Family history and psychiatric comorbidity in persons with compulsive buying: preliminary findings

Behavioural Addiction: A Concept Analysis

AIM

This concept analysis aims to clarify the uncertain and evolving concept of behavioural addiction, addressing its complexities and ambiguities to better inform its potential inclusion and classification in future revisions of the Diagnostic and Statistical Manual (DSM) and International Classification of Diseases (ICD).

BACKGROUND

Evidence suggests that rates of behavioural addictions continue to rise. Conceptual clarity of behavioural addictions is essential for mental health providers. Clarifying the concept of behavioural addiction will aid in developing specialised tools in diagnosis and treatment.

METHODS

The Walker and Avant method of concept analysis was applied to 17 articles after a literature search that included search terms such as 'behavioral addiction', 'non-substance use addiction' and 'internet gaming disorder', among others, was conducted. Characteristics, antecedents and consequences of behavioural addiction were identified, and model, borderline and contrary cases were developed.

DATA SOURCES

Articles from PubMed, PsycINFO and Google Scholar.

RESULTS

Six essential characteristics of behavioural addiction were identified: salience, euphoria, tolerance, withdrawal symptoms, conflict and reinstatement. Additionally, antecedents identified were family psychiatric history, psychiatric comorbidity, environmental factors, accessibility and exposure to stressors. There are four major consequences of behavioural addiction: physical and mental health problems, disruption of interpersonal relationships, neurobiological adaptation and financial, social or occupational repercussions.

CONCLUSION

This analysis examined the concept of behavioural addiction to promote an understanding for clinical utility. Further research is required to establish additional support for establishing clarity of the concept of behavioural addiction and aid in the development and implementation of diagnostic tools and treatments for people experiencing behavioural addiction.

IMPLICATIONS FOR THE PROFESSION

A thorough concept analysis of behavioural addiction helps to delineate its boundaries, core attributes, antecedents and consequences. This clarity allows for more precise communication among researchers, practitioners and policymakers. It can lead to the development of standardised diagnostic criteria and intervention strategies tailored to behavioural addictions.

IMPACT

This analysis addressed the concept of behavioural addictions and increased clarity on the characteristics, antecedents and consequences that define this phenomenon.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Purchasing Under the Influence of Alcohol: The Impact of Hazardous and Harmful Patterns of Alcohol Consumption, Impulsivity, and Compulsive Buying

The current research examined how hazardous and harmful patterns of alcohol consumption, problematic online shopping when drinking alcohol, impulsivity, and compulsive buying were associated with and predicted the frequency of making purchases while under the influence of alcohol. A sample of American adults between the ages of 25 and 64 who reported having at least one drink per week over the past 6 months were surveyed. Regression-based path modeling revealed for those who made online purchases while moderately intoxicated, hazardous and harmful patterns of drinking alcohol and, problematic online shopping when drinking alcohol, predicted the frequency of making purchases while intoxicated. For those who made online purchases while heavily intoxicated, hazardous and harmful patterns of drinking alcohol, impulsivity, problematic online shopping when drinking alcohol, and compulsive buying predicted the frequency of making purchases while intoxicated. We explain our findings by suggesting individuals engage in frequent drunk purchases because they are motivated to alleviate their negative mood states.

Compulsive shopping behaviour and executive dysfunction in young adults

"Compulsive Shopping" is characterized by poorly controlled preoccupations/urges/behaviors focused on shopping and spending, causing significant distress/impairment. This study looked at what roles executive and related memory problems might exist in compulsive shopping. 205 adults completed on-line questionnaires measuring compulsive shopping, mood, as well as working memory and inhibition components of executive function. The Bergen Shopping Addiction Scale was used to assign participants to either a High Compulsive Shopping (HCS) group or Low Compulsive Shopping (LCS) group. Working memory (WM) and inhibition control (IC) were measured as two components of executive function (EF) using the Adult Executive Functioning Inventory (ADEXI), the Dysexecutive Questionnaire Revised (DEX-R) measured general EF. The Hospital Anxiety and Depression Scale measured anxiety and depression. MANCOVA and mediation analyses were carried out controlling for age, gender, anxiety, depression. The HCS group scored significantly higher on all three EF measures, indicating greater executive difficulties. Subsequent mediation analyses with the ADEXI-IC as the mediator removed the significance of the relationship between Group and both the DEX-R and ADEXI-WM outcome variables. Thus, observed Group difference in DEX-R and ADEXI-WM could be fully accounted for by group differences in inhibitory control. The results highlight the role inhibitory control plays in compulsive shopping.

The Roles of Anxiety and Self-Esteem in the Risk of Eating Disorders and Compulsive Buying Behavior

In contemporary society, following the sudden changes that occur, different forms of addiction are becoming popular. Of note are the new addictions and concepts of poly-dependencies that involve common behaviors and trap people who suffering from them in a vicious circle. The main goal of this study is to investigate the possible mediating role that self-esteem had between trait anxiety and two specific new addictions: compulsive buying behavior and eating disorders. Furthermore, it was verified through a multigroup analysis that trait anxiety had a greater effect on eating disorders in a group of compulsive consumers. Three-hundred and fifty-two participants (67.9% women) were enrolled to participate in this study. The results showed that there was a direct effect of trait anxiety on eating disorders and on compulsive buying behavior; self-esteem mediated the effect of trait anxiety on eating disorders and compulsive buying behavior with specific differences; multi-group analysis showed differences in anxiety's effect on eating disorders between compulsive and non-compulsive consumers; the group of compulsive consumers revealed a significant and stronger effect of trait anxiety on eating disorders in all domains identified. Further research is recommended to better understand the predictors of these disorders and to contribute to a more effective preventive intervention.

