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Der Kick beim Kauf – Das unterschätzte Phänomen pathologisches Kaufen
Abstract
Psychologische und Medizinische Rehabilitation -
Pathologisches Kaufen stellt ein schon lange bekanntes und zunehmend erforschtes Phänomen dar, welches erhebliche negative Konsequenzen für die Betroffenen mit sich bringt. Es äußert sich in einer enormen gedanklichen Beschäftigung mit Kaufaspekten, in einem als unwiderstehlich empfundenen Kaufdrang und in regelmäßigem Kontrollverlust, der in Kaufepisoden mündet. Dabei werden die erworbenen Güter wenig bis gar nicht genutzt. Die wiederkehrenden Kaufepisoden führen zu schweren Belastungen durch soziale, berufliche, psychologische und rechtliche Konsequenzen. Patient*innen mit pathologischem Kaufen leiden zudem häufig an Komorbiditäten, vor allem Binge-Eating-
Störung, pathologisches Horten, Angststörungen oder Depression. Bisher erfolgreiche Behandlungsansätze sind manualisierte kognitiv-verhaltenstherapeutische Gruppenkonzepte. Online-Handel und personalisierte Werbung führen zu einem Anstieg der geschätzten Prävalenz von pathologischem Kaufen, die aktuell bei etwa 5% liegt. So ist es kaum verständlich, dass pathologisches Kaufen nach wie vor keine anerkannte eigenständige psychische Störung ist. Aktuell präferiert wird die Zuordnung zu den Verhaltenssüchten. Eine Anerkennung als eigenes Störungsbild ist längst überfällig, auch um Patient*innen verlässlich zu identifizieren und so zu verhindern, dass diese Störung unerkannt bleibt. Auch für die Entwicklung von spezifischen Behandlungs- und Präventionskonzepten ist die Anerkennung notwendig. Ziel dieses Beitrages ist es, pathologisches Kaufen anhand einer narrativen Literaturübersicht zu beschreiben und über Klassifikation, Epidemiologie, Diagnostik und Therapie zu informieren.
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Background and aims:
Consensus in acknowledging compulsive buying-shopping disorder (CBSD) as a distinct diagnosis has been lacking. Before research in this area can be advanced, it is necessary to establish diagnostic criteria in order to facilitate field trials.
Methods:
The study consisted of the following phases: (1) operationalization of a broad range of potential diagnostic criteria for CBSD, (2) two iterative rounds of data collection using the Delphi method, where consensus of potential diagnostic criteria for CBSD was reached by an international expert panel, and (3) interpretation of findings taking into account the degree of certainty amongst experts regarding their responses.
Results:
With respect to diagnostic criteria, there was clear expert consensus about inclusion of the persistent and recurrent experience of (a) intrusive and/or irresistible urges and/or impulses and/or cravings and/or preoccupations for buying/shopping; (b) diminished control over buying/shopping; (c) excessive purchasing of items without utilizing them for their intended purposes, (d) use of buying-shopping to regulate internal states; (e) negative consequences and impairment in important areas of functioning due to buying/shopping; (f) emotional and cognitive symptoms upon cessation of excessive buying/shopping; and (g) maintenance or escalation of dysfunctional buying/shopping behaviors despite negative consequences. Furthermore, support was found for a specifier related to the presence of excessive hoarding of purchased items.
Conclusions:
The proposed diagnostic criteria can be used as the basis for the development of diagnostic interviews and measures of CBSD severity.
Background: During the lockdown, governmental restrictions resulted in changes to the day-to-day routines of many individuals. Some people appear to cope with stress by panic buying in an attempt to stockpile specific goods, resulting in empty supermarket shelves. Moreover, e-commerce experienced significant growth during this period. We aimed to investigate potential changes in shopping frequencies and preferred shopping type (offline/online) and their relationship with pandemic-specific anxiety and stress during the 2020 spring lockdown in Germany.
Methods: To address this question, we assessed self-reported changes in shopping behavior in a German sample via an online survey conducted during April and May 2020.
Results: A total of 3,122 adults were included in the analysis. Of the total sample, 35% reported no changes in their shopping behavior, 46.8% shopped less, while 18.2% shopped more during the lockdown. The groups differed with respect to sociodemographic variables, and those participants who were shopping more reported greater pandemic-related health fears and stress due to the restrictions. Moreover, they shopped online more often during the lockdown than the other two groups.
Conclusion: While the majority of the sample reported no changes in their shopping behavior or even shopped less during the 2020 spring lockdown, a subgroup of individuals was shopping more during this time, especially food and drugstore products. It is important to understand which factors influenced individuals to shop more so that policy makers can target this group and prevent panic buying, especially during subsequent waves of infection. It is also important to inform vulnerable persons about the risk of developing a buying–shopping disorder.
Background:
Gambling and gaming disorders have been included as "disorders due to addictive behaviors" in the International Classification of Diseases (ICD-11). Other problematic behaviors may be considered as "other specified disorders due to addictive behaviors (6C5Y)."
Methods:
Narrative review, experts' opinions.
Results:
We suggest the following meta-level criteria for considering potential addictive behaviors as fulfilling the category of "other specified disorders due to addictive behaviors":1. Clinical relevance: Empirical evidence from multiple scientific studies demonstrates that the specific potential addictive behavior is clinically relevant and individuals experience negative consequences and functional impairments in daily life due to the problematic and potentially addictive behavior.2. Theoretical embedding: Current theories and theoretical models belonging to the field of research on addictive behaviors describe and explain most appropriately the candidate phenomenon of a potential addictive behavior.3. Empirical evidence: Data based on self-reports, clinical interviews, surveys, behavioral experiments, and, if available, biological investigations (neural, physiological, genetic) suggest that psychological (and neurobiological) mechanisms involved in other addictive behaviors are also valid for the candidate phenomenon. Varying degrees of support for problematic forms of pornography use, buying and shopping, and use of social networks are available. These conditions may fit the category of "other specified disorders due to addictive behaviors".
Conclusion:
It is important not to over-pathologize everyday-life behavior while concurrently not trivializing conditions that are of clinical importance and that deserve public health considerations. The proposed meta-level-criteria may help guide both research efforts and clinical practice.
There is an ongoing debate about whether buying-shopping disorder (BSD) should be acknowledged as a behavioral addiction. The current study investigated if mechanisms that play a prominent role in disorders due to substance use or addictive behaviors are relevant in BSD, particularly cue reactivity, craving, cognitive bias and reduced inhibitory control regarding addiction-relevant cues. The study included 39 treatment-seeking patients with BSD and 39 healthy control (HC) participants (29 women and 10 men in each group). Subjective responses toward buying/shopping-relevant visual cues were compared in patients vs. control participants. Experimental paradigms with neutral and semi-individualized buying/shopping-related pictures were administered to assess attentional bias, implicit associations and response inhibition with respect to different visual cues: Dot-probe paradigm (DPP), Implicit Association Task (IAT), Go/nogo-task (GNG). The severity of BSD, craving for buying/shopping, and symptoms of comorbid mental disorders (anxiety, depressive and hoarding disorders) were measured using standardized questionnaires. The BSD-group showed more general craving for buying/shopping, stronger subjective craving reactions towards buying/shopping-related visual cues, and more symptoms of anxiety, depression and hoarding disorder than control participants. Task performance in the DPP, IAT and GNG paradigm did not differ between the two groups. The present findings confirm previous research concerning the crucial role of craving in BSD. The assumption that attentional bias, implicit associations and deficient inhibitory control with respect to buying/shopping-related cues are relevant in BSD could not be proven. Future research should address methodological shortcomings and investigate the impact of acute psychosocial stress and present mood on craving responses, cognitive processing, and response inhibition in patients with BSD.
