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Problem Shopping

People with problem shopping are often preoccupied with buying, have re-occurring buying episodes and urges to buy.1 This can lead to social, family and financial difficulties.2 Problem shopping can co-occur with problem gambling3 and technology use4–7; therefore when seeing clients with gambling or technology use problems, it is important to be informed of the screening, assessment and treatment options for problem shopping.


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Gambling, Gaming & Technology Use
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Problem Shopping

People with problem gambling or technology use may experience co-occurring problem shopping.1,3–8 Problem shopping is a condition that shares many similarities with problem gambling and technology use9,10 and can negatively affect social, family and financial well-being.2 It is therefore crucial to provide early screening, assessment and treatment for clients with problem shopping.

This webpage looks at the evidence on screening, assessing, and treating people with problem shopping; the links with problem gambling and technology use; and ways to apply the evidence in your clinical practice. The content on this webpage is based on a review of the evidence and was reviewed by an expert in the field of problem shopping and problem gambling, gaming, and technology use.


About problem shopping

Problem shopping is also known as compulsive buying disorder, compulsive buying behaviour, or shopping addiction.10

People with problem shopping are preoccupied with purchasing, have re-occurring purchasing episodes and experience overwhelming urges to purchase1. Problem shopping often leads to social, family and financial difficulties and can also lead to legal and criminal problems.2,8,11 Purchasing, whether for themselves or for loved ones8, is commonly associated with an instant feeling of pleasure, excitement, or relief, followed by shame and guilt.1,2 Problem shopping may not just include purchasing goods, but also services (e.g., massages, cosmetic procedures, etc.) and experiences (e.g., concerts, vacations).12

As with problem gambling, problem shopping tends to start early in life and frequently co-occurs with other mental health problems such as substance use, mood and anxiety disorders.9,10

Neither the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)13 nor the International Classification of Diseases, 11th Revision (ICD-11)14 has problem shopping as an official diagnosis. However, McElroy and colleagues proposed a set of criteria for diagnosis that is widely accepted in the clinical literature:15,16

Maladaptive preoccupation with buying or shopping, or maladaptive buying or shopping impulses or behaviour, as indicated by at least one of the following:

  • frequent preoccupation with buying or impulses to buy that is/are experienced as irresistible, intrusive and/or senseless
  • 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

The buying preoccupations, impulses or behaviours cause marked distress, are time consuming, significantly interfere with social or occupational functioning, or result in financial problems (e.g. indebtedness or bankruptcy).

The excessive buying or shopping behaviour does not occur exclusively during periods of hypomania or mania.6,17

Despite the acceptance of these criteria, there is still an ongoing debate in the literature about whether to classify problem shopping as an impulse-control disorder or behavioural addiction, and how to accurately identify and measure symptoms in a standardized way.1


What does the evidence say?

Worldwide, about five to eight per cent of people have a shopping problem.6,11,18–20 Some studies have shown that females and younger people are more likely to experience problem shopping, but this has been an inconsistent finding across studies.18 Problem shopping typically starts early in life,9,10 generally between 20 and 30 years of age.1,2,18

Problem shopping co-occurs with problem gambling3 as well as problem technology use.4–7 It also co-occurs with other mental health problems, including anxiety, depression, substance use disorders, obsessive-compulsive disorder, personality disorders, eating disorders, and compulsive hoarding.1,8,19

Research shows that people may use problem shopping as a coping strategy to improve negative mood states or self-esteem.8 Problem shopping can also be influenced by today's consumer culture, including credit card availability, easy access to purchasing means (e.g., in-person and online), a high prevalence of advertisements, and the amount of free time and disposable income.1,6,11,19

Cognitive-behavioural therapy (CBT) is the most widely studied treatment for problem shopping to date. Group CBT was found to decrease problem shopping symptoms,21,22 buying episodes,21 time and money spent shopping,21 as well as depressive symptoms.23 A study of individual CBT showed that about half of participants did not have a relapse during the 12 weeks of treatment.24

Guided self-help programs have also shown some promise for treating clients with problem shopping. One guided self-help program that offered a self-help manual modelled after a CBT protocol21 as well as five group phone sessions with a therapist over the course of 10 weeks lowered problem shopping symptoms.23 Another guided self-help program in which participants took part in 12 weekly group sessions, either in-person or over the phone, and received a self-help manual, two journals, and a support partner decreased the severity and number of problem shopping symptoms to non-clinical levels at 6-months' follow up.25 It also decreased the amount of time and money spent shopping, as well as the number of problem shopping episodes.25