Criteria for the establishment of a new behavioural addiction •

When does repeated behaviour constitute behavioural addiction? There has been considerable debate about non-substance-related addictions and how to determine when impaired control over a behaviour is addiction. There are public health benefits to identifying new behavioural addictions if intervention can improve outcomes. However, criteria for establishing new behavioural addictions must guard against diagnostic inflation and the pathologizing of normal problems of living. Criteria should include clinical relevance (Criterion 1), alignment with addiction phenomenology (Criterion 2) and theory (Criterion 3), and taxonomic plausibility (Criterion 4). Against such criteria, evidence does not yet support classification of pornography-use and buying-shopping disorders as addictions.

Measurement of shopping addiction and its relationship with personality traits and well-being among Polish undergraduate students

There is still a scarcity of studies showing the relative contribution of different personality characteristics differentiating various behavioral addictions within an integrated model. In comparison to other addictions, fairly little is known about the role of specific personality traits in compulsive shopping. In addition, few studies have investigated the unique contribution of shopping addiction in terms of explaining different facets of well-being above and beyond personality characteristics previously shown to be related to psychosocial functioning. The present study shows validation of the Bergen Shopping Addiction Scale (BSAS) and a tentative integrated model of potential shopping addiction personality risk factors. BSAS was administered to 1156 Polish students. In addition, demographic variables, and personality traits (Big Five), self-esteem, self-efficacy, perceived narcissism, loneliness, social anxiety, and well-being indicators were measured. BSAS had acceptable fit with the data and demonstrated good reliability. The investigated model showed that shopping addiction was related to higher extraversion, perceived narcissism, and social anxiety, and lower agreeableness and general self-efficacy. Woman and older participants scored higher on BSAS. Shopping addiction was further related to all facets of impaired well-being and explained worse general health, and decreased sleep quality above and beyond other variables in the model. The results support the notion that shopping addiction may have specific personality risk factors with low agreeableness as an outstanding characteristic. This has implications for the development of early prevention and intervention programs.

Coping associated with compulsive buying tendency

Research on general coping is limited within compulsive buying (CB) literature. Nevertheless, other behavioural addictions and hoarding might provide insights into coping in CB. One-hundred and ninety-nine participants (M age = 52.72, SD = 16.06; 50.3% female, 1% unknown sex) completed online questionnaires. Mental and behavioural disengagements were hypothesized to predict greater self-reported CB tendency. Whilst these relationships were found in the correlations, a regression analysis indicated that only mental disengagement significantly predicted CB tendency. Additionally, the exploration of denial and substance use identified that denial was an important predictor of CB tendency coping. The relationship between CB tendency and substance use could not be explored given the large degree of participants reporting minimal scores. CB tendency is associated with maladaptive mental disengagement, denial and lack of acceptance coping strategies, which could be useful to consider in therapy.

Buying-shopping disorder-is there enough evidence to support its inclusion in ICD-11?

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.

Identity processes and clusters in individuals with and without pathological buying

The present study investigated the association between pathological buying (PB) and identity processes and clusters. Forty-one patients with PB and 41 gender/age-matched controls (73% females) filled out the Dimensions of Identity Development Scale (DIDS), the Pathological Buying Screener, and self-report questionnaires to assess comorbid psychopathology, such as depressive symptoms, pathological internet shopping, and hoarding (excluding acquisition). Patients with PB reported significantly higher scores on ruminative exploration and lower scores on identity commitment processes compared to healthy controls. In the total sample, as well as in the PB sample, we identified four identity clusters: troubled diffusion, moratorium, foreclosure, and achievement, similar to Marcia's identity statuses. Patients with PB were overrepresented in the troubled diffusion cluster and less represented in the foreclosure and achievement clusters. Patients with PB in the troubled diffusion cluster scored significantly higher on PB, pathological internet shopping, hoarding, and depressive symptoms as compared to patients with PB in the other clusters. Based on these findings, we can conclude that patients with identity diffusion report more severe PB and related comorbid symptomatology. PB and related symptoms may be considered as coping strategies to deal with identity-related issues.

Relationships between Behavioural Addictions and Psychiatric Disorders: What Is Known and What Is Yet to Be Learned?

This article provides a narrative review of the relationships between several behavioural addictions [pathological gambling, problematic Internet use (PIU), problematic online gaming, compulsive sexual behaviour disorder, compulsive buying, and exercise addiction] and psychiatric disorders. Associations between most behavioural addictions and depressive and anxiety disorders are strong and seem relatively non-specific. Strong links with substance use disorders may support the notion that some people are more prone to addictive behaviours, regardless of whether these involve substances or problematic activities. Other associations seem relatively specific, for example, those between PIU/online gaming and attention-deficit/hyperactivity disorder, between compulsive buying on the one hand and eating disorders and hoarding on the other hand and between exercise addiction and eating disorders. The quality of the research varies, but most studies suffer from methodological limitations, including a cross-sectional or correlational design, non-representative study populations, small sample sizes, reliance on self-report assessment instruments, diverse diagnostic criteria, and conceptual heterogeneity of most behavioural addictions. Due to these limitations, generalisability of the findings is questionable and the direction of causality, if any, is unknown in the relationships between behavioural addictions and psychiatric disorders. Regardless of the aetiological uncertainty, these relationships often call for a modified treatment approach. Prospective studies are needed to clarify the longitudinal relationships between behavioural addictions and psychiatric disorders.

