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Arielle Ingber Mr. Gaffigan Senior Capstone April 20, 2009

In America today, we are especially cognizant of those individuals who are obsessed with buying, obsessed with acquiring more goods, and obsessed with pumping money into the shopping economy. We all know the distinctive personality the woman who hears the television advertisement for the Macys shoe warehouse sale, at a location far away from her home, who immediately changes her daily schedule to attend the sale. Needless to say, she does not need another pair of shoes, but nonetheless adjusts her schedule to make it to the sale and cannot resist the impulse to shop. Though familiar to many, this trait may sound unknown to some. These characteristics, however, are symptoms to a very real problem for hundreds of thousands of Americans. This compulsive need to shop affects the lives of many Americans in ways not dissimilar from alcoholism and drug addiction. HISTORY OF COMPULSIVE SHOPPING Compulsive shopping, though not discussed as such, is a serious epidemic. However, the problem of compulsive shopping did not just come about recently. Mental health professionals have been discussing and dealing with the issue of compulsive shopping since the start of the 20th century. In 1915, Emil Kraeplin, a well-known German psychiatrist, was among the first to identify oniomania buying mania. Kraeplin mentioned it in the eighth edition of his textbook of psychiatry (Hemler 15). For almost a century, compulsive shopping has been a topic of discussion and a topic of controversy. Eugene Bleuler, another prominent psychiatrist at the start

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of the 20th century, identified compulsive shopping by describing it as reactive impulsive or impulsive insanity (Black 14). It was not until Kraeplin and Bleuler reported publicly on these issues that compulsive shopping became known as a clinical disorder. Several decades went by in the 20th century with little to no clinical recognition, with the exception of consumer behaviorists and psychoanalysts. Much later along, in the early 1990s, interest in the disorder of compulsive shopping revived when clinical case studies from three independent research groups appeared (University of Cincinnati College of Medicine, University of Iowa College of Medicine, and the University of Minnesota Department of Psychiatry). The disorder has now been recognized worldwide, with important research work in the United States, Canada, England, Germany, France, and Brazil (Black 14). The quickly escalating consumerism in the developed nations brought the issue of compulsive shopping to the forefront of new medical research. It was both shocking and impressive to many to see such developed nations, like the United States, detailing the effects and intricacies of compulsive shopping within its own borders. For so many decades, the American people were supported by their communities and the government in the ideology of a material world (Catalano 39). Americans were taught to measure success on the basis of we are what we have and possess (Benson 76). Thus it was truly shocking, yet even impressive, to see prominent research facilities within American universities shedding light on an issue that so deeply affected, and still affects, so many in this nation. Although compulsive shopping has never been fully identified by the Diagnostic Statistical Manual as a disorder, it was still frequently mentioned in early articles throughout the 20th century and newspaper reports. Some people thought the idea of shopping as a disorder was

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simply absurd. The fact that shopping could actually be a disorder has been ridiculed by many on the basis that it places blame somewhere other than the person doing the actual shopping. In an article in Newsweek in 1985, the author asked: Compulsive shopping? Youve got to be kidding, Is that the answer to the latest trivia-game question on trendy addictions? It may sound absurd, but to the shopper who cant stop at the hosiery counter without blowing a cold $100, the obsession is no joke. Thousands of Americans are caught in the grip of shopping madness, flocking to malls and boutiques across the land. Mental health experts acknowledge that the problem is still relatively unexplored, but many believe it is widespread (Hemler 22). The release of this 1985 article in a mainstream, national magazine represented a transition in a change of perception for America. For a country that was so quick to dismiss addiction as something outside its own borders, this article confronted the realities and tendencies of a widespread behavior. The notion of compulsive shopping became more and more normative in the late 1980s and early 1990s. In the last 20 years many articles and books have been published, describing the fact that compulsive shopping is not a joke. As Jennifer Hemler suggests, this Newsweek article set the stage for compulsive shopping to emerge as a disorder (22). BACKGROUND & SYMPTOMS OF COMPULSIVE SHOPPING Before one can fully understand the symptoms of compulsive shopping, one must be able to recognize the context of the disorder, or the specific reasons behind the compulsive addiction.

