Let’s Stop Smiling at the Smiled-Upon Addiction

A piece for Paradigm magazine by April Lane Benson. Click here to access the complete issue online. 

Whoever said that money can’t buy happiness didn’t know where to shop.

Shopping makes for easy jokes. This post-it version hints at shopping as panacea, a magical elixir that promises more than it could ever deliver. Retailers seize any opportunity to prey on this fantasy. One of the most fashionable stores in New York City unabashedly mailed postcards to its customers, inviting them to a “psychotherapy sale,” urging them to bring in their emotional baggage to fill with mood-enhancing bargains. “Get in touch with your inner shopper,” the store beckoned.

Whether it’s the overpromising post-it, a tongue-in-cheek postcard, or the bumper stickers that boast “When the going gets tough, the tough go shopping” and “Shop ‘til you drop!”— shopping stereotypes are quick fodder for a laugh. All this comedy underscores a strongly mixed cultural message: shopping, however important to our economy, is silly and superficial, as is anyone who passionately pursues it.

Though often referred to as the “smiled upon addiction”, after all, ­our economy is fueled by overconsumption, compulsive buying disorder is no laughing matter. It can and often does have serious, long-lasting aftershocks. In addition to the obvious financial consequences, emotional, interpersonal, and occupational problems abound; in extreme cases, incarceration and suicide have occurred. Despite the fact that compulsive buying disorder has been inching its way farther and farther out of the closet, research interest in this widespread, often addictive, disorder is still in its infancy. Compared to its psychological siblings—eating disorders, substance abuse, and gambling disorder—research interest in effective treatment for compulsive buying has been extremely limited and relatively few therapists and clinics screen for this problem.

What is Compulsive Buying Disorder?

Compulsive buying disorder is broadly and formally defined as a maladaptive preoccupation with buying or shopping, characterized by irresistible, intrusive, and/or senseless impulses and behaviors, or results in frequent buying of more than can be afforded, frequent buying of items that are not needed, or shopping for longer periods of time than intended, even in the face of adverse personal, social, and financial consequences (McElroy et al., 1994). In short, the compulsive buyer is a person who allows shopping to destructively deflect resources—whether of time, energy, or money—from the fabrication of everyday life.

Prevalence and Subtypes

A large-scale telephone survey of over 2,000 randomly selected U.S. households suggested that 5.8%—approximately 17 million Americans—may demonstrate symptoms of compulsive buying disorder (Koran et al., 2006). Particularly noteworthy about this study was the fact that the 5.8% whose responses were suggestive of compulsive buying disorder were almost evenly divided between the two genders. A later study examined the prevalence of compulsive buying disorder in three narrowly defined subgroups and concluded that the prevalence of compulsive buying disorder may be even higher (Ridgway et al., 2008). Despite the variations in percentages and sample populations, such studies unequivocally demonstrate that compulsive buying is extremely prevalent in the United States.

Evidence that compulsive buying is a grave and worsening problem is mounting. In the only longitudinal study to date, Neuner et al. (2005) reported that the frequency of compulsive buying in Germany increased significantly between 1991 and 2001, following the fall of the Berlin Wall, attributing this rapid rise, in part, to the acculturation process brought by reunification. While compulsive buying is considered a culture-bound syndrome that occurs mostly in cultures that offer “mushrooming credit facilities and boundless buying opportunities,” globalization and the internet have greatly extended its reach. Either scholarly or popular articles have been written about compulsive buying on every continent but Antarctica. Visitors from over 125 countries have visited my website (www.shopaholicnomore.com); compulsive buying is a nearly universal problem.

An accurate conception of the “typical” compulsive buyer remains elusive. Like other addictions, shopping addiction is complex and multi-determined, and the spectrum of compulsive buyers is wide, reflecting a set of people who differ from one another in age and gender, in socioeconomic status, in the intensity of their compulsion, and in underlying motivation. Compulsive buyers also differ in their patterns of buying. Some are compulsive daily shoppers, some go on occasional but consequential shopping “binges,” and some collect compulsively. There are image spenders, revenge spenders, bulimic spenders (who need to rid themselves of their money), and codependent spenders (who enable the spending of others). Some buy multiples of each item, some compulsively hunt for bargains, others are compulsive hoarders, and still others engage in ceaseless buy-return cycles. This diversity suggests that efforts to capture the essence of the archetypal overshopper are likely to be fruitless.

Why Overshop?

American culture is one of “competitive consumption,” in which the acquisition of consumer goods and services is associated with the attainment of happiness. Women are taught that a flattering outfit or the perfect hair care product will make them irresistible to men, while men come to believe that purchasing a sports car attests to their masculinity and success. The false belief that goods are transformative agents becomes toxic when combined with the over-availability of credit cards.

Many shopaholics seek and achieve emotional relief and momentary euphoria through compulsive buying. Some overshop in response to loss or a major life trauma, to avoid confronting something important, or to feel more in control. Others overshop to express anger or exact revenge, or use buying for others as a way to hold onto love. Still others overshop to belong to an appearance-obsessed society or to put forth an image of wealth and power. Underlying many of these motivations is an attempt, albeit ultimately unsuccessful, to gain social status or move closer to what they believe is a better or ideal self. It’s an attempt to bridge the gap between how they see themselves, how they wish to be, and how they wish to be seen (Dittmar, et al., 2007). Compulsive buyers experience a higher than normal rate of associated disorders—depression, anxiety, substance abuse, eating disorders, and impulse-control disorders—and may be using their overshopping to self-medicate.