Treatments for compulsive buying: A systematic review of the quality, effectiveness and progression of the outcome evidence

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.

Five-year follow-up of people diagnosed with compulsive shopping disorder

BACKGROUND

The authors assessed clinical symptoms and self-reported shopping and spending behavior in people diagnosed with compulsive shopping (CS) at a 5-year follow-up interview.

METHODS

All met the criteria of McElroy et al. for lifetime CS and had the disorder for >1year. Structured and semistructured instruments and self-report questionnaires were used to collect data.

RESULTS

Of the original 26 subjects, 17 (65%) were interviewed and are the focus of this report. At follow-up, their ages ranged from 23 to 67years (mean=44years). Lifetime psychiatric comorbidity was common, but few had current psychiatric disorders at follow-up. Interest in shopping and spending decreased for eight (47%), stayed the same for five (29%), and increased for four (24%) subjects. Eleven subjects (65%) reported having attempted to quit their CS and three (18%) reported successfully doing so. Triggers for returning to CS included feelings of pressure/excitement/tension to shop; boredom; negative feelings such as sadness, depression, frustration, or anger; and the desire for positive feelings like happiness, power, or elation. Mean scores on the Compulsive Buying Scale (CBS) and the shopping version of the Yale-Brown Obsessive-Compulsive Scale showed overall improvement in CS symptoms (d=1.16 and d=-1.19, respectively); subjects were also less impulsive (d=-0.48). At baseline and follow-up, those with a lifetime mood disorder tended to have greater CS severity.

CONCLUSIONS

While the subjects showed overall improvement, most had ongoing symptoms of CS. The implications of the findings are discussed.

The prevalence of compulsive buying: a meta-analysis

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 of 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, 4686 participants). Being young and female were associated with increased tendency, but not location (United States versus non-United States). Meta-regression revealed large heterogeneity within subgroups, due mainly to diverse measures and time-frames (current versus life-time) used to assess CBB.

CONCLUSIONS

A pooled estimate of compulsive buying behaviour in the populations studied is approximately 5%, but there is large variation between samples accounted for largely by use of different time-frames and measures.

At-Risk/Problematic Shopping and Gambling in Adolescence

Elevated levels of both pathological gambling (PG) and problem shopping (PS) have been reported among adolescents, and each is associated with a range of other negative health/functioning measures. However, relationships between PS and PG, particularly during adolescence, are not well understood. In this study, we explored the relationship between different levels of problem-gambling severity and health/functioning characteristics, gambling-related social experiences, gambling behaviors and motivations among adolescents with and without at-risk/problematic shopping (ARPS). Survey data from Connecticut high school students (n = 2,100) were analyzed using bivariate analyses and logistic regression modeling. Although at-risk/problematic gambling (ARPG) was not increased among adolescents with ARPS, adolescents with ARPG (vs non-gamblers) were more likely to report having experienced a growing tension or anxiety that could only be relieved by shopping and missing other obligations due to shopping. In comparison to the non-ARPS group, a smaller proportion of respondents in the ARPS group reported paid part-time employment, whereas a greater proportion of respondents reported excessive gambling by peers and feeling concerned over the gambling of a close family member. In general, similar associations between problem-gambling severity and measures of health/functioning and gambling-related behaviors and motivations were observed across ARPS and non-ARPS adolescents. However, associations were weaker among ARPS adolescents for several variables: engagement in extracurricular activities, alcohol and caffeine use and gambling for financial reasons. These findings suggest a complex relationship between problem-gambling severity and ARPS. They highlight the importance of considering co-occurring risk behaviors such as ARPS when treating adolescents with at-risk/problem gambling.

Prevalence and construct validity of compulsive buying disorder in shopping mall visitors

Compulsive buying is a relatively new psychopathological concept and very few data are currently available regarding the prevalence and validity of compulsive buying disorder. In this cross-sectional study, we establish the prevalence of compulsive buying disorder in shopping mall visitors and explore the construct validity of the concept using the revised version of the Edwards Compulsive Buying Scale in 1441 shopping mall visitors looking at shopping habits, current substance use (smoking, alcohol and illicit drug) and various psychological characteristics. Overall, 8.7% (95% CI: 7.3-10.3) of our sample was classified as having a compulsive buying disorder. Compulsive buyers were younger, less educated and more likely to be female than non-compulsive buyers. They were also more likely to have used licit and illicit substances. Compulsive buyers also reported higher levels of impulsivity and obsessive-compulsive symptoms, lower levels of well-being and self-esteem and more psychological distress. Finally, compulsive buyers were five times more likely to meet criteria for borderline personality disorder than non-compulsive buyers. Compulsive buying is a frequent disorder in shopping mall visitors and is associated with important and robust indicators of psychopathology thus supporting the validity of the construct.