Additional supports that may be helpful for people with problem shopping include financial/credit counselling, 12-step programs (e.g., Debtors Anonymous), couples/family therapy, support groups, and engagement in meaningful activities.6,19

While there have been case studies and small-scale randomized controlled trials evaluating the use of various medications to treat problem shopping, no best practice recommendations can be made due to limited studies and inconsistent study quality.26

The presence of concurrent disorders has been shown to negatively affect treatment outcomes24, therefore it is important to consider any co-occurring mental health problems when planning and providing treatment, and to work with all healthcare providers to provide coordinated care for clients.1

Putting the evidence into practice


Screening and assessment

When screening a client for problem shopping, explore their shopping behaviours, reasons for shopping, their feelings and thoughts, and the consequences of problem shopping.27,28 Validated clinical screening tools for problem shopping include:

  • Compulsive Buying Measurement Scale (also referred to as the Canadian Compulsive Buying Measurement Scale)29,30
  • Compulsive Buying Scale31,32
  • Edwards Compulsive Buying Scale15,33
  • Richmond Compulsive Buying Scale15,34
  • Survey on Compensatory and Addictive Shopping Behavior35

To assess whether your client's problematic behaviour can be better explained by another disorder, conduct a full psychiatric and medical history.6,19 Your assessment should look for problematic shopping behaviours that arise during mania or hypomania in bipolar disorder8,28; compulsive hoarding as part of obsessive-compulsive disorder28; purchasing behaviours based on delusions in psychosis28; and medical conditions such as tumours or neurological conditions that can cause problem shopping behaviours.6 Treatment of these underlying conditions may resolve the problem shopping behaviours.

Your assessment should also look for co-occurring disorders to determine whether you need to refer your client for other mental health services. If your client is receiving mental health treatment from another provider, it is important to coordinate their care and ensure treatment approaches and goals are aligned.1


Treatment

When developing your client's treatment plan, take into consideration co-occurring mental health problems as these may negatively affect treatment outcomes.24 You should also discuss with your client  how to manage external triggers that can contribute to the problem shopping behaviour, including exposure to advertisements, access to credit cards and disposable income, and stressful situations.1,6,11,19


Cognitive-behavioural therapy

You can offer your clients CBT, since this has been effective in addressing problem shopping.21,26 When offering group or individual CBT sessions to your client, consider including the following topics:

  1. Treatment overview (i.e., defining problem shopping and treatment goals)
  2. Identifying problem buying behaviours, and the reasons for and against changing behaviour
  3. Cues and consequences (i.e., what leads to and results from problem shopping)
  4. Cash/credit card management, and hoarding
  5. Responses: thoughts, feelings and behaviours
  6. Restructuring thoughts
  7. Cues and chains (i.e., recognizing and interrupting patterns of behaviour that lead to problem shopping)
  8. Self-esteem
  9. Exposure, response prevention (i.e., planned and repeated exposure to shopping triggers such as a favourite store)
  10. Stress management and problem solving
  11. Relapse prevention and relapse plan
  12. Summary and outlook.21,26,36

 

It may be beneficial to offer your client group CBT to address feelings of loneliness and ambivalence towards change. These feelings can also be addressed through group self-help programs.37

Guided self-help programs

You can refer your client for guided self-help programs available in your local area or online, since they have shown some success in managing problem shopping.23,25

You can also incorporate elements of these programs into your own practice, including encouraging your client to track mood states and shopping behaviours through journalling and/or helping your client to identify a responsible shopping partner.25,37

Other treatment options

If your client expresses relationship difficulties as a result of problem shopping, consider offering or referring your client for couples or family therapy.6,19

Depending on the degree of debt resulting from problem shopping, clients may also benefit from financial/credit counselling or joining a 12-step program such as Debtors Anonymous.6,19

In addition, consider working with your client to schedule and look for opportunities to engage in meaningful activities6,19, since shopping typically occurs during leisure time.


Additional resources


References

Last modified: January 16, 2019

This information is intended to help clinicians in their use of evidence-informed practice (EIP) when screening, assessing, and treating clients with behavioural addiction(s). Evidence-informed practice, sometimes called evidence-based practice, is a client-centred approach to clinical decision making. It’s a way to solve problems by integrating the best available research evidence with the clinician’s experience, the client’s preferences and values, and the organizational and cultural context.1,2,3,4