Background and aims
Recent research has applied cue-reactivity paradigms to behavioral addictions. The aim of the current meta-analysis is to systematically analyze the effects of learning-based cue-reactivity in behavioral addictions.
Methods
The current meta-analysis includes 18 studies (29 data sets, 510 participants) that have used a cue-reactivity paradigm in persons with gambling (eight studies), gaming (nine studies), or buying (one study) disorders. We compared subjective, peripheral physiological, electroencephal, and neural responses toward addiction-relevant cues in patients versus control participants and toward addiction-relevant cues versus control cues in patients.
Results
Persons with behavioral addictions showed higher cue-reactivity toward addiction-relevant cues compared with control participants: subjective cue-reactivity (d = 0.84, p = .01) and peripheral physiological and electroencephal measures of cue-reactivity (d = 0.61, p < .01). Increased neural activation was found in the caudate nucleus, inferior frontal gyrus, median cingulate cortex, subgenual cingulate, and precentral gyrus. Persons with gambling, gaming, or buying disorders also showed higher cue-reactivity toward addiction-relevant cues compared with control cues: subjective cue-reactivity (d = 0.39, p = .11) and peripheral physiological and electroencephal measures of cue-reactivity (d = 0.47, p = .05). Increased neural activation was found in the caudate nucleus, inferior frontal gyrus, angular gyrus, inferior network, and precuneus.
Discussion and conclusions
Cue-reactivity not only exists in substance-use disorders but also in gambling, gaming, and buying disorders. Future research should differentiate between cue-reactivity in addictive behaviors and cue-reactivity in functional excessive behaviors such as passions, hobbies, or professions.
Purpose of Review
We aimed to review recent research drawing attention to the parallels between compulsive buying and other addictive disorders. More specifically, special focus was given to common risk factors, comorbidity in compulsive buying, and shared diagnostic obstacles with other behavioral addictions.
Recent Findings
New research reaffirms that compulsive buying possesses many commonalities with both substance use disorders and other behavioral addictions. Specific personality traits, sociodemographic variables, and neurobiological vulnerabilities are understood to be risk factors for compulsive buying, as with other addictive disorders. Compulsive buying is not yet categorized as an addictive disorder despite its similarities to gambling disorder; consensus on diagnostic criteria is needed.
Summary
The latest research suggests that compulsive buying should be classified as a behavioral addiction. More empirical research is required to determine universal diagnostic criteria. Concerted efforts on the treatment and prevention of compulsive buying would advance the field.
Purpose of the Review
The current review summarizes the literature for buying disorder (BD) with a focus on addiction-relevant concepts such as craving, executive functions, and decision making.
Recent Findings
First, studies could demonstrate craving reactions in relationship to BD in both offline and online contexts. Decision-making studies demonstrated disadvantageous decision-making performance in individuals with BD when the outcomes and contingencies of the decision options are unknown (ambiguous risk). In contrast, unimpaired decision making was observed when outcomes and probabilities were explicitly provided (objective risk). Most studies reported normal executive functions in individuals with BD.
Summary
The findings emphasize the role of craving in the context of BD. Decision-making performance seems to be related to difficulties in emotional processing of negative consequences rather than to executive dysfunctions. The findings are discussed in the context of current models of addiction and decision making. We also suggest an integrative approach for a better understanding of the psychological processes underlying the phenomenon of BD and point out future research directions.
Purpose of Review
Although not recognized as a discrete psychiatric disorder, compulsive buying (CB) is a widespread psychological problem characterized by a preoccupation with shopping and impulses to purchase that are experienced as irresistible and chronic, leading to distress and significant impairment.
Recent Findings
Social psychological frameworks for CB highlight the link between CB and materialistic value endorsement and individuals’ motives to compensate for a perceived deficiency in self-concept. Alternatively, cognitive frameworks for CB focus on the role of beliefs about possessions (e.g. perceiving goods as “essential” and “unique,” and buying opportunities as “occasions not to be missed”) in order to explain CB. Both models also strongly implicate the role of mood in CB phenomena.
Summary
Strong links have been found between materialism, mood, and CB. The relevance of self and cognitions to CB has also been supported, albeit fewer studies have examined such links.
Purpose of Review
We summarized studies focusing on the associations between compulsive buying and temperament/personality traits in community and clinical samples published between 2010 and 2016.
Recent Findings
We found significant associations between compulsive buying (CB) and high levels of Behavioral Activation System (BAS) reactivity, Novelty Seeking, and Positive Urgency (promotion focus), as well as high levels of Neuroticism, Emotional Instability, and Negative Urgency (prevention focus). Finally, the results showed negative relationships between CB and lack of Effortful Control, Self-Control, Perseverance, and Premeditation.
Summary
CB seems to be driven by positive reinforcement and negative reinforcement as well as a breakdown in self-regulation. Longitudinal studies should investigate the development of CB throughout time, and experimental studies should examine whether individuals with CB suffer from a general vs. a cue-specific breakdown in self-regulation. Psychotherapy should focus on the training of self-control as well as the development of behavioral alternatives to regulate emotions.
Within the last two decades, many studies have addressed the clinical phenomenon of Internet-use disorders, with a particular focus on Internet-gaming disorder. Based on previous theoretical considerations and empirical findings, we suggest an Interaction of Person-Affect-Cognition-Execution (I-PACE) model of specific Internet-use disorders. The I-PACE model is a theoretical framework for the processes underlying the development and maintenance of an addictive use of certain Internet applications or sites promoting gaming, gambling, pornography viewing, shopping, or communication. The model is composed as a process model. Specific Internet-use disorders are considered to be the consequence of interactions between predisposing factors, such as neurobiological and psychological constitutions, moderators, such as coping styles and Internet-related cognitive biases, and mediators, such as affective and cognitive responses to situational triggers in combination with reduced executive functioning. Conditioning processes may strengthen these associations within an addiction process. Although the hypotheses regarding the mechanisms underlying the development and maintenance of specific Internet-use disorders, summarized in the I-PACE model, must be further tested empirically, implications for treatment interventions are suggested.