Compulsive buying: Earlier illicit drug use, impulse buying, depression, and adult ADHD symptoms

This longitudinal study examined the association between psychosocial antecedents, including illicit drug use, and adult compulsive buying (CB) across a 29-year time period from mean age 14 to mean age 43. Participants originally came from a community-based random sample of residents in two upstate New York counties. Multivariate linear regression analysis was used to study the relationship between the participant's earlier psychosocial antecedents and adult CB in the fifth decade of life. The results of the multivariate linear regression analyses showed that gender (female), earlier adult impulse buying (IB), depressive mood, illicit drug use, and concurrent ADHD symptoms were all significantly associated with adult CB at mean age 43. It is important that clinicians treating CB in adults should consider the role of drug use, symptoms of ADHD, IB, depression, and family factors in CB.

Specific and general facets of hoarding: A bifactor model

Whereas it has been suggested that hoarding is a multidimensional construct comprising distinct but interrelated factors (i.e., difficulty discarding, excessive clutter, and excessive acquisition), a high degree of overlap as well as a lack of discriminant validity among these factors and exogenous constructs suggests that a correlated factors approach may not adequately capture this phenomenon. The factor structure of the Saving Inventory Revised (SIR) was examined in a large non-selected clinic sample (N=490). A bifactor model of hoarding, comprising a general Hoarding factor and orthogonal Urge-Related Acquiring, Distress-Related Acquiring, Difficulty Discarding, and Clutter factors fit the data best. Further, whereas the general Hoarding factor was related to several depression facets, the specific hoarding factors demonstrated differential relations with depression. This study establishes that acquiring behaviors are motivated by both positive/urge-related and negative/distress-related emotions. Additionally, general and distinct factors should be considered to properly contextualize hoarding behavior.

[Comorbodity of kleptomania and eating disorders]

A case of comorbid anorexia nervosa and kleptomania is reported in a female patient aged 31 years old. Personality pathology and kleptomanic behavior developed since childhood together with dysmorphophobia related to the congenital chest defect. Later on, the distinct association between the severity of dysmorphophobia, affective disorder and appearances of pathological drives was identified. The patient received several ICD-10 diagnoses (F61.0, F50.0, F62.3, F33.1). The patient's condition was improved after pharmacotherapy in the combination with psychotherapy.

Co-occurrence of alcohol use disorder and behavioral addictions: relevance of impulsivity and craving

PURPOSE

The aims of the study were to evaluate the occurrence of behavioral addictions (BAs) in alcohol use disorder (AUD) subjects and to investigate the role of impulsivity, personality dimensions and craving.

METHODS

95 AUD outpatients (DSM-5) and 140 homogeneous controls were assessed with diagnostic criteria and specific tests for gambling disorder, compulsive buying, sexual, internet and physical exercise addictions, as well as with the Barratt Impulsiveness Scale (BIS-11) and Temperamental and Character Inventory-Revised (TCI-R). The Obsessive Compulsive Drinking Scale (OCDS) and Visual Analogue Scale for craving (VASc) were also administered to the AUD sample.

RESULTS

28.4% (n=27) of AUD subjects had at least one BA, as compared to 15% (n=21) of controls (χ(2)=6.27; p=.014). In AUD subjects, direct correlations between BIS-11 and Compulsive Buying Scale (CBS), Internet Addiction Disorder test (IAD), Exercise Addiction Inventory-Short Form (EAI-SF) scores (p<.01), between OCDS obsessive and CBS and VASc and CBS, IAD scores (p<.003), were found. BIS-11 (t=-2.36; p=.020), OCDS obsessive (Z=-4.13; p<.001), OCDS compulsive (Z=-2.12; p=.034) and VASc (Z=-4.94; p<.001) scores were higher in AUD subjects with co-occurring BAs. The occurrence of BAs was associated with higher impulsivity traits (BIS-11 scores; OR=1.08; p=.012) and higher craving levels (VASc scores; OR=2.48; p<.001).

CONCLUSIONS

Our findings emphasize a significant rate of co-occurrence of BAs in AUD. High levels of impulsivity and craving for alcohol seem to be associated with other addictive behaviors.

Measuring compulsive buying behaviour: psychometric validity of three different scales and prevalence in the general population and in shopping centres

Due to the problems of measurement and the lack of nationally representative data, the extent of compulsive buying behaviour (CBB) is relatively unknown. The validity of three different instruments was tested: Edwards Compulsive Buying Scale (ECBS; Edwards, E.A., 1993. Development of a new scale for measuring compulsive buying behaviour. Financial Counseling and Planning. 4, 67-85), Questionnaire About Buying Behavior (QABB; Lejoyeux, M., Ades, J., 1994. Les achats pathologiques: une addiction comportementale. Neuro-Psy. 9, 25-32.) and Richmond Compulsive Buying Scale (RCBS; Ridgway, N.M., Kukar-Kinney, M., Monroe, K.B., 2008. An expanded conceptualization and a new measure of compulsive buying. Journal of Consumer Research. 35, 622-639.) using two independent samples. One was nationally representative of the Hungarian population (N=2710) while the other comprised shopping mall customers (N=1447). As a result, a new, four-factor solution for the ECBS was developed (Edwards Compulsive Buying Scale Revised (ECBS-R)), and confirmed the other two measures. Additionally, cut-off scores were defined for all measures. Results showed that the prevalence of CBB is 1.85% (with QABB) in the general population but significantly higher in shopping mall customers (8.7% with ECBS-R, 13.3% with QABB and 2.5% with RCBS-R). Conclusively, due to the diversity of content, each measure identifies a somewhat different CBB group.