Challenges for the therapist

Even as our marketing-intensive culture has elevated retail seduction to a high art, shopping is simultaneously discouraged and devalued. We therapists are hardly immune from this institutionalized ambivalence about shopping and spending. While I’ve studied, researched, and treated compulsive buyers for nearly twenty years, it’s been extremely difficult to attract enough therapists to develop a specialty in working with compulsive buyers to adequately serve this under-recognized population is adequately served. Why?

Until I developed a specialty in the treatment of compulsive buying, my own clinical experience reflected that of my colleagues i.e. that it is unusual for someone to refer him or herself for treatment for a compulsive buying problem. Typically the compulsive buyer is referred by a financial counselor, lawyer, law enforcement officer, family member, or spouse. It’s normally not until overshoppers incur large amounts of debt, experience repeated conflicts with family members about spending, encounter legal or criminal problems related to their buying, or begin to see their behavior being repeated by their children that they look for help. Much more frequently, a compulsive buying problem reveals itself in the course of ongoing psychotherapy, either directly, in the context of financial independence and responsibility issues, relationship or parenting problems, or difficulties at work. Compulsive buying may also present itself indirectly in therapy: a patient may wear something new or different to every session, arrive with shopping bags week after week, repeatedly give gifts to the therapist, or fall behind in paying the bill. Often, a patient will enact several of these behaviors simultaneously.

Unless a therapist thinks to ask relevant questions, he or she is very likely to miss the problem altogether.Inquiring about finances, debt, and about the acquisition and disposal of possessions will invite these issues into the room, although many therapists are afraid that if they ask such specific and targeted questions that their clients will flee. We might also under-inquire because we haven’t examined our own money scripts, those unconscious and unexamined beliefs about money that lead to our own self-limiting money behaviors and keep us blind to those of our clients. (Klontz, et al., 2008).

For example, an overspending therapist may join with the client and unconsciously reinforce his or her justifications for overspending. Alternatively, because of early money messages that revered scarcity, a therapist may be overly harsh once a client’s overspending has been brought to light. We may feel hostility toward a client who treats us as an “object” or just another “hired hand,” rather than a collaborator. As members of a humanitarian profession, some of us don’t feel entitled to be paid adequately for our services and feel conflicted about acquiring status and expensive possessions. More often, though, we want success, approval, wealth, and comfort as much as most Americans and contend with the same acquisitive pressures as our overshopping clients.Feelings of envy, jealousy, competitiveness or idealization may be inevitable when a client is wealthy or more comfortable around money than we are. We might silently belittle and judge a client as shallow and superficial, all the while denying our distaste for the parts of ourselves that wish we had the client’s financial resources. We need to remember that we don’t always adhere to the more enlightened values that we would like to help our clients move towards. The opportunity to discover parts of ourselves we were only vaguely aware of is some of what makes this work so rich and so fascinating.

Treatment

While a number of different forms of treatment with compulsive buyers have been reported since the late 1980’s, the only randomized controlled treatment studies for compulsive buying have been of drug therapy and group therapy. Among drug treatments, the results have been equivocal. Two identically designed studies, done at the same medical school, showed contradictory results and much of the rest of drug treatment reported is based on only one or two cases (Black, 2007). Group therapy provides the most consistently positive evidence of successful treatment. The results of three randomized controlled trials (Mitchell et al., 2006, Mueller et al., 2008; Mueller et al., 2012), using the same cognitive behavior therapy 12-week group treatment for compulsive buying, suggested that the treatment was effective in significantly reducing compulsive buying behavior and that these gains held at six months. In a recently published study (Benson, et al., 2014), my colleagues and I were able to quantify the efficacy of the Stopping Overshopping program, a 12-week group experience that integrates aspects of cognitive and dialectical behavior therapy, psychodynamic psychotherapy, psycho-education, motivational interviewing, acceptance and commitment therapy, and mindfulness.

The Stopping Overshopping Program

Following the publication of I Shop, Therefore I Am: Compulsive Buying and the Search for Self (2000), I began to hear from compulsive buyers, their loved ones, their therapists, and sometimes even their lawyers, and began to be known as someone who specialized in working with compulsive buyers. Over the next five years, I developed a treatment program, using techniques that had proven effective when I had worked with people with eating disorders and incorporated other tools and strategies that had proven efficacy in helping people with other addictions.

I’ve used the program, published as To Buy or Not to Buy: Why We Overshop and How to Stop (2008), with individuals and groups for the last nine years; it teaches specific skills, tools, and strategies that help compulsive buyers break the cycle that leads to compulsive buying and develop the capacity to lead a richer life in the process. A detailed description of the model can be found in Benson & Eisenach (2013). As I came to see changes, sometimes small, often enormous, in my own clients and the clients of the therapists that I trained, I decided that it was time to test the model empirically and see if my subjective experience of it’s efficacy would be confirmed by objective measures. In 2010, we embarked on a pilot randomized controlled trial that compared the efficacy of this model with a waiting list control group. Results showed significant improvement on all compulsive buying measures. In fact, scores improved from levels solidly in the compulsive buying range to scores that were solidly in the normal buying range. The amount of money and time spent, and the number of compulsive shopping episodes were also significantly reduced. All these improvements were well-maintained at six-month follow-up. (Benson, et al., 2014).

 Considered the smiled upon addiction because consumption fuels our economy, compulsive buying is too often under-recognized, under-diagnosed, and under-treated. As the growing body of research suggests, the severity and frequency of compulsive buying symptoms can be addressed clinically to great effect and scores of overshoppers have told me, over the years, what a relief it has been to find specialized, effective treatment for this problem. It’s been a hard sell to the mental health community, though. Isn’t it time that we, as counselors and therapists who work with people with addictions, start offering shopping addicts effective help that they can usefully buy into?