Compulsive buying behavior (CBB) has begun to be recognized as a condition worthy of attention by clinicians and researchers. Studies on the commonalities between CBB and other behavioral addictions such as gambling disorder (GD) exist in the literature, but additional research is needed to assess the frequency and clinical relevance of the comorbidity of CBB and GD. The aim of the study was to estimate the point-prevalence of CBB+GD in a clinical setting. Data corresponded to n=3,221 treatment-seeking patients who met criteria for CBB or GD at a public hospital unit specialized in treating behavioral addictions. Three groups were compared: only-CBB (n=127), only-GD (n=3,118) and comorbid CBB+GD (n=24). Prevalence for the co-occurrence of CBB+GD was 0.75%. In the stratum of patients with GD, GD+CBB comorbidity obtained relatively low point prevalence (0.77%), while in the subsample of CBB patients the estimated prevalence of comorbid GD was relatively high (18.9%). CBB+GD comorbidity was characterized by lower prevalence of single patients, higher risk of other behavioral addictions (sex, gaming or internet), older age and age of onset. CBB+GD registered a higher proportion of women compared to only-GD (37.5% vs. 10.0%) but a higher proportion of men compared to only-CBB (62.5% vs. 24.4%). Compared to only-GD patients, the simultaneous presence of CBB+GD was associated with increased psychopathology and dysfunctional levels of harm avoidance. This study provides empirical evidence to better understand CBB, GD and their co-occurrence. Future research should help delineate the processes through which people acquire and develop this comorbidity.
Background:
Obsessive-compulsive disorder (OCD) has a heterogeneous and complex phenomenological picture, characterized by different symptom dimensions and comorbid psychiatric disorders, which frequently co-occur or are replaced by others over the illness course. To date, very few studies have investigated the associations between specific OCD symptom dimensions and comorbid disorders.
Methods:
Cross-sectional, multicenter clinical study with 1001 well-characterized OCD patients recruited within the Brazilian Research Consortium on Obsessive-Compulsive and Related Disorders. The primary instruments were the Dimensional Yale-Brown Obsessive Compulsive Scale (DY-BOCS) and the Structured Clinical Interview for DSM-IV Axis I Disorders. Bivariate analyses between symptom dimensions and comorbidities were followed by logistic regression.
Results:
The most common comorbidities among participants (56.8% females) were major depression (56.4%), social phobia (34.6%), generalized anxiety disorder (34.3%), and specific phobia (31.4%). The aggressive dimension was independently associated with posttraumatic stress disorder (PTSD), separation anxiety disorder, any impulse-control disorder and skin picking; the sexual-religious dimension was associated with mood disorders, panic disorder/agoraphobia, social phobia, separation anxiety disorder, non-paraphilic sexual disorder, any somatoform disorder, body dysmorphic disorder and tic disorders; the contamination-cleaning dimension was related to hypochondriasis; and the hoarding dimension was associated with depressive disorders, specific phobia, PTSD, impulse control disorders (compulsive buying, skin picking, internet use), ADHD and tic disorders. The symmetry-ordering dimension was not independently associated with any comorbidity.
Limitations:
Cross-sectional design; participants from only tertiary mental health services; personality disorders not investigated.
Conclusions:
Different OCD dimensions presented some specific associations with comorbid disorders, which may influence treatment seeking behaviors and response, and be suggestive of different underlying pathogenic mechanisms.
Aims:
To estimate the pooled prevalence of compulsive buying behaviour (CBB) in different populations and to determine the effect of age, gender, location, and screening instrument on the reported heterogeneity in estimates CBB and whether publication bias could be identified.
Methods:
Three databases were searched (Medline, PsychInfo, Web of Science) using the terms "compulsive buying", "pathological buying" and "compulsive shopping" to estimate the pooled prevalence of CBB in different populations. Forty studies reporting 49 prevalence estimates from 16 countries were located (n=32,000). To conduct the meta-analysis, data from non-clinical studies regarding mean age and gender proportion, geographical study location, and screening instrument used to assess CBB were extracted by multiple independent observers and evaluated using a random effects model. Four a-priori subgroups were analysed using pooled estimation (Cohen's Q) and covariate testing (moderator and meta-regression analysis).
Results:
The CBB pooled prevalence of adult representative studies was 4.9% [3.4%-6.9%, eight estimates, 10,102 participants] although estimates were higher among university students: 8.3% [5.9%-11.5%, 19 estimates, 14,947 participants], in adult non-representative samples: 12.3% [7.6%-19.1%, 11 estimates, 3929 participants], and in shopping-specific samples: 16.2% [8.8%-27.8%, 11 estimates, 4,686 participants]. Being young and female were associated with increased tendency, but not location (USA vs. non-USA). Meta-regression revealed large heterogeneity within subgroups, mostly due to diverse measures and timeframes (current vs. lifetime) used to assess CBB.
Conclusions:
A pooled estimate of compulsive buying behaviour in the populations studied is around 5% but there is large variation between samples largely accounted for by use of different time frames and measures.
The study aimed to investigate different factors of vulnerability for pathological buying in the online context and to determine whether online pathological buying has parallels to a specific Internet addiction. According to a model of specific Internet addiction by Brand and colleagues, potential vulnerability factors may consist of a predisposing excitability from shopping and as mediating variable, specific Internet use expectancies. Additionally, in line with models on addiction behavior, cue-induced craving should also constitute an important factor for online pathological buying. The theoretical model was tested in this study by investigating 240 female participants with a cue-reactivity paradigm, which was composed of online shopping pictures, to assess excitability from shopping. Craving (before and after the cue-reactivity paradigm) and online shopping expectancies were measured. The tendency for pathological buying and online pathological buying were screened with the Compulsive Buying Scale (CBS) and the Short Internet Addiction Test modified for shopping (s-IATshopping). The results demonstrated that the relationship between individual’s excitability from shopping and online pathological buying tendency was partially mediated by specific Internet use expectancies for online shopping (model’s R² = .742, p < .001). Furthermore, craving and online pathological buying tendencies were correlated (r = .556, p < .001), and an increase in craving after the cue presentation was observed solely in individuals scoring high for online pathological buying (t(28) = 2.98, p < .01, d = 0.44). Both screening instruments were correlated (r = .517, p < .001), and diagnostic concordances as well as divergences were indicated by applying the proposed cut-off criteria. In line with the model for specific Internet addiction, the study identified potential vulnerability factors for online pathological buying and suggests potential parallels. The presence of craving in individuals with a propensity for online pathological buying emphasizes that this behavior merits potential consideration within the non-substance/behavioral addictions.
The study was designed to develop a new screening instrument for pathological buying (PB), and to examine its psychometric properties in a large-scale sample. By using a facet theoretical approach and based on literature as well as on clinical experience, a 20-item Pathological Buying Screener (PBS) was developed and administered to a representative German sample (n = 2,539). Valid data were available from 2,403 participants who were subjects for three subsequent empirical studies. The first study explored the factor structure using exploratory factor analyses in a subsample of 498 participants. Based on factor loadings, a 13-item version with the two factors loss of control / consequences and excessive buying behavior was revealed. This two-factor model was confirmed in study 2 by confirmatory factor analysis performed on another subsample (n = 1,905). Study 3 investigated age and gender effects and convergent validity of the PBS using the Compulsive Buying Scale (CBS) in the full sample (N = 2,403). The total PBS score was adequately correlated with the CBS score. Hierarchical regression analyses with the CBS score as the dependent variable and the two PBS factors as the predictors indicated an own incremental validity of the two factors in participants ≤ 65 years. The reliability of the total score as well as of the two subscales was good to excellent. Overall, the PBS represents a useful measure for PB. Future studies are needed to replicate the two-factor structure in clinical samples and to define a valid cutoff for PB.
