Compulsive buying disorder
Compulsive buying disorder (CBD), or oniomania (from Greek ὤνιος ṓnios "for sale" and μανία manía "insanity"), is characterized by an obsession with shopping and buying behavior that causes adverse consequences. According to Kellett and Bolton, compulsive buying "is experienced as an irresistible–uncontrollable urge, resulting in excessive, expensive and time-consuming retail activity [that is] typically prompted by negative affectivity" and results in "gross social, personal and/or financial difficulties". Most people with CBD meet the criteria for a personality disorder. Compulsive shopping is classified by ICD-10 (F63.8) as an "impulse control disorder, not otherwise classified". Several authors consider compulsive shopping rather as a variety of dependence disorder.
Emil Kraepelin originally described oniomania over a century ago, and he and Bleuler  both included the syndrome in their influential early psychiatric textbooks. However, little interest was taken in CB until the 1990s, and even in the 21st century compulsive shopping can be considered a barely recognised mental illness.
CBD is frequently comorbid with mood, anxiety, substance abuse and eating disorders. People who score highly on compulsive buying scales tend to understand their feelings poorly and have low tolerance for unpleasant psychological states such as bad moods. Onset of CBD occurs in the late teens and early twenties and is generally chronic. CBD is similar to, but distinguished from, OCD hoarding and mania. Compulsive buying is not limited to people who spend beyond their means; it also includes people who spend an inordinate amount of time shopping or who chronically think about buying things but never purchase them. Promising treatments for CBD include medication such as selective serotonin reuptake inhibitors (SSRIs), and support groups such as Debtors Anonymous.
The terms compulsive shopping, compulsive buying, and compulsive spending are often used interchangeably, but the behaviors they represent are in fact distinct. (Nataraajan and Goff 1992)[page needed] One may buy without shopping, and certainly shop without buying: of compulsive shoppers, some 30% described the act of buying itself as providing a buzz, irrespective of the goods purchased.
Compulsive buying seems to represent a search for self in people whose identity is neither firmly felt nor dependable, as indicated by the way purchases often provide social or personal identity-markers. Those with associated disorders such as anxiety, depression and poor impulse control are particularly likely to be attempting to treat symptoms of low self-esteem through compulsive shopping.
Others, however, object that such psychological explanations for compulsive buying do not apply to all people with CBD.
Readily available credit cards enable casual spending beyond one's means, and some would suggest that the compulsive buyer should lock up or destroy credit cards altogether. Online shopping also facilitates oniomania, with online auction addiction, used to escape feelings of depression or guilt, becoming a recognisable problem.
What differentiates oniomania from healthy shopping is the compulsive, destructive and chronic nature of the buying. Where shopping can be a positive route to self-expression, in excess it represents a dangerous threat.
Materialism and image seeking
A social psychological perspective suggests that compulsive buying may be seen as an exaggerated form of a more normal search for validation through purchasing. Also, pressures from the spread of materialist values and consumer culture over the recent decades can drive people into compulsive shopping.
In a global context where we are all encouraged to "shop till we drop"—compulsive shopping inevitably poses the further question, "Minority pathology or Mass problem?". With advertisements offering not so much products as narratives (of success, glamour) to identify with, compulsive buying may seem only an extreme aspect of what consumer culture demands from us all.
Symptoms and course
Diagnostic criteria for compulsive buying have been proposed: 1. Over-preoccupation with buying; 2. distress or impairment as a result of the activity; 3. compulsive buying is not limited to hypomanic or manic episodes.
While initially triggered by a perhaps mild need to feel special, the failure of compulsive shopping to actually meet such needs may lead to a vicious cycle of escalation, with sufferers experiencing the highs and lows associated with other addictions. The 'high' of the purchasing may be followed by a sense of disappointment, and of guilt, precipitating a further cycle of impulse buying. With the now addicted person increasingly feeling negative emotions like anger and stress, they may attempt to self-medicate through further purchases, followed again by regret or depression once they return home - leading to an urge for yet another spree.
As debt grows, the compulsive shopping may become a more secretive act. At the point where bought goods are hidden or destroyed, because the person concerned feels so ashamed of their addiction, the price of the addiction in mental, financial and emotional terms becomes even higher.
The consequences of oniomania, which may persist long after a spree, can be devastating, with marriages, long-term relationships, and jobs all feeling the strain. Further problems can include ruined credit history, theft or defalcation of money, defaulted loans, general financial trouble and in some cases bankruptcy or extreme debt, as well as anxiety and a sense of life spiraling out of control. The resulting stress can lead to physical health problems and ruined relationships, or even suicide.
Treatment involves becoming conscious of the addiction through studying, therapy, group work, etc... Research done by Michel Lejoyeux and Aviv Weinstein suggests that the best possible treatment for CB is through cognitive behavioral therapy. They suggest that a patient first be "evaluated for psychiatric comorbidity, especially with depression, so that appropriate pharmacological treatment can be instituted." Their research indicates that patients who received cognitive behavioral therapy over 10 weeks had reduced episodes of compulsive buying and spent less time shopping as opposed to patients who did not receive this treatment (251).
Lejoyeux and Weinstein also write about pharmacological treatment and studies that question the use of drugs on CB. They declare "Few controlled studies have assessed the effects of pharmacological treatment on compulsive buying, and none have shown any medication to be effective" (252). The most effective treatment is to attend therapy and group work in order to prevent continuation of this addiction.
Selective serotonin reuptake inhibitors such as fluvoxamine and citalopram may be useful in the treatment of CBD, although current evidence is mixed. Opioid antagonists such as naltrexone and nalmefene are promising potential treatments for CBD. A review concluded that evidence is limited and insufficient to support their use at present, however. Naltrexone and nalmefene have also shown effectiveness in the treatment of gambling addiction, an associated disorder.
- Mary Todd Lincoln was addicted to shopping, running up (and concealing) large bills on credit, feeling manic glee at spending sprees, followed by depressive reactions in the face of the results.
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