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In Consuming Passions: Help for Compulsive Shoppers, the authors determined eight specific reasons why people shop. The eight most common impulses of compulsive shoppers are: (1) To elevate sense of self-worth; (2) Diversion; (3) To vent hostility; (4) To fill a void of loneliness; (5) To compensate deprived feelings; (6) Immediate gratification; (7) To relieve depression; (8) Perceived loss of control (Catalano 71). These eight various explanations reflect the fact that everyone shops for a different reason. In some cases, people shop for themselves, but in other cases, people buy for their family members and friends. Either way, excessive and impulsive shopping leads to many problems for the individual doing the shopping, as well as those around the individual. In support groups and studies on compulsive shopping, there appears to be a commonality in the childhood of the shoppers. While compulsive shopping may develop during adulthood, it is usually derived from experiences in the past. Some childhood prototypes that can cause a spending addiction are: a withholding father/overprotective mother, a sexually abused child, the loss of a mother, or an addicted parent. For many of these shopaholics with one of these formative childhoods, shopping becomes a form of escape and release (Damon 36). Even with two decades of research, there is not one clear, identified, causative reason as to why people shop impulsively and compulsively. This lack of clear reasoning may explain why the disorder is still not universally recognized among mental health professionals. Psychiatrists around the nation, even around the globe, seem to be able to agree on the symptoms of the disorder although each cases symptoms differ slightly. Some who are compulsive shoppers get a thrill of feeling like nothing else simply when he or she walks into a store. Sophie Kinsella, bestselling author of Confessions of a Shopaholic, writes about her

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fictional character, Rebecca Bloomwood, a compulsive shopper. As Kinsella describes Rebecca Bloomwood entering a store, it is clear that Kinsella did a great deal of research on the actual urges and feelings of this compulsion so as to appropriately describe the feelings of intensity to the reader: As I walk into Smiths I feel my whole body expand in relief. Theres a thrill about walking into a shop any shop which you cant beat. Its partly the anticipation, partly the buzzy, welcoming atmosphere, partly just the lovely newness of everything. Shiny new magazines, shiny new pencils, shiny new protractors. Not that Ive needed a protractor since I was eleven but dont they look nice, all clean and unscratched in their packets? Theres a new range of leopard-print stationery that I havent seen before, and for a moment Im almost tempted to linger. But instead I force myself to stride on past, down to the back of the shop where the books are stacked (Kinsella 81). Rebecca Bloomwood so accurately reflects the intricacies of obsessive shopping disorder. As a young professional, she recognizes that she is so drawn to an item that she does not even have a use for in her daily life. That said, she still feels the temptation to linger in a section of a store that is of no use to her. These urges may be difficult to comprehend by non-compulsive shoppers, but Kinsella details the symptoms perfectly in her depiction of Rebecca. Although the book is fiction, the images and feelings that Rebecca is living through are as if this story was an entirely true one. One important element to note in Rebecca Bloomwoods case, however, is that unlike most obsessive shoppers, Rebecca is able to identify her own symptoms. Unlike most

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shoppers, including even herself in most cases, Rebecca stride[s] on past, down to the back of the shop (Kinsella 81). The anticipation that the compulsive shopper above felt in the store is a real phase of compulsive shopping. There are four separate phases of compulsive shopping disorder, as detailed by Donald Black of the Department of Psychiatry at the University of Iowa. These phases are: (1) Anticipation; (2) Preparation; (3) Shopping; (4) Spending (Black 15). As Kinsella writes of the anticipation phase of Rebecca Bloomwood as she enters a store, so too can Rebecca serve as a depiction of the second, third and fourth phases of this disorder as well. If Rebecca were to have thoughts of which credit card to use to pay for her protractors, these thoughts would fall into the preparation phase of the disorder. In addition, her decisions of when and where to go, [and] on how to dress would fall into the preparatory phase (Black 15). In another instance in which Rebecca is in a store and purchases a scarf, the second phase of the disorders symptoms are depicted. Ill pay cash for the scarf. No one can argue with cash. I can get 100 out on my cash card, so all I need is another 20, and the scarf is mine (Kinsella 24). The act of the shopping experience itself is cause for the third phase of the disorder, which Black details as intensely exciting (15). The fourth and final phase of the disorders symptoms is the spending phase. This can be detailed by the completion of the purchase, which in some cases is followed by a feeling of disappointment as the excitement and act of shopping is now complete.