Background:
Previous research demonstrated a close relationship between hoarding disorder (compulsive hoarding, CH) and compulsive buying (CB). Hoarding disorder was included in the 5th version of the Diagnostic and Statistical Manual of Mental Disorders (APA, 2013) with excessive acquisition as a specifier. This pilot study aimed to investigate whether individuals with both hoarding and buying symptoms (CBCH group) will present with the highest severity levels of hoarding as well as buying psychopathology compared to the respective group exhibiting only one syndrome (CH group: only hoarding, CB group: only buying).
Methods:
The three groups (CH: n = 40, CBCH: n = 60, CB: n = 35) completed the Saving Inventory-Revised, the Compulsive Acquisition Scale und the Compulsive Buying Scale. Data were analysed using non-parametric tests.
Results:
The CBCH group did not differ from the CH group with regard to the severity of key hoarding symptoms such as clutter, difficulty discarding possessions, and the acquisition of free things, but showed a higher severity of CB than the CB group.
Conclusions:
While the findings indicate remarkable overlap in primary features of CH in compulsive hoarders with and without excessive buying, they suggest more severe CB in individuals with both hoarding and buying symptoms compared to individuals with only CB. Future studies should address the question whether both disorders are part of a larger construct.
Background and objectives:
Compulsive buying is a serious but understudied problem, where individuals are unable to resist or control their buying behaviour, leading to substantial social and financial problems. To date there has been a lack of experimental research into the disorder.
Methods:
The relationship between mood and compulsive buying was examined in compulsive buyers (N = 18) and non-clinical controls (N = 17), using experimental information-processing paradigms. In study 1, it was expected that, if buying behaviours function as a coping strategy for depressed mood, then an induction of depressed mood would lead to an enhanced memory for appealing consumer-objects in compulsive buyers, but not controls. In study 2, we examined the association between emotional and functional constructs and consumer items. It was expected that compulsive buyers would show stronger semantic relationships and thus better episodic memory for object-emotion pairs, relative to object-function pairs, for appealing items.
Results:
Unexpectedly, in study 1 the memory-facilitating effect of depressed mood was evident among control participants and absent among compulsive buyers. In study 2, compulsive buyers showed a lesser association of undesirable objects with positive emotional concepts than did non-clinical controls, and compulsive buyers were found to more strongly associate all consumer items with emotional concepts than with concepts of function.
Limitations:
Key limitations were low power and possible floor effects due to error frequency data.
Conclusion:
These findings provide insights into the processes underlying CB phenomena, in particular supporting the role of mood in compulsive buying.
Zusammenfassung
Ziel der Studie Verhaltenssüchte treten in der Regel mit komorbiden psychischen Störungen auf und werden immer noch unterdiagnostiziert. Ziel dieser multizentrischen Querschnittsuntersuchung war es, die geschätzte Punktprävalenz von Verhaltenssüchten bei konsekutiven Patient*innen, die wegen anderer Diagnosen in der Psychosomatik behandelt wurden, zu erheben.
Methodik An der Studie nahmen 801 Patient*innen aus acht psychosomatischen Universitätskliniken teil. Die Erfassung von Verhaltenssüchten erfolgte anhand standardisierter Fragebögen.
Ergebnisse Bei 24,1% der Patient*innen ergab sich der Verdacht auf mindestens eine Verhaltenssucht. Der überwiegende Teil dieser Patient*innen beschrieb Symptome einer isolierten Verhaltenssucht. Basierend auf den Fragebögen wurden folgende Prävalenzraten geschätzt: Störung durch Glücksspielen 3,4%, pathologische Internetnutzung 1,9%, pathologisches Kaufen 16,7%, hypersexuelle Störung 5,4% und suchtartiges Sporttreiben 3,5%. Hinweise auf einen Zentrumseffekt oder Einfluss des Settings (ambulant, tagesklinisch, stationär) waren nicht erkennbar.
Diskussion Die vorliegende klinische Stichprobe deutet auf eine hohe Verbreitung von Kaufsuchtsymptomen bei Patient*innen in psychosomatisch-psychotherapeutischer Behandlung hin. Von Kaufsucht sind insbesondere Frauen betroffen. Demgegenüber leiden Männer eher an Glücksspiel- und Sexsucht. Insgesamt ergibt sich eine hohe Belastung durch Verhaltenssuchtsymptome. Bis dato werden Verhaltenssüchte häufig noch unterdiagnostiziert.
Schlussfolgerung Patient*innen in psychosomatischer-psychotherapeutischer Versorgung leiden häufig unter Symptomen einer Verhaltenssucht, was in der Behandlung berücksichtigt werden sollte.
Zusammenfassung. Fragestellung: Es existiert eine Vielzahl von Begriffen für Verhaltenssüchte, die Mängel in Operationalisierung, Bezug zum Verhalten, Kompatibilität mit internationalen Klassifikationen sowie nicht stigmatisierender Nutzung aufweisen. Daher werden einheitliche Begriffe für Verhaltenssüchte benötigt. Methode: Im Rahmen einer Leitlinie zur Diagnostik und Behandlung Internetbezogener Störungen wurden Lösungen in Form eines Expertenkonsens entwickelt. Ergebnisse: Als Grundlage wurde die Einteilung von Verhaltenssüchten in der 11. Revision der International Classification of Diseases (ICD-11) genutzt. Es wurden die Begriffe Computerspielstörung (CSS) und Glücksspielstörung (GSS) für die beiden in ICD-11 enthaltenen Verhaltenssüchte gewählt sowie drei weitere spezifizierte Verhaltenssüchte vorgeschlagen: Soziale-Netzwerke-Nutzungsstörung (SNS), Shoppingstörung (ShS) und Pornografie-Nutzungsstörung (PNS). Für CSS, GSS und ShS wird weiterhin zwischen vorwiegend online oder vorwiegend offline unterschieden. Als Oberbegriff wird Störungen aufgrund von Verhaltenssüchten vorgeschlagen. Für Störungen aufgrund von Verhaltenssüchten, die sich vorwiegend auf online ausgeübte Verhaltensweisen beziehen, kann alternativ der Oberbegriff Internetnutzungsstörungen verwendet werden. Schlussfolgerung: Die vorgeschlagenen Termini weisen Verbesserungen im Vergleich zu uneindeutigen oder aus anderen Gründen ungünstigen Begriffen dar. Gleichzeitig konnte eine Kompatibilität mit der ICD-11 ermöglicht werden.
Background
Theoretical models summarize the mechanisms that are potentially involved in the development and maintenance of a psychological disorder. Regarding behavioral addictions, several models exist that are mainly based on theories explaining substance use disorders.Objective
The article informs about recent theoretical assumptions considering psychological processes that are likely involved in behavioral addictions.Material and methodsNarrative literature review.ResultsThe theoretical models differentiate between general and specific vulnerability factors, affective reactions to specific stimuli, and processes of action control. These processes are considered central in recent models.Conclusion
Theoretical models may inspire research but may also be helpful in clinical practice, for example in the context of psychoeducation. They provide indications for potential specific interventions.
