Buying trouble: consumerism can become a compulsion

In a land where people are implored to shop as an expression of patriotism, where little girls can attend summer camp cruising the stores of a mall and where the average credit-card holder is $1,673 behind in payments, buying things in the United States is more than a hunt for daily provisions. It's a national pastime, a form of therapy, a means of self-expression.

But for more than 1 in 20 Americans, shopping is something darker. 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 U.S. 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.

As the drumbeat of depressing economic indicators accelerates, they are increasingly 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,' " said psychiatrist Timothy Fong, director of the Impulse Control Disorders Clinic at the University of California, Los Angeles, and co-director of the university's Addiction Medicine Clinic.

For the truly addicted shopper, Fong said, "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."

May I help you?

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. They have found no shortage of clients.

J.P., a 66-year-old Los Angeles man, is one of them. For six years a member of the 12-step group Debtors Anonymous (and so, following its rules, he's declined to identify himself by name), J.P. calls himself "a constantly struggling compulsive shopper" and "a binge person" by nature. Echoing the observations of many compulsive shoppers and those who treat them, J.P. said that what seems to trigger his impulse to spring for something is "a feeling of needing to fix yourself ... a sense of filling a void."

J.P. said that buying something — in his case, costly services such as workshops and courses — would give him a shot of energy and a sense of purpose. But the crash, coming hours, days or weeks later when he realized he had succumbed to a costly impulse, has always been hard. "I feel suckered. I feel incompetent in a way that I didn't feel before.

It becomes an addiction because it feels the more you do this thing, the better you're going to be. It's completely wrongheaded, wrong thinking.

Programs designed to address such thinking are in demand. In the past five years, Stanford University and UCLA have established treatment programs for those who report out-of-control shopping. Debtors Anonymous, meanwhile, has seen an uptick of attendance at its meetings in recent years — a measure, said Jan S., a trustee of the organization, both of hard economic times and people's inability to curb their spending habits accordingly.

Crossing the line

We all shop. In that simple fact, experts say, lies the difficulty of distinguishing the avid shopper, or even the occasionally excessive shopper, from the shopper who is out of control. "You don't want to medicalize normal behavior," said Dr. Eric Hollander, chairman of psychiatry at the Mount Sinai School of Medicine. But a small percentage of consumers, he said, seem to suffer from "a profound deficit" in the ability to resist their impulse to shop, despite negative consequences. For those people, Hollander said, the term disorder "seems to fit."

In 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, mortgage woes and growing job insecurity, 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," Hollander said. In fact, for a true compulsive buyer, rising food costs and gas prices, possible layoffs and a hike in mortgage rates might even trigger a perverse reaction: Stressed by financial difficulties, many problem consumers will escape their worries with a shopping trip.

If those seeking treatment are any gauge, compulsive shopping is an overwhelmingly 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, said Dr. Lorrin Koran, a professor of psychiatry (emeritus) 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 said.

Breaking the spell

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, Koran said. 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.

But it can be broken, said New York therapist April Lane Benson, who has pioneered a telephone-based form of group therapy for compulsive shoppers. She also authored 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 most 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 cast. "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."