A study investigating the association between compulsive buying with measures of anxiety and obsessive-compulsive behavior among internet shoppers

BACKGROUND

Compulsive buying is a chronic, repetitive behavior that becomes a primary response to negative events and feelings. Compulsive buyers are obsessed by buying and their behavior occurs in response to negative emotions and results in a decrease in the intensity of negative emotions. Euphoria or relief from negative emotions is the most common consequence of compulsive buying. A large number of studies have investigated the association between compulsive buying and anxiety, and some studies have used the Spielberger trait-state anxiety inventory.

PROCEDURE

Compulsive buying, state and trait anxiety and general obsessive-compulsive measures were assessed among 120 habitual internet shoppers (2+ times a week, 70 men and 50 women).

RESULTS

Results showed that Edwards Compulsive Buying scale measures were associated with Spielberger trait and not state anxiety measures. Spielberger Trait anxiety measures were also correlated with measures of Yale-Brown Obsessive-Compulsive scale (Y-Bocs). Finally, there were no sex differences in this sample.

CONCLUSIONS

The results of this study support existing evidence for an association between compulsive buying and anxiety and they will be discussed in view of current research on comorbidity of behavioural addiction.

Effects of mood induction on consumers with vs. without compulsive buying propensity: an experimental study

Compulsive buying (CB) is excessive and leads to impairment and distress. Several studies aimed to explore the phenomenology and antecedents of CB, especially affective states. However, these studies mostly used retrospective self-report and mostly focused on compulsive buyers only. Therefore, this study aims to directly compare consumers with CB propensity and controls on experimental proxies of buying behavior and to investigate 1) effects of neutral vs. negative mood inductions and 2) whether mood effects on buying behavior are specific to CB. Forty female consumers with CB propensity and 40 female controls were randomly assigned to a neutral or negative mood induction. Buying related behavior (likelihood to expose oneself to a shopping situation, urge and probability to buy, willingness to pay) was assessed. Consumers with CB propensity differed from controls in all buying behavior aspects except for willingness to pay. Neither main effects of mood nor group×mood interaction effects on buying behavior were found. However, consumers with CB propensity were emotionally more strongly affected by a negative mood induction. Although negative affect has previously been reported to precede buying episodes in CB, our findings do not indicate specific negative mood effects on buying, neither in CB nor in controls.

Experimental evidence for the influence of cognitions on compulsive buying

BACKGROUND AND OBJECTIVES

Compulsive buying is a disabling condition, where individuals are unable to resist or control their buying behavior, leading to substantial social and financial problems. Cognitive models implicate the role of beliefs as one factor in buying behavior, for example, "this item is unique and will help me improve my life".

METHODS

This study experimentally examined the contribution of such beliefs to the disorder, in individuals who compulsively buy (N = 18) and in non-clinical controls (N = 17). Participants were presented with photographs of idiosyncratically appealing and unappealing items, in the context of imagined scenarios that either minimized or maximized aspects relevant to hypothesized "compulsive buying beliefs" (i.e., beliefs that acquisition can compensate for negative feelings, beliefs regarding uniqueness and lost opportunities, and emotional reasons for buying).

RESULTS

It was found that individuals who compulsively buy demonstrated stronger urges to purchase than control participants, regardless of context, but the overall strength of these urges was responsive to manipulations of beliefs about consumer items said to be associated with compulsive buying.

LIMITATIONS

The main limitation of the study was a small sample size, potentially reducing power.

CONCLUSIONS

Nonetheless, these findings provide insights into the processes underlying compulsive phenomena, in particular supporting the role of cognitions in compulsive buying.

Characteristics of online compulsive buying in Parisian students

BACKGROUND

Online compulsive buying is a little-studied behavioral disorder.

AIMS

To better understand its clinical aspects by focusing on (i) prevalence rate, (ii) correlation with other addictions, (iii) influence of means of access, (iv) motivations to shop to the internet and (v) financial and time-consuming consequences.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

200 students in two different centers of Paris Diderot University - Paris VII.

MEASUREMENTS

Brief self-questionnaires, to screen online compulsive buying, internet addiction, alcohol and tobacco use disorders, to rate frequency of online purchase by private-sale websites, by advertising banners, by mobile phone or to avoid stores, to rate motivations like "more discreet", "lonelier", "larger variety of products", "more immediate positive feelings", and "cheaper" and to assess the largest amount of online purchasing and the average proportion of monthly earnings, and time spent, both day and night.

FINDINGS

Prevalence of online compulsive buying was 16.0%, while prevalence of internet addiction was 26.0%. We found no significant relationship with cyberdependence, alcohol or tobacco use disorders. Online compulsive buyers accessed more often shopping online by private-sale websites (56.2% vs 30.5%, p<0.0001) or by mobile phone (22.5% vs 7.9%, p=0.005) and preferred online shopping because of exhaustive offer (p<0.0001) and immediate positive feelings (p<0.0001). Online compulsive buyers spent significantly more money and more time in online shopping.

