day of a national holiday spending spree, shopaholics will find lumps of coal in their mailboxes when the credit card statements arrive. But that's OK: they're not spendthrifts, they're sick.
Welcome to Compulsive Buying Syndrome.
If you use Good Morning America as a low cal sweetener with your coffee, you may be aware of this strange new malady of modern life. After the last shopping season, it featured a Big City Professional (BCP) who had become a bulimic spender. She had lost her home and her 401K in shopping malls. This woman in yuppie hell described her plight in a parrot-like mantra, "It’s the bingeing, the purging, the bingeing, the purging," she moaned.
However, the professional helping community is hard at work rescuing those afflicted by their Pavlovian response to the four-letter word SALE. Over the last few years, the disease of compulsive buying has become widely accepted in the therapeutic community. Healing programs are available with vague and non-stigmatising names like Stop Overshopping. The familiar AA approach, Debtors Anonymous, has also been established.
Now the psychiatric establishment is considering whether this is not just a weakness, but a disease. In a continuing campaign to turn problems of living into medical problems, the October American Journal of Psychiatry published research from Stanford on compulsive/impulsive buying, "Estimated Prevalence of Compulsive Buying Behaviour in the United States". This claims that the prevalence of compulsive buying is 5.8 per cent -- more than one in 20 Americans.
An accompanying editorial argued that Compulsive Buying should be placed in a new category of mental disorders, behavioural addictions, as proposed by the National Institute on Drug Abuse. "Similar phases seem to occur for behavioural and substance addictions," argue Drs Eric Hollander and Andrea Allen. "Initially, episodes are characterised by increasing physiological and emotional arousal before the act; pleasure, high, or gratification associated with the act; and a decrease in arousal and feelings of guilt and remorse afterward. Tolerance and physiological withdrawal can also develop." Well, this does sound like an authentic description of a trip to the mall at Christmas time. The question is whether it is normal or nutty.
Some mental health professionals contend that recasting bad habits as addiction amounts to surrendering to pop psychology. They complain that psychiatry has been popping out new addictions faster than Hollywood’s ability to get celebrity addicts into rehab for them. However, the extension of addiction into new territories fits into the spreading biological reductionism of psychiatric thought since the Decade of the Brain was declared in 1990.
Criteria have now been proposed the next edition of the psychiatrists' Bible, the Diagnostic Statistical Manual to identify compulsive shopping. If you buy unneeded items, if you ever spend more than you can afford, if you feel remorseful over bad purchases or if you have financial difficulties, then you may be a certified shopaholic.
In their editorial, Drs Hollander and Allen assure us that compulsive buying can be distinguished from "normal excessive". Yet, isn’t our normal excessive, especially around Christmas time? When the media hyped Black Friday this year, no one suggested that people waiting in line on Thanksgiving night to catch the next day's bargains were a little wacky. In fact, a consumer who doesn’t buy unneeded products is a statistical oddity. Hollander and Allen propose that distress and impairment are what differentiates the nutters from the normals. Yet, aren't distress, conflicted feelings and remorse possible signs of wisdom gained from painful experience?
Moreover, is the distress due to excess spending or to lack of money? Not surprisingly, the Stanford study found an inverse relationship between the prevalence of compulsive buying and income. Higher income was correlated to less compulsive buying. Other researchers have found that the severity of compulsive buying is related to lower incomes. So, when it's all said and done, the post-sale blues is due to a lack of cash. Income is the unspoken but determinative factor in compulsive buying. Compulsive buying may be the first illness literally prevented and cured by money.
Furthermore, does this mean that if one does not suffer distress, then he is normal? I recall watching Michael Jackson on a shopping spree in a television interview a few years ago. There was a compulsive buyer if there ever was one. Like a three-year-old on meth, he went through the store flailing his arms: "I want this! I want that!" Even though he probably spent thousands of dollars, he had no apparent feelings of distress or second thoughts. His face only manifested a puerile delight. Super-spenders such as Oprah Winfrey and Michael Jackson celebrate their ostentatious frivolity. Is it only the poor who can be struck down by this mysterious malady?
The authors of the Stanford study acknowledge that there are some problems with classifying spending as a medical issue. Once a behaviour is turned into an illness, they state, "the possible social contributions to the disordered behaviour, eg, easy credit, inadequate money management training and skills, predatory interest rates, and dilution of family structure are ignored." Yet their own article illustrates the problem with medicalising a habit. They dismiss issues such as easy credit and inexperience with money management as secondary problems. And they overlook other possible contributions such as advertising.
But the worst consequence of turning spending into a psychiatric disorder is a shift from personal responsibility to finding a medical cure and posing as a victim. What will Compulsive Buying Disorder mean for retailers and credit card companies if it becomes an entry in the Diagnostic Statistical Manual? Once a personal problem becomes a public health problem, government intervention will surely be required. After all, children must be protected from themselves. Big Retail could become the next Big Tobacco. Commercials might come with health disclaimers. Perhaps we will see the CEOs of Wal-Mart, Target and Macy’s in front of a congressional panel. What will they say when asked, "Is shopping addictive?"
Theron Bowers MD is a psychiatrist Deep in the Heart of Texas and may be contacted at [email protected].


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