'Shoppingitis': A new disease?

In the Philippines, where three of the 10 biggest malls in the world are found, shopping is undeniably a national pastime. And, of course, we all shop, especially now during this holiday season. In that simple fact, experts say, lies the difficulty of distinguishing the avid shopper, or even the occasional excessive shopper, from the shopper who is out of control.

The fact is, for every one out of 20 people, shopping is a problem. A study published in the October 2006 issue of the American Journal of Psychiatry found that at some point in the lives of an estimated 5.8 percent of the US population, shopping will become a source of shame, a cry for help, the cause of job losses and broken relationships, a road to financial ruin. They are “compulsive buyers” — troubled by intrusive impulses to shop, prone to lose track of time while doing so, plagued by post-purchase remorse, guilt and financial woes, and sometimes given up by loved ones. And as the drumbeat of the depressing economic indicators accelerates, they are a group coming out of the closet!

“I get several calls a month from people who say, “I don’t know what you call it, but this is out of control,” says psychiatrist Timothy Fong, director of the Impulse Control Disorders Clinic at the University of California in Los Angeles. For the truly addicted shopper, Fong says, “it’s not lack of willpower” that makes him or her unable to stop shopping. “It’s an inability to control impulses and desires and behaviors.”

Mental health professionals are actively debating how to label and treat these consumers’ problematic behavior. As they do so, clinics, self-help groups and therapists specializing in the care and rehabilitation of compulsive shoppers are popping up across the country like so many specialized boutiques. In the last five years alone, Stanford University and UCLA have established treatment programs for those who report out-of-control shopping. They have found no shortage of patients.

Meanwhile, Debtors Anonymous, a self-help group modeled after Alcoholics Anonymous, has seen an uptick of attendance at its meetings in recent years — a measure both of hard economic times and people’s inability to curb their spending habits accordingly.

Is it a disorder?

There is little doubt that compulsive shopping can cause severe impairment and distress — two key criteria for formal recognition as a mental disorder. “You don’t want to medicalize normal behavior,” says Eric Hollander, MD, chairman of psychiatry at the Mount Sinai School of Medicine in New York. But a small percentage of consumers, he says, seem to suffer from “a profound deficit” in the ability to resist their impulse to shop, despite negative consequences. For those people, Hollander says, the term disorder “seems to fit.”

In the boom times, these shoppers’ passion for purchasing can be dismissed as a pricey hobby or hidden like so many unopened shopping bags in a closet. In times of economic downturn, an uncontrolled yen for shopping becomes an addiction that few can afford to deny. “In hard times, people’s money may be tighter so it might cause functional impairment at an earlier stage,” says Hollander. In fact, for a true compulsive buying, rising food costs and gas prices might even trigger a perverse reaction: Stressed by financial difficulties, many problem consumers will escape their worries with a shopping trip.

A gender divide?

If those seeking treatment are any gauge, compulsive shopping is an overwhelming female condition. Some 80 percent of those who come forward, experts say, are women. But, there’s every reason to believe that men are just as likely to buy compulsively, says Lorrin Koran, MD, professor of psychiatry at Stanford, who wrote the 2006 study gauging the prevalence of problem shoppers in the United States. It’s just that “men don’t come for help,” he says.

For both men and women, purchases bring a rush of relief from uncomfortable feelings: Patients frequently describe a “rush” of arousal and a release from the unpleasant feelings that generally build in the hours and days before a shopping expedition, says Koran. Indeed, brain-imaging studies have shown that even in normal subjects, anticipating a purchase prompts activity in many of the same pleasure-seeking circuits that are activated when addicts find a “fix.” But disinterest, guilt, and remorse tend to set in quickly. Purchases are often stowed in the back of a closet, their price tags never removed. The resulting ill feeling builds again, and a compulsive shopper will frequently feel the need for another shopping fix. The cycle continues.

Treatment

But it can be broken, says New York therapist April Lane Benson, author of the book I Shop, Therefore I Am. Since 2005, participants in her group psychotherapy sessions have kept journals and shopping lists that track their moods, their impulses, and their household needs. When contemplating a purchase, Benson’s patients record their answers to questions such as these: Why am I here? How do I feel? Do I need this? What if I wait? How will I pay for it? Where will I put it?

For compulsive buyers, Benson believes that losing control is a chronic vulnerability. But with rigorous self-examination, she said, “I don’t think it’s as hard as people think” to break the spell that shopping seems to cost. “People have to understand what their triggers are, what the emotional aftermath is, what happens after the bill comes. And they have to think about what their values are and their vision in life.”

Los Angeles psychotherapist Eileen Gallo, co-author of The Financially Intelligent Parent, has led many shopping-addicted patients into the light. The road to solvency, says Gallo, starts with a journey of self-discovery. When shopping begins to cause marital discord, missed appointments, and financial woes, Gallo says, “It’s time to take a look inside and find out the motivation for the behavior. Some shop just to fill themselves up, and of course it doesn’t last long.

While psychotherapy appears to help, treating other co-existing psychological problems with medication and therapy is widely viewed as essential. Preliminary studies have found that antidepressants that increase the availability of the neurochemical serotonin in the brain can ease shopping compulsion. And naltrexone, a drug that blunts the inebriating effects of alcohol, has shown modest effectiveness in curbing the urge to shop.

Is it a true disease?

So, is compulsive shopping a biologically driven disease of the brain, a learned habit ran amok, an addiction in its own right or a symptom of other dysfunctions — most notably depression — that so often accompany it? Where is the line between avid shopping and compulsive shopping? Is it really true illness?

Compulsive buying is not recognized as a disorder by the mental health profession’s guidebook, the Diagnostic and Statistical Manual of Mental Disorders, generally called DSM. That might change soon, as psychiatrists draft the next version of the DSM, due out sometime after 2010.

In anticipation, researchers and academic practitioners are debating what the cause of such a condition might be, how widespread it is, and how best to diagnose, characterize, and treat it. A decision to adopt compulsive shopping as a diagnosis would spur new research on the phenomenon and very likely escalate what is now a modest search by pharmaceutical companies for drugs that could curb its symptoms.

It will also raise ethical issues about the nature of “behavioral addictions” — a catch-all term that includes Internet addiction, hypersexuality, and compulsive gambling. Preliminary evidence suggests that these “behavior addictions” involve malfunctions in many of the same brain circuits — those involved in arousal and reward-seeking behavior, deferral of gratification and repetitions of actions that result in harm. All are expected to be considered for inclusion in the coming DSM.

Shoppingitis? Whatever it will be finally called, I’m sure you and I already know a lot of Filipinos afflicted with this disorder!