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PROFILE FOR THOSE WHO SUFFER When most people think of the image of a compulsive shopper, the stereotypical image of a young girl strolling through the mall, carrying dozens of shopping bags, comes to mind. While the mental image of a compulsive shopper may fall to women in most minds, this may not be a completely unfounded assumption. While the response to assume that more women are obsessive shoppers may seem sexist, studies show that the demographic is almost entirely women. According to the Handbook of Addictive Disorders, the studies concluded that [compulsive] shopping affects almost entirely women. These studies and results, however, leave room for error and alert readers with caution about jumping to conclusions from the results. When seeking compulsive shoppers for the study, two-thirds of studies seeking to recruit compulsive buyers used sampling strategies that are more likely to reach women than men (Coombs 419). Therefore, it may be a biased study in which women are identified at a higher percentage than men. While one argument may be that women are most frequently assumed to be the victims of obsessed shopping disorder, it is also possible that this is simply the demographic that sheds light on the problem more publicly. As Ellen Mohr Catalano explains in Consuming Passions: Help for Compulsive Shoppers, it is possible that both genders are exposed to the symptoms of the disorder but only one brings it to the surface publicly: Women are more often socialized to shop, in part to fulfill their traditional role of taking care of the home and the childrens needs, but also to conform to other patterns of expected behavior for example, blowing off steam by going out

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with friends and spending money (stereotypically, someone elses). In fact, experts believe that men may be as susceptible to problem shopping behavior as women. Men may not talk about it as much or even admit or recognize the problem (23). Catalano argues that the problem of compulsive shopping does not fall simply on one gender over another, and instead that while both men and women are susceptible to the disorder, that only women publicly discuss and recognize it as a problem. On the contrary, there are those that argue that perhaps the caution of the studies from the Handbook of Addictive Disorders is unnecessary, because if women are the ones being recruited most frequently for the studies, then most likely, they are the ones with the bigger problem to deal with. Donald Black takes on this role of the contrary argument and summarized the tests conducted in the early 1990s on the subject of Compulsive Buying Disorder (also known as CBD). Community based and clinical surveys suggest that 80% to 95% of persons with CBD are women. Later in the article he goes on to prove that men are fully represented in studies and that it is factual that women are more likely to be compulsive shoppers than men (Black 14). Based upon the differing research of both Catalano and Black, one could reasonably argue that while Catalano takes an accurate approach at the fact that not only women are susceptible to this behavior, that Black appropriately identifies that this behavior truly does affect more women than men.

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MEDICAL DIAGNOSIS In medical communities around the world, the difference in classifying certain behavior as a disorder versus simply frequent behavior is an important distinction. Simply the use of the word disorder brings to the surface questions of medical research, appropriate diagnosis, and case studies. The Diagnostic and Statistical Manual of Mental Disorders (also known as DSM) is a manual used by mental health professionals around the globe that serves as the definitive list of approved mental disorders, symptoms, and how to treat them. If something is referenced in the DSM, it means it is publicly recognized as a real disorder. Compulsive shopping is not technically considered a disorder since it is not directly listed in the DSM, although some argue that compulsive shopping is assumed to be understood in the section on impulsive disorders. The decision on whether or not to include a disorder in the DSM is based on decades of studies and research. There were many rumors and false reports stating that the American Psychiatric Association (also known as APA) intended to add compulsive shopping disorder to the next edition of the DSM, but in 2003 APA disclosed that they had no plans of adding CBD to the list of mental disorders (APA Statement). Although CBD is not yet therefore medically diagnosed, some still believe despite its absence from the DSM that it is considered a real disorder. A checklist of symptoms and a definition seems to be enough for compulsive buying to be considered a disorder, even without a formal classification (McElroy, Keck, Phillips). In researching whether or not CBD should be classified as a real mental disorder, one must understand that the official definition of a mental disorder is. According to the third edition of the DSM, a mental disorder is a:

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clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress [] or disability [] or with a significantly increased risk of suffering. [] It must currently be considered a manifestation of a behavioral, psychological, or biological dysfunction in the individual (American Psychiatric Association). There are hundreds of publications, studies, and medical research that have been written and conducted on the topic of CBD. That said, the DSM still has not included this publicized disorder as an actual disorder in their manual. Whether or not the behavior accurately falls into the APA definition of a disorder, one might argue that a behavior that is already so mainstream and deeply affecting of the citizens of this country should have already been medically classified as a disorder. Many psychiatrists are already prescribing medicine and treatment to those suffering from something that the DSM still does not classify as a mental disorder. One of the largest elements of a disorder being classified in the DSM is that once defined as a mental disorder, insurance companies are obligated to partially compensate individuals suffering from this disorder in their insurance plans. One might argue perhaps that pressure in todays society from the insurance industries is what is stopping the APA from including compulsive buying disorder in their previous manuals. In this case, it is shocking to think that our nation is suffering from what we would classify as a disorder and individuals are being forced to pay out of their own pockets for treatment simply because their doctor cannot medically diagnose it as a disorder.