CONCLUSION

Online compulsive buying seems to be a distinctive behavioral disorder with specific factors of loss of control and motivations, and overall financial and time-consuming impacts. More research is needed to better characterize it.

Cue-induced craving in pathological buying: empirical evidence and clinical implications

OBJECTIVE

Pathological buying is associated with marked distress and impaired functioning in important life domains. It is currently under debate whether pathological buying can be considered a behavioral addiction. In analogy to results reported in addicted individuals, craving reactions elicited by addiction-related cues might be an underlying mechanism for the etiology and pathogenesis of pathological buying.

METHODS

In the present study, 30 pathological buyers and 30 matched control participants were examined with a cue-reactivity paradigm consisting of shopping and control cues. Skin conductance responses, as well as subjective ratings for arousal, valence, and urge to buy, were assessed. Subjective craving reactions were measured before and after the cue-reactivity paradigm.

RESULTS

On a physiological level, skin conductance responses toward shopping cues were higher in pathological buyers (mean [M; standard deviation {SD}] = 0.26 [0.13]) compared with control participants (M [SD] = 0.19 [0.09]; t(58) = 2.29, p = .025, d = 0.60). On a behavioral level, the individuals with pathological buying rated the shopping cues as more arousing and more positive, and reported a greater urge to buy compared with control participants and with control cues. An increase in subjective craving after completing the cue-reactivity paradigm was observed only in the pathological buyers (Mpre [SD] = 1.95 [1.47], Mpost [SD] = 2.87 [1.79]; t(29) = 5.07, p < .001, d = 0.97).

CONCLUSIONS

Cue-reactivity and craving might be potential correlates for the development and maintenance of pathological buying. The results demonstrate similarities between pathological buying and substance or behavioral addictions and provide implications for clinical treatment.

Relationships that compulsive buying has with addiction, obsessive-compulsiveness, hoarding, and depression

BACKGROUND AND OBJECTIVES

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.

METHODS

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.

RESULTS

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.

LIMITATIONS

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.

CONCLUSIONS

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.

Role of behavioral addictions in predicting reactivity in bipolar mood disorder patients

Background:

Behavioral addictions (BAs) can be understood as disorders characterized by repetitive occurrence of reactivity and uncontrolled behaviors. Very few studies have investigated their association with bipolar mood disorders.

Objectives:

The present study aimed to determine the role of behavioral addictions in predicting interpersonal behavioral addictions in bipolar mood disorder patients.

Materials and Methods:

This study had a cross-sectional correlation design. The statistical population was composed of all outpatients with bipolar mood disorders referring to clinical centers in Ardabil. The sample included 60 bipolar mood patients selected from patients referring to clinical centers using the available sampling method. A researcher-made behavioral addiction checklist, Interpersonal Behavioral Addictions Index, and exercise, sexual, and work addiction questionnaires, were used for data collection. The data were analyzed with a Pearson’s correlation coefficient and multivariate regression analysis.

Results:

The results showed a significant negative relationship between behavioral addictions and interpersonal behavioral addictions (P ≥ 0.01). Multivariate regression analysis results also showed that behavioral addictions are significant and can explain 61% of the variance of interpersonal behavioral addictions in bipolar mood patients.

Conclusions:

These results suggest that addictive behaviors can affect behavioral addictions in bipolar mood patients. Behavioral addictions lead to negative emotional regulation strategies and result in increased behavioral addictions in these patients. People with high levels of arousal or those who cannot control their behavioral addictions are probably more prone to addictive behaviors.

Prevalence and characteristics of compulsive buying in college students

Compulsive buying (CB) is a potentially devastating problem involving repetitive urges to shop and uncontrolled spending behaviors. Prevalence of CB in the general population has been estimated at 5.8%. This epidemiological study aims to better understand the prevalence and characteristics of college students who meet criteria for CB. During the spring of 2011, an online survey examining CB (using a clinically validated screening instrument, the Minnesota Impulse Disorders Interview), stress and mood states, psychiatric comorbidity, and psychosocial functioning was emailed to 2108 University students. Overall survey response rate was 35.1% (n=2108). Our data indicated that 3.6% (n=67) of college students surveyed met criteria for CB with significantly more women affected (4.4%, n=48) than men (2.5%, n=19). Relative to students not meeting criteria for CB, college students who met criteria for CB endorsed significantly greater psychiatric comorbidity, lower grade point averages, increased stress, and poorer physical health. Presence of CB is likely associated with a variety of problems in college students. These data may warrant increased screening of CB in college students to establish early interventions.

A targeted review of the neurobiology and genetics of behavioural addictions: an emerging area of research

This review summarizes neurobiological and genetic findings in behavioural addictions, draws parallels with findings pertaining to substance use disorders, and offers suggestions for future research. Articles concerning brain function, neurotransmitter activity, and family history and (or) genetic findings for behavioural addictions involving gambling, Internet use, video game playing, shopping, kleptomania, and sexual activity were reviewed. Behavioural addictions involve dysfunction in several brain regions, particularly the frontal cortex and striatum. Findings from imaging studies incorporating cognitive tasks have arguably been more consistent than cue-induction studies. Early results suggest white and grey matter differences. Neurochemical findings suggest roles for dopaminergic and serotonergic systems, but results from clinical trials seem more equivocal. While limited, family history and genetic data support heritability for pathological gambling and that people with behavioural addictions are more likely to have a close family member with some form of psychopathology. Parallels exist between neurobiological and genetic and family history findings in substance and nonsubstance addictions, suggesting that compulsive engagement in these behaviours may constitute addictions. To date, findings are limited, particularly for shopping, kleptomania, and sexual behaviour. Genetic understandings are at an early stage. Future research directions are offered.