Aim:
The aim of the study was to evaluate the psychometric properties of the 13-item Pathological Buying Screener (PBS, [1]) in a clinical sample.
Method:
The PBS was administered to a total sample of 413 treatment-seeking patients (buying-shopping disorder n=151, gambling disorder n=59, alcohol dependency n=60, other mental disorders [anxiety, depressive, eating, somatoform disorders] n=143). Factor structure was tested in the total sample using confirmatory factor analysis (CFA), reliability was determined by means of Cronbach's α. Group comparisons were used to determine to which degree the PBS discriminates between patients with BSD and other clinical groups. The BSD-group completed a battery of other measures to explore convergent and divergent validity. A subgroup (n=29) answered the PBS before and after psychotherapy to investigate sensitivity to change. A receiver operating characteristic (ROC) curve analysis with PBS data of patients with buying-shopping disorder and those from a previous community sample 1 was performed to define a cut-off point for buying-shopping disorder.
Results:
The CFA showed a good model fit for both a one-factor and a two-factor structure with the subscales "loss of control/consequences" (10 items) and "excessive buying behavior" (3 items). The subscales were highly intercorrelated (r=0.92). A hierarchical regression analysis with another BSD measure as dependent variable did not indicate an own incremental validity of the subscale "excessive buying behavior". Good convergent, divergent and discriminative capacity was obtained for the PBS total score. At its recommended cut-off point of ≥29 the PBS has a sensitivity of 98% and a specificity of 94.7%.
Conclusion:
The findings indicate good psychometric properties of the PBS and suggest that the PBS total score can be used in clinical settings.
We propose an updated version of the Interaction of Person-Affect-Cognition-Execution (I-PACE) model, which we argue to be valid for several types of addictive behaviors, such as gambling, gaming, buying-shopping, and compulsive sexual behavior disorders. Based on recent empirical findings and theoretical considerations, we argue that addictive behaviors develop as a consequence of the interactions between predisposing variables, affective and cognitive responses to specific stimuli, and executive functions, such as inhibitory control and decision-making. In the process of addictive behaviors, the associations between cue-reactivity/craving and diminished inhibitory control contribute to the development of habitual behaviors. An imbalance between structures of fronto-striatal circuits, particularly between ventral striatum, amygdala, and dorsolateral prefrontal areas, may be particularly relevant to early stages and the dorsal striatum to later stages of addictive processes. The I-PACE model may provide a theoretical foundation for future studies on addictive behaviors and clinical practice. Future studies should investigate common and unique mechanisms involved in addictive, obsessive-compulsive-related, impulse-control, and substance-use disorders.
Background and aims:
Subjects with buying-shopping disorder (BSD) continue to buy offline as well as online despite negative consequences. Previous studies indicate that subjects with BSD show cue-reactivity and craving when exposed to shopping cues and have problems in long-term advantageous decision-making. The current study aimed at investigating the effect of online-shopping cues on decision-making, and whether addiction-relevant concepts such as cue-reactivity/craving and the symptom severity of BSD are related to decision-making.
Methods:
A non-clinical sample of 57 participants played a version of the modified Iowa Gambling Task (IGT), with online-shopping-related pictures shown either on the advantageous decks or on the disadvantageous decks (with control pictures on the opposing ones). Symptom severity of online-BSD and the craving to buy were assessed using questionnaires. In addition, the online-shopping pictures were rated concerning arousal, valence, and urge to buy.
Results:
The participants who played the IGT with the online-shopping pictures displayed on the disadvantageous decks performed significantly poorer than the other group with online-shopping pictures on the advantageous decks. The between-group differences were moderated by craving reactions and the symptom severity of online-BSD: When online-shopping pictures were displayed on the disadvantageous decks, this only interfered with IGT performance in participants who had high craving reactions towards shopping cues and/or high symptom severity of online-BSD.
Conclusion:
Results indicate that exposure to online-shopping cues interferes with advantageous decision-making, especially in individuals with craving reactions and high symptoms of online-BSD. Results contribute to the question of why some people continue to buy despite negative consequences.
The phenomenon of buying-shopping disorder (BSD) was described over 100 years ago. Definitions of BSD refer to extreme preoccupation with shopping and buying, to impulses to purchase that are experienced as irresistible, and to recurrent maladaptive buying excesses that lead to distress and impairments. Efforts to stop BSD episodes are unsuccessful, despite the awareness of repeated break-downs in self-regulation, experiences of post-purchase guilt and regret, comorbid psychiatric disorders, reduced quality of life, familial discord, work impairment, financial problems, and other negative consequences. A recent meta-analysis indicated an estimated point prevalence of BSD of 5%. In this narrative review, the authors offer a perspective to consider BSD as a mental health condition and to classify this disorder as a behavioral addiction, based on both research data and on long-standing clinical experience.
At present, there is a considerable lack of human studies that investigated the impact of conditioned cues on instrumental responding although these processes are considered as core mechanisms contributing to the development and maintenance of addictive behaviours. No studies are available that assessed these processes with regard to Internet gaming or Internet shopping applications. We thus developed a Pavlovian-to-instrumental transfer (PIT)-Paradigm implementing appetitive stimuli related to Internet gaming and Internet shopping applications and investigated whether an outcome-specific PIT-Effect is observed. In addition, we assessed whether the problematic use of gaming or shopping applications, personality traits and stress would affect the acquisition of knowledge of the experimental contingencies during Pavlovian training and the impact of conditioned stimuli on instrumental responding. A PIT-Paradigm, screenings for Internet gaming disorder and Internet shopping disorder (s-IAT), and questionnaires on personality traits (NEO-FFI, BIS-15) and perceived stress (PSQ20) were administered to sixty-six participants. The PIT-Paradigm demonstrated the effects of stimuli conditioned to rewards related to Internet gaming and Internet shopping applications on instrumental responding to obtain such rewards. Findings also indicated that severity of problematic Internet gaming, but not Internet shopping, contributed to the acquisition of knowledge of the experimental contingencies. Stress, extraversion, neuroticism and gender emerged as further predictors. The strength of expectancy of the different reinforcers affected the 'gaming PIT'-Effect; however, none of the variables assessed in the present study showed any effect on the 'shopping PIT'-Effect. Future studies including participants with pathological use patterns that can be classified as internet use disorder are warranted to extend these findings.
