Psychiatric Annals

CME 

Internet Shopping from a Psychiatric Perspective

Astrid Müller, MD, PhD; James E. Mitchell, MD

Abstract

Compulsive buying is characterized by extreme preoccupation with buying, by recurrent episodic purchasing of consumer goods that are unneeded, by losing control over spending, and by continued buying despite harmful consequences, such as psychological distress, familial conflicts, interference in social or occupational functioning, and debts. Compulsive buying episodes serve as a maladaptive coping strategy to satisfy emotional needs. Individuals with compulsive buying report increased material values endorsement and experience high psychiatric comorbidity, with the most common comorbid disorders being social anxiety, depression, hoarding disorder, binge eating disorder, and substance use disorders. A population-based survey estimated the point prevalence of compulsive buying to be approximately 6% in the United States. Compulsive buying may occur in different buying environments, including traditional offline buying in stores and buying on the Internet. Research on online compulsive buying, however, is still relatively sparse. It is likely that psychiatric aspects that play a role in traditional offline compulsive buying may also be of importance in online compulsive buying. [Psychiatr Ann. 2014; 44(8):384–387.]


Abstract

Compulsive buying is characterized by extreme preoccupation with buying, by recurrent episodic purchasing of consumer goods that are unneeded, by losing control over spending, and by continued buying despite harmful consequences, such as psychological distress, familial conflicts, interference in social or occupational functioning, and debts. Compulsive buying episodes serve as a maladaptive coping strategy to satisfy emotional needs. Individuals with compulsive buying report increased material values endorsement and experience high psychiatric comorbidity, with the most common comorbid disorders being social anxiety, depression, hoarding disorder, binge eating disorder, and substance use disorders. A population-based survey estimated the point prevalence of compulsive buying to be approximately 6% in the United States. Compulsive buying may occur in different buying environments, including traditional offline buying in stores and buying on the Internet. Research on online compulsive buying, however, is still relatively sparse. It is likely that psychiatric aspects that play a role in traditional offline compulsive buying may also be of importance in online compulsive buying. [Psychiatr Ann. 2014; 44(8):384–387.]


Compulsive buying is characterized by an extreme preoccupation with buying and shopping, by recurrent episodic excessive purchasing of consumer goods that are useless or unneeded, and by repeated unsuccessful attempts to control the buying behavior.1 Patients with compulsive buying experience overpowering urges to buy, as well as