Phenomenology and treatment of behavioural addictions

Behavioural addictions are characterized by an inability to resist an urge or drive resulting in actions that are harmful to oneself or others. Behavioural addictions share characteristics with substance and alcohol abuse, and in areas such as natural history, phenomenology, and adverse consequences. Behavioural addictions include pathological gambling, kleptomania, pyromania, compulsive buying, compulsive sexual behaviour, Internet addiction, and binge eating disorder. Few studies have examined the efficacy of pharmacological and psychological treatment for the various behavioural addictions, and therefore, currently, no treatment recommendations can be made.

The structure of common and uncommon mental disorders

BACKGROUND

Co-morbidity patterns in epidemiological studies of mental illness consistently demonstrate that a latent internalizing factor accounts for co-morbidity patterns among unipolar mood and anxiety disorders, whereas a latent externalizing factor underlies the covariation of substance-use disorders and antisocial behaviors. However, this structure needs to be extended to include a broader range of disorders.

METHOD

Exploratory and confirmatory factor analyses were used to examine the structure of co-morbidity using data from the Collaborative Psychiatric Epidemiological Surveys (n = 16 233).

RESULTS

In the best-fitting model, eating and bipolar disorders formed subfactors within internalizing, impulse control disorders were indicators of externalizing, and factor-analytically derived personality disorder scales split between internalizing and externalizing.

CONCLUSIONS

This was the first large-scale nationally representative study that has included uncommon mental disorders with sufficient power to examine their fit within a structural model of psychopathology. The results of this study have important implications for conceptualizing myriad mental disorders.

Neuropsychological performance, impulsivity, ADHD symptoms, and novelty seeking in compulsive buying disorder

We examined the neuropsychological performance of people with compulsive buying disorder (CBD) and control subjects, along with trait impulsivity, symptoms of attention deficit hyperactivity disorder (ADHD), and selected personality characteristics. Subjects received a comprehensive neuropsychological test battery, depression and ADHD symptom assessment, the Barratt Impulsiveness Scale, and a version of the Temperament and Character Inventory. Persons with CBD (n=26) and controls (n=32) were comparable in terms of age, sex, and years of education. Subjects with CBD had a mean age of 36.3 years (S.D.=15.7) and an age at onset of 19.7 years (S.D.=7.0). Compulsive buyers had more lifetime mood, anxiety, and impulse control disorders. People with Compulsive buying performed significantly better on the Wechsler Abbreviated Scale of Intelligence Picture Completion task, a test of visual perception; otherwise, there were no consistent differences in neuropsychological measures. They also had elevated levels of self-reported depression, ADHD symptoms, trait impulsivity, and novelty seeking. In conclusion, compulsive buyers have greater lifetime psychiatric comorbidity than controls, and higher levels of self-rated depression, ADHD symptoms, trait impulsivity, and novelty seeking. The present study does not support the notion that there is a pattern of neuropsychological deficits associated with CBD.

Family-based association analysis of serotonin genes in pathological gambling disorder: evidence of vulnerability risk in the 5HT-2A receptor gene

Pathological gambling (PG) has become a growing public health problem in many countries around the world. PG is an impulse control disorder and its behavior and psychopathology present similarities with substance abuse disorders. Evidence from twin studies supports a significant genetic predisposition to PG, but the precise genetic loci still remain unclear. The present study investigates the allele and genotype distribution of polymorphisms of the serotonin transporter, serotonin receptor 1B and 2A genes in 140 sib-pairs discordant for the diagnosis of PG. A significant association of the C/C genotype of the serotonin receptor 2A T102C (rs 6313) polymorphism and the PG phenotype was observed [OR = 1.7 (1.1-3.4)]. This preliminary result is consistent with the hypothesis that the serotonin system is associated with addiction behavior and similar results have been reported for nicotine and alcohol dependence.

Heterogeneity within compulsive buyers: a Q-sort study

OBJECTIVES

This study investigated how compulsive buyers make sense of their excessive shopping behaviour to explore possible sources of heterogeneity between compulsive buyers.

METHOD

Twenty female participants met 'caseness' for compulsive buying (CB) on the CB Scale (CBS), prior to completing a Q-sort specifically related to their experiences of shopping. Participants provided details of occupation, income, and debt levels and completed two psychometric scales: the Hospital Anxiety and Depression Scale (HADS) and Yale Brown Obsessive Compulsive Scale-Shopping Version (YBOCS-SV).

RESULTS

Principle component analysis (PCA) identified two groups within the compulsive buyers (labelled positive reinforcement and emotional distress) that explained 44% of the study variance. Ten women defined the positive reinforcement factor and tended to identify with pleasurable aspects of buying. Six women characterized the emotional distress factor and endorsed varied financial, emotional, and interpersonal difficulties associated with their CB. The emotional distress group carried significantly greater current debt levels and had significantly more severe CB.