Background and aims This review appraises the progression and status of the evidence base for the treatment of compulsive buying disorder (CBD), in order to highlight what currently works and to prompt useful future research. Methods Online databases ISI Web of Knowledge, PsycINFO, and PubMed via Ovid were searched at two time points. Two quality checklists and an established model of therapy evaluation (hourglass model) evaluated the quality and progression of both psychotherapy and pharmacotherapy treatments for CBD. Uncontrolled effect sizes were calculated and meta-regression analyses were performed regarding treatment duration. Results A total of 29 articles met the inclusion criteria, which were divided into psychotherapy (n = 17) and pharmacotherapy treatments (n = 12). Of the 29 studies, only 5 studies have been tested under conditions of high methodological quality. Both forms of treatment had been evaluated in a haphazard manner across the stages of the hourglass model. Although large effects were demonstrated for group psychotherapy and pharmacotherapy, such evidence of effectiveness was undermined by poor study quality and risk of publication bias. Long-term CBD treatment was associated with improved outcome with pharmacotherapy, but not when delivering psychotherapy. Discussion Group psychotherapy currently appears the most promising treatment option for CBD. Poor methodological control and sporadic evaluation of specific treatments have slowed the generation of a convincing evidence base for CBD treatment. Defining the active ingredients of effective CBD treatment is a key research goal.
At present, no treatment recommendations can be made for compulsive buying disorder. Recent studies have found evidence for the efficacy of psychotherapeutic options, but less is known regarding the best pharmacologic treatment. The purpose of this review is to present and analyze the available published evidence on the pharmacological treatment of compulsive buying disorder. To achieve this, we conducted a review of studies focusing on the pharmacological treatment of compulsive buying by searching the PubMed/MEDLINE database. Selection criteria were applied, and 21 studies were identified. Pharmacological classes reported included antidepressants, mood stabilizers, opioid antagonists, second-generation antipsychotics, and N-methyl-D-aspartate receptor antagonists. We found only placebo-controlled trials for fluvoxamine; none showed effectiveness against placebo. Three open-label trials reported clinical improvement with citalopram; one was followed by a double-blind discontinuation. Escitalopram was effective in an open-label trial but did not show efficacy in the double-blind phase. Memantine was identified as effective in a pilot open-label study. Fluoxetine, bupropion, nortriptyline, clomipramine, topiramate and naltrexone were only reported to be effective in clinical cases. According to the available literature, there is no evidence to propose a specific pharmacologic agent for compulsive buying disorder. Future research is required for a better understanding of both pathogenesis and treatment of this disorder.
Purpose:
In the present study, we investigated whether the relationship between identity confusion and compulsive buying (offline/online) and hoarding is mediated by materialistic value endorsement and depression.
Procedures:
The community sample consisted of 254 Flemish adults who completed self-report questionnaires to assess identity confusion (Erikson Psychosocial Stage Inventory), compulsive buying tendencies (Compulsive Buying Scale/short-Internet Addiction Scale, adapted for shopping), hoarding tendencies (Saving-Inventory Revised), materialistic value endorsement (Materialistic Value Scale), and depression (Patient Health Questionnaire-9).
Findings:
We found significant positive associations between identity confusion, compulsive buying, and hoarding. The association between identity confusion and compulsive buying was fully mediated by materialistic value endorsement; whereas depression mediated the association between identity confusion and hoarding.
Conclusions:
The results suggest that the collection or buying of material goods can be considered as identity substitutes.
Pathological buying (PB) is described as dysfunctional buying behavior, associated with harmful consequences. It is discussed whether decision-making deficits are related to PB, because affected individuals often choose the short-term rewarding option of buying despite persistent negative long-term consequences. We investigated 30 patients suffering from PB and 30 matched control participants with two different decision-making tasks: the Iowa Gambling Task (IGT) measures decisions under ambiguity and involves emotional feedback processing, whereas the Game of Dice Task (GDT) measures decisions under risk and can be solved strategically. Potential emotional and cognitive correlates of decision making were investigated by assessing skin conductance response (SCR) and executive functioning. In comparison to the control participants, the patients showed more disadvantageous decisions under ambiguity in the IGT. These data were supported by the SCR results: patients failed to generate SCRs that usually occur before disadvantageous decisions. The physiological and behavioral performance on decisions under risk and executive functioning did not differ between groups. Thus, deficits in emotional feedback processing might be one potential factor in etiology and pathogenesis of PB and should be considered in theory and treatment.
Copyright © 2015. Published by Elsevier Ireland Ltd.
Psychiatric classifications have traditionally recognized a number of conditions as representing impulse control disorders. These have included pathological gambling, intermittent explosive disorder, kleptomania, pyromania, and trichotillomania.
Objective
To examine reactive and regulative temperament in patients with compulsive buying (CB) by means of self-report measures and performance-based tasks and to explore the relationship between both measurement approaches.
Method
The study included 31 treatment-seeking patients with CB (25 women, 6 men) and an age and gender matched non-clinical control group without CB (CG). All participants answered the Compulsive Buying Scale (CBS). Reactive temperament was assessed using the Behavioral Inhibition System/Behavioral Activation System Scales (BIS/BAS) and the Iowa Gambling Task (IGT). Regulative temperament was measured using the Effortful Control subscale of the Adult Temperament Questionnaire (ATQ-EC) and a computerized version of the Stroop Task. To control the results for depression, the Patient Health Questionnaire-Depression Scale (PHQ-9) was administered.
Results
Crude group comparisons revealed higher BIS and BAS scores, poorer IGT performance and lower ATQ-EC scores in the CB-group compared to the CG. The groups did not differ in their performance on the Stroop task. After controlling for depressive symptoms that were significantly higher in the CB-group, only the group differences in BAS reactivity remained significant. No significant associations were found between questionnaires and performance-based tasks.
Conclusion
Overall, the findings indicate that CB in the present clinical sample of treatment-seeking patients was mainly associated with higher approach tendencies and more depressive symptoms. The lacking correlation between self-reports and performance-based tasks is in line with prior research and suggests that both methodologies tap into different aspects of temperament.
Compulsive buying has been associated with addiction, depression, and obsessive-compulsive disorder, as well as hoarding. The present study investigated the relationship that compulsive buying (CB) has with 'addictive' (i.e., sensitivity to reward), obsessive-compulsive, and depressive phenomena, after controlling for hoarding, substance dependence, manic, and Borderline Personality Disorder symptoms.
87 participants from a community population completed the online questionnaires for the study, however 70 participants (M=29.19, SD=10.45; 70% were female) were used in the analyses because of exclusion criteria.
As expected, CB measures correlated with hoarding, depression, sensitivity to reward, and, but less so, obsessive-compulsive measures. Sensitivity to reward was the most important predictor of CB severity, compared to obsessive-compulsive and depression symptoms. Hoarding was also an important predictor of CB severity.
Small sample size meant gender comparisons could not be made, and the use of a novel, communicated questionnaire meant that interpretation should be considered conservatively.
Overall, findings suggest that CB may be most closely related to the phenomena associated with addiction (an increased sensitivity to reward), rather than obsessive-compulsive or depression symptoms. Hoarding and reward sensitivity perhaps might separate compulsive buying from ordinary and recreational shopping.