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CLINICAL STUDIES AND DRUGS AVAILABLE Medical institutions like the University of Cincinnati College of Medicine and the University of Minnesota Department of Psychiatry are conducting studies in order to find more clinical information about compulsive shopping. These studies are not only providing the demographic profile for those with compulsive shopping but also providing doctors with drugs and treatment options that will treat them. Anti-depressants are a common treatment option for CBD. The results of the clinical studies are fairly conclusive with the medications available for those with compulsive shopping. Two medications, both anti-depressants, have shown some early positive results in treatment. However, doctors are perhaps not as eager to prescribe these medications on a large scale, as the DSM has still not officially recognized the disorder. The first medication is a Selective Serotonin Reuptake Inhibitors (SSRI) paroxetine with a suggested dose of 60 mg/day. This paroxetine is recommended to be taken with atypical neuroleptic medication (olanzapine, with a suggested dose of 5 mg/day). This combination of anti-depressants is shown to be able to be able to put shopping under control for some people and have more control over the urges associated with the phases of compulsive shopping (Grant 132-133). The second medication option is citalopram, also an anti-depressant, which is proven to help curb the uncontrollable shopping urges (Anti-Depressant Helps Alleviate Compulsive Shopping Disorder 1). HOW TO DEAL WITH COMPULSIVE SHOPPING Like other impulsive disorders most treatment techniques have not focused on psychiatric anti-depressants but rather on behavior modification. While the anti-depressant combinations

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help to minimize the urges of compulsive shopping, some medical specialists argue that minor changes to an individuals daily life can also help to curb the symptoms in a more behavioral manner. Some doctors suggest counseling, cutting up active credit cards, as well as finding other activities to busy oneself with in order to resist shopping as a daily activity. Most doctors and counselors also argue that a support network around the victim of the behavior is also an essential element of treatment. In a lengthy interview with Dr. Howard Schachter, a clinical psychologist from Ottawa, Canada, Schachter explained that Professionals dont know what [compulsive shopping] is really about it might be an addiction, a compulsion, an obsession but there is no agreement in mental health. It doesnt matter what we call it a disorder, problem or addiction but if people are suffering, we need to respond to their suffering. While Dr. Schachter and other researchers are absolutely correct, the people who suffer from the disorder need attention now before their lives spiral out of control. They cannot wait from the American Psychiatric Association to add one more disorder to their list.

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Works Cited "American Psychiatric Association Issues Statement on Compulsive Shopping." Ed. Laurie Oseran. 18 Aug. 2003. APA Statement. 22 Feb. 2009. "Antidepressant Helps Alleviate Compulsive Shopping Disorder, Stanford Researchers Find." Science Daily: News & Articles in Science, Health, Environment & Technology. 12 Feb. 2009 <http://www.sciencedaily.com/releases/2003/07/030717090529.htm>. Benson, April Lane. I Shop, Therefore I Am: Compulsive Buying & The Search for Self. Northvale: Jason Aronson, 2000. Black, Donald W. "A review of compulsive buying disorder." World Psychiatry 6 (2007): 14-18. Catalano, Ellen Mohr and Nina Sonenberg. Consuming passion help for compulsive shoppers. Oakland, CA: New Harbinger Publications, 1993. Coombs, Robert H., ed. Handbook of Addictive Disorders. New Jersey: John Wiley & Sons, Inc., 2004. Damon, Janet. Shopaholics serious help for addicted spenders. Los Angeles, CA: Price Stern Sloan, 1988. Diagnostic and Statistical Manual of Mental Disorders. 3rd ed. Washington: American Psychiatric Association, 1987. Grant, Jon E. and Suck Won Kim. Stop Me Because I Can't Stop Myself Taking Control of Impulsive Behavior. New York: McGraw-Hill Companies, 2002.

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Hemler, Jennifer. The Medicalization of Compulsive Shopping: A Sociological Analysis of a Disorder-in-the-Making. 12 Aug. 2007. Department of Sociology, Rutgers University. 22 Feb. 2009 <http://sociology.rutgers.edu/DOCUMENTS/conf_papers/Hemler_Jennifer.pdf>. Kinsella, Sophie. Confessions of a Shopaholic. New York: Bantam Dell, 2003. McElroy, Susan L., Paul Keck Jr., and Katharine A. Phillips. "Kleptomania, compulsive buying, and binge-eating d...[J Clin Psychiatry. 1995] - PubMed Result." NCBI HomePage. 1995. 29 Mar. 2009 <http://www.ncbi.nlm.nih.gov/pubmed/7713861>. Schachter, Dr. Howard. "Compulsive Shopping." Telephone interview. 22 Feb. 2009.