CONCLUSIONS

The study illustrates that compulsive buyers can relate to their 'symptoms' in dissimilar ways. The clinical implications of such heterogeneity are discussed, methodological shortcomings identified, and areas for future research indicated.

Relations among delay discounting, addictions, and money mismanagement: implications and future directions

BACKGROUND

Delay discounting is a reduction in the subjective value of a delayed outcome. Elevated delay discounting is a type of impulsivity that is associated with harmful behaviors, including substance abuse and financial mismanagement.

METHODS

Elevated delay discounting as related to addiction and financial mismanagement was reviewed from psychological, neurobiological, and behavioral economic perspectives.

RESULTS

Addiction and financial mismanagement frequently co-occur, and elevated delay discounting may be a common mechanism contributing to both of these problematic behaviors.

CONCLUSIONS

Future research on the relationships between delay discounting, substance abuse, and financial mismanagement can provide important insights for developing improved prevention and treatment strategies.

Behavioural addictions in adolescents and young adults: results from a prevalence study

Our study aims to assess the prevalence of behavioural addictions in an adolescent population, evaluating the effects of gender and age, and to assess the correlations among different behavioural addictions. 2853 high school students were assessed in order to evaluate the prevalence of behavioural addictions such as Pathological Gambling (PG), Compulsive Buying (CB), Exercise Addiction (EA), Internet Addiction (IA), and Work Addiction (WA), in a population of Italian adolescents. The South Oaks Gambling Screen-Revised Adolescent (SOGS-RA), the Compulsive Buying Scale (CBS), the Exercise Addiction Inventory (EAI), the Internet Addiction Test (IAT), and the Work Addiction Risk Test (WART), were compiled anonymously by the students. Overall prevalence was 7.0% for PG, 11.3% for CB, 1.2% for IA, 7.6% for WA, 8.5% for EA. PG and EA were more common among boys, while gender had no effect on the other conditions. CB was more common among younger (<18 years old) students. The scores of all of these scales were significantly correlated. The strong correlation among different addictive behaviours is in line with the hypothesis of a common psychopathological dimension underlying these phenomena. Further studies are needed to assess personality traits and other clinical disorders associated with these problems behaviours.

Anxiety in Parkinson's disease: a critical review of experimental and clinical studies

Parkinson's disease (PD) is the second most common neurodegenerative disorder affecting about 1% of the population older than 60 years. Classically, PD is considered as a movement disorder, and its diagnosis is based on the presence of a set of cardinal motor signs that are the consequence of a pronounced death of dopaminergic neurons in the substantia nigra pars compacta. There is now considerable evidence showing that the neurodegenerative processes leading to sporadic PD begin many years before the appearance of the characteristic motor symptoms, and that additional neuronal fields and neurotransmitter systems are also involved in PD, including olfactory structures, amygdala, caudal raphe nuclei, locus coeruleus, and hippocampus. Accordingly, adrenergic and serotonergic neurons are also lost, which seems to contribute to the anxiety in PD. Non-motor features of PD usually do not respond to dopaminergic medication and probably form the major current challenge in the clinical management of PD. Additionally, most studies performed with animal models of PD have investigated their ability to induce motor alterations associated with advanced phases of PD, and some studies begin to assess non-motor behavioral features of the disease. The present review attempts to examine results obtained from clinical and experimental studies to provide a comprehensive picture of the neurobiology and current and potential treatments for anxiety in PD. The data reviewed here indicate that, despite their high prevalence and impact on the quality of life, anxiety disorders are often under-diagnosed and under-treated in PD patients. Moreover, there are currently few clinical and pre-clinical studies underway to investigate new pharmacological agents for relieving these symptoms, and we hope that this article may inspire clinicians and researchers devote to the studies on anxiety in PD to change this scenario. This article is part of a Special Issue entitled 'Anxiety and Depression'.

Impulse control disorders: updated review of clinical characteristics and pharmacological management

Impulse control disorders (ICDs) are characterized by urges and behaviors that are excessive and/or harmful to oneself or others and cause significant impairment in social and occupational functioning, as well as legal and financial difficulties. ICDs are relatively common psychiatric conditions, yet are poorly understood by the general public, clinicians, and individuals struggling with the disorder. Although ICD treatment research is limited, studies have shown ICDs may respond well to pharmacological treatment. This article presents a brief overview about the clinical characteristics of ICDs and pharmacological treatment options for individuals with ICDs.

The relationship between compulsive buying, eating disorder symptoms, and temperament in a sample of female students

The aim of the present study was to investigate the relationship between compulsive buying (CB), eating disorder symptoms, and temperament (controlling for depression) in a sample of female students. We assessed 211 female undergraduate students using the Compulsive Buying Scale, the Eating Disorder Inventory, the Behavioral Inhibition System and Behavioral Activation System scales, the Adult Temperament Questionnaire, and the Physical Health Questionnaire-Depression. The results show a positive association between CB and the Eating Disorder Inventory-II drive for thinness and bulimia subscales. Both CB and eating disorder symptoms were related to low levels of effortful control. Finally, CB was also related to high levels of Behavioral Activation Scale reactivity (impulsivity), whereas eating disorder symptoms (especially drive for thinness) were more strongly related to high levels of Behavioral Inhibition Scale reactivity (anxiety). The implications of these findings for the treatment of CB and eating disorder symptoms will be discussed.