Compulsive buying of consumer goods increasingly occurs in conventional shops and stores, but has also started to emerge when people buy online. Extending previous research (e.g., Dittmar, 2005a, b), a model of vulnerability factors is proposed whereby the endorsement of materialistic values predicts individuals' seeking to enhance their emotions and identity when they buy goods, which, in turn, predicts tendencies toward compulsive buying. This model is tested with respect to the Internet, a fast-growing alternative to conventional buying. A preliminary survey (n = 110) confirmed emotional enhancement and identity gains (in addition to economic concerns and efficiency) as distinct online buying dimensions. The findings of the main survey (n = 126) provided good initial support for the proposed model, showing that materialistic individuals who seek to enhance their emotions and identity when buying goods online reported the strongest tendencies toward compulsive buying on the Internet. Implications for intervention are discussed.
Obwohl das Phänomen pathologisches Kaufen zunehmend ins Forschungsinteresse rückt, wird es in der klinischen Praxis noch häufig übersehen. Unter pathologischem Kaufen werden zumeist sinnlose Kaufexzesse verstanden, die starken Leidensdruck verursachen und zu sozialen, beruflichen und finanziellen Problemen führen. Die aktuellen Klassifikationssysteme erlauben eine Einordnung als „nicht näher bezeichnete abnorme Gewohnheit oder Störung der Impulskontrolle” (ICD-10 F63.9). Pathologisches Kaufen ist assoziiert mit einer sehr hohen psychiatrischen Komorbidität, v. a. mit affektiven und Angststörungen, Zwangsstörungen, Binge Eating Störung, Substanzmissbrauch, Persönlichkeitsstörungen und anderen Impulskontrollstörungen. Bisherige Forschungsergebnisse haben gezeigt, dass ein Großteil der Patienten mit pathologischem Kaufen auch zwanghaft hortet. Bislang existieren keine evidenzbasierten Leitlinien zur Behandlung von pathologischem Kaufen und die Zahl der Behandlungsstudien ist gering. Offene Medikamentenstudien lassen zwar darauf schließen, dass Antidepressiva wirkungsvoll sein könnten, dies konnte durch einige wenige plazebokontrollierte Medikamentenstudien mit kleinen Fallzahlen jedoch nicht bestätigt werden. Zudem scheint die Plazeboresponserate beim pathologischen Kaufen hoch zu sein. Hingegen konnte die Wirksamkeit kognitiver Verhaltenstherapie bereits in zwei Efficacy-Studien nachgewiesen werden. Darauf basierende Empfehlungen für die psychotherapeutische Behandlung von Patienten mit pathologischem Kaufen werden gegeben.
Background: The 7-item Generalized Anxiety Disorder Scale (GAD-7) is a practical self-report anxiety questionnaire that proved valid in primary care. However, the GAD-7 was not yet validated in the general population and thus far, normative data are not available.
Objectives: To investigate reliability, construct validity, and factorial validity of the GAD-7 in the general population and to generate normative data.
Research Design: Nationally representative face-to-face household survey conducted in Germany between May 5 and June 8, 2006.
Subjects: Five thousand thirty subjects (53.6% female) with a mean age (SD) of 48.4 (18.0) years.
Measures: The survey questionnaire included the GAD-7, the 2-item depression module from the Patient Health Questionnaire (PHQ-2), the Rosenberg Self-Esteem Scale, and demographic characteristics.
Results: Confirmatory factor analyses substantiated the 1-dimensional structure of the GAD-7 and its factorial invariance for gender and age. Internal consistency was identical across all subgroups (α = 0.89). Intercorrelations with the PHQ-2 and the Rosenberg Self-Esteem Scale were r = 0.64 (P < 0.001) and r = -0.43 (P < 0.001), respectively. As expected, women had significantly higher mean (SD) GAD-7 anxiety scores compared with men [3.2 (3.5) vs. 2.7 (3.2); P < 0.001]. Normative data for the GAD-7 were generated for both genders and different age levels. Approximately 5% of subjects had GAD-7 scores of 10 or greater, and 1% had GAD-7 scores of 15 or greater.
Conclusions: Evidence supports reliability and validity of the GAD-7 as a measure of anxiety in the general population. The normative data provided in this study can be used to compare a subject's GAD-7 score with those determined from a general population reference group.
This study examined the extent to which patterns of mood and daily stress experienced by individuals with compulsive buying (CB) are associated with CB episodes by using Ecological Momentary Assessment. The comparison of mood and the impact of daily stress on days on which CB occurred to those days on which CB episodes did not occur did not reveal any significant differences. Within-day analysis indicated that negative affect increased significantly and positive affect decreased significantly prior to a CB episode. There was also evidence of a significant decrease in negative affect following a CB episode. Positive affect did not change significantly after a CB episode. The findings suggest that CB episodes hold negative reinforcing properties for individuals with CB. Treatment of patients with CB should focus on functional assessment of the affective antecedents and consequences of CB episodes and the identification of alternative, more functional behaviors to deal with these affective states.
The aims of the current study were to determine if compulsive acquisition behaviors are meaningfully related to quality of life and psychiatric work impairment and to determine if compulsive buyers who engage in 2 forms of acquisition (buying and excessive acquisition of free items) are more impaired than individuals who only engage in 1 form of acquisition. In a community-recruited sample, analysis of covariance conducted between groups identified as noncompulsive buyers (NCB) (n = 30), compulsive buyers who did not acquire free items (CBB) (n = 30), and compulsive buyers who also acquired free items (CBF) (n = 35) revealed that both acquisition groups reported higher levels of depression and stress and lower quality of psychological well-being than the NCB group, despite a comparable number of individuals self-reporting a current mental health disorder in each group. The CBF group reported higher levels of anxiety and general distress as well as greater work inefficiency days compared with the NCB and CBB groups. Furthermore, regression analyses supported the unique contribution of acquisition of free items to the prediction of psychiatric work impairment. Taken together, the findings highlight the serious impact of compulsive buying on work functioning, general quality of life, and psychological well-being and provide avenues for future research to investigate the role of acquisition of free items in symptom severity. Limitations and future directions are discussed.
Although drug craving has received considerable research attention over the past several decades, to date there has been no systematic review of the general clinical significance of craving. This paper presents an overview of measurement issues of particular relevance to a consideration of use of craving in clinical settings. The paper then considers the relevance of craving across a broad array of clinical domains, including diagnosis, prognostic utility, craving as an outcome measure, and the potential value of craving as a direct target of intervention. The paper is both descriptive and prescriptive, informed by the current state of the science on craving with recommendations for the definition of craving, assessment practices, future research, and clinical applications. We conclude that craving has considerable utility for diagnosis and as a clinical outcome, and that findings from future research will likely expand the clinical potential of the craving construct in the domains of prognosis and craving as a treatment target.
Compulsive buying (CB) is defined as extreme preoccupation with buying/shopping and frequent buying that causes substantial negative psychological, social, occupational and financial consequences. There exists preliminary evidence that group cognitive-behavioural therapy (CBT) is effective in the treatment of CB. The present pilot study made a first attempt to compare group CBT for CB with telephone-guided self-help (GSH). Fifty-six patients were allocated randomly to one of the three conditions: (1) group CBT (n = 22); (2) GSH (n = 20); and (3) a waiting list condition (n = 14). The results indicate that face-to-face group CBT is superior not only to the waiting list condition but also to GSH. Patients who received GSH tended to have more success in overcoming CB compared with the waiting list controls. Given the sample size, the results must be considered as preliminary and further research is needed to address the topic whether GSH also could be a helpful intervention in reducing CB. Copyright © 2011 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE: Group cognitive-behavioural therapy is effective in the treatment of compulsive buying and superior to telephone-guided self-help. Preliminary data suggest that individuals who received telephone-guided self-help reported some improvement in compulsive buying compared with a waiting list condition. Further research is needed to investigate whether guided-self help is effective in overcoming compulsive buying.
