Compulsive shopping: If the psychiatrists put it in the diagnostic manual, does that make it an illness?

A recent article in the American Journal of Psychiatry (October 2006) describes "compulsive buying" as a relatively common affliction. An editorial in the same journal argues that the condition should be recognized as a "mental disorder" and included in the next edition of the official diagnostic manual. Is this another example of psychiatry's quest to describe every human failing and foible as an illness?

The study, conducted by Stanford University medical professor Lorrin M. Koran (et al), was an effort to estimate the prevalence of this problem. They conducted a telephone survey, asking people about a series of behaviors that are associated with compulsive buying.

What they found is interesting: 5 or 6 percent of the people in the population fit the profile of compulsive buyers. They spend beyond their means for things they don't need, can't afford or really won't use, and they abuse credit and create financial difficulties for themselves. And it is a behavior these people find to be troubling. The prevalence is 1 out of 20 people, and that can be considered a very large number.

The other important thing they found is that it is not just women. Previous estimates have focused on the fact that women are more likely to admit that shopping is a problem. In other words, women are more likely to seek help. The previous estimate was that 80 or 90 percent of compulsive shoppers were women, and that estimate turned out to be completely wrong. What Dr. Koran and his colleagues found is that the numbers are equal. Whether or not the stereotype is true, it can be said that in the electronics department or at the hardware store, men are behaving exactly the same way as women in the shoe department or at the department store. (And there we have another stereotype.)

So is it an illness just because it has a high prevalence and is equally distributed, irrespective of gender?

Actually, there is another factor involved. It is a behavior that causes distress and is associated with both anxiety and depression. It can either result from or result in emotional disturbance.

But still, does that make it an illness or a "diagnosable mental disorder?"

For now, I am not going to try to explain the dynamics of compulsions or the complex nature of addictions. What I want to focus on is what it means when a condition is described as a disorder in psychiatry's official diagnostic manual, the Diagnostic and Statistical Manual of Mental Disorders: the "DSM" or "bible" of disorders.

To be included in the DSM, a pattern or a syndrome, a condition or an ailment, a disorder or a disease does not have to actually be something that we would all generally recognize as a "mental illness."

To be included in the DSM, what is required is that a typical pattern of feeling, thinking and behaving is common enough for us to recognize it when we see it. Conditions can be recognized as something to which attention should be paid or towards which treatment should be directed. Conditions are listed in the DSM so that clinicians can say: "this is what I saw, what I saw is an example of ..." What the DSM provides is a systematic way for clinicians to describe their observations.

In my yard, there are trees that look like bushes and bushes that look like trees. For individuals who are suffering, the DSM tells us how to distinguish between the two.

If "compulsive buying" should in fact become a formal diagnostic label, it doesn't mean that anyone has concluded that it is the result of an illness or a disease process. It doesn't mean that anyone will be less responsible before the law. It does not mean that this is an excuse, even though it might perhaps help to provide an explanation.

The fact that psychiatrists have said that this is a pattern of behavior that we should pay attention to does not mean anything more than that this is a pattern of behavior towards which we should direct attention.

If the pattern proves to be stable and consistent enough to make it into the diagnostic manual, it doesn't mean it's an "illness."

All it means is that it is common, that it's a problem, that we can recognize it, that there are typical features, that we should study it, that it disrupts people's lives, that we should help them, and that there is common agreement about what we are looking at.

With that having been said, I'm off to the mall to buy that 42 inch HDTV monitor I've had my eye on ... I know I can't afford it, but I can put it on my visa card.

Copyright, Paul G. Mattiuzzi,Ph.D.