The aims of the study were to estimate the prevalence rate of compulsive hoarding, and to determine the association between compulsive hoarding and compulsive buying in a nationally representative sample of the German population (N = 2307). Compulsive hoarding was assessed with the German version of the Saving Inventory-Revised (SI-R; Frost, R.O., Steketee, G., & Grisham, J. (2004). Measurement of compulsive hoarding: saving inventory-revised. Behaviour Research and Therapy, 42, 1163-1182.). The point prevalence of compulsive hoarding was estimated to be 4.6%. Individuals with compulsive hoarding did not differ significantly from those without compulsive hoarding regarding age, gender, and other sociodemographic characteristics. Significant correlations were found between the compulsive hoarding and the compulsive buying measures. Participants with compulsive hoarding reported a higher propensity to compulsive buying than respondents without hoarding. About two thirds of participants classified as having compulsive hoarding were also defined as suffering from compulsive buying. In summary, these results suggest that compulsive hoarding may be relatively prevalent in Germany and they confirm the close association between compulsive hoarding and compulsive buying through the investigation of a large scale representative sample.
Compulsive buying (CB) has only relatively recently become a topic of interest for researchers and clinicians alike. This hiatus means that (unlike other impulse control disorders) there is currently little theoretical guidance for clinicians attempting to intervene with CB clients and no established model for researchers to evaluate, distil and refine. The current paper summarizes and organizes the main extant identified factors in the CB literature into four distinct phases: (1) antecedents; (2) internal/external triggers; (3) the act of buying; and finally, (4) post-purchase. The relationships and interactions between the identified phases are then hypothesized, within the proposed cognitive-behavioural model. The model distinguishes the key cognitive, affective and behavioural factors within each phase and identifies how CB can become self-reinforcing over time. The over-arching treatment implication is that CB can be re-conceptualized as chronic and repetitive failure in self-regulation efforts, and that psychological interventions can accommodate this in attempting to facilitate change. A successful case example is provided of a 'co-dependent compulsive buyer' using the model, with psychometric evaluation of key aspects of CB and mental health at assessment, termination and 6-month follow-up. The research and clinical implications of the proposed model are discussed, alongside identified short-comings and the need for psychological services to respond appropriately to CB clients seeking help.
Following damage to the ventromedial prefrontal cortex, humans develop a defect in real-life decision-making, which contrasts with otherwise normal intellectual functions. Currently, there is no neuropsychological probe to detect in the laboratory, and the cognitive and neural mechanisms responsible for this defect have resisted explanation. Here, using a novel task which simulates real-life decision-making in the way it factors uncertainty of premises and outcomes, as well as reward and punishment, we find that prefrontal patients, unlike controls, are oblivious to the future consequences of their actions, and seem to be guided by immediate prospects only. This finding offers, for the first time, the possibility of detecting these patients' elusive impairment in the laboratory, measuring it, and investigating its possible causes.
Compulsive buying is a probably common but little studied disorder. To further characterize this syndrome, the authors assessed 20 compulsive buyers.
Twenty consecutive psychiatric patients with problematic buying behavior characterized as (1) uncontrollable; (2) markedly distressing, time-consuming, and/or resulting in family, social, vocational, and/or financial difficulties; and (3) not occurring only in the context of hypomanic or manic symptoms were evaluated with structured diagnostic interviews. Family histories of psychiatric disorders and patients' responses to psychological and biological treatments were also assessed.
Nineteen (95%) of the compulsive buyers studied had lifetime diagnoses of major mood disorders. Sixteen (80%) had lifetime diagnoses of anxiety disorders, 8 (40%) had impulse control disorders, and 7 (35%) had eating disorders. First-degree relatives displayed a high prevalence of mood disorders. Nine (69%) of 13 patients receiving thymoleptics at the time of compulsive buying episodes reported reduction or remission of their buying symptoms.
Compulsive buying may cause significant psychological, interpersonal, and financial difficulties; may co-occur with other psychiatric disorders; may be treatable; and, thus, should be further studied as a mental disorder in its own right. To this end, preliminary operational criteria for its diagnosis are proposed.
A new scale to measure severity and change in persons with compulsive buying is described. Data were gathered during an open-label study in which compulsive buyers were treated with fluvoxamine, a serotonin reuptake inhibitor. The instrument showed good-to-excellent interrater reliability and high internal consistency. Its 10 separate items showed at least moderate correlations with the total score. The instrument was also sensitive to clinical change and correlated highly with other measures of illness severity. We conclude that this new instrument is both reliable and valid in measuring severity and change in persons with compulsive buying.
On a gambling task that models real-life decisions, patients with bilateral lesions of the ventromedial prefrontal cortex (VM) opt for choices that yield high immediate gains in spite of higher future losses. In this study, we addressed three possibilities that may account for this behaviour: (i) hypersensitivity to reward; (ii) insensitivity to punishment; and (iii) insensitivity to future consequences, such that behaviour is always guided by immediate prospects. For this purpose, we designed a variant of the original gambling task in which the advantageous decks yielded high immediate punishment but even higher future reward. The disadvantageous decks yielded low immediate punishment but even lower future reward. We measured the skin conductance responses (SCRs) of subjects after they had received a reward or punishment. Patients with VM lesions opted for the disadvantageous decks in both the original and variant versions of the gambling task. The SCRs of VM lesion patients after they had received a reward or punishment were not significantly different from those of controls. In a second experiment, we investigated whether increasing the delayed punishment in the disadvantageous decks of the original task or decreasing the delayed reward in the disadvantageous decks of the variant task would shift the behaviour of VM lesion patients towards an advantageous strategy. Both manipulations failed to shift the behaviour of VM lesion patients away from the disadvantageous decks. These results suggest that patients with VM lesions are insensitive to future consequences, positive or negative, and are primarily guided by immediate prospects. This 'myopia for the future' in VM lesion patients persists in the face of severe adverse consequences, i.e. rising future punishment or declining future reward.
Compulsive buying is a disorder that has begun to receive attention from researchers in recent years. The results of a handful of studies suggest that compulsive buying occurs in response to negative emotions and results in a decrease in the intensity of the negative emotions. In this investigation, we used interview and self-monitoring methods to evaluate the antecedents and consequences of compulsive buying in a sample of women who met criteria for compulsive buying on the compulsive buying scale (J. Consumer Res. 19 (1992) 459). As a group, the participants reported negative emotions as the most common antecedents to compulsive buying, and euphoria or relief from the negative emotions as the most common consequence of compulsive buying. These findings were consistent across the interview and self-monitoring assessment methods. The implications for assessment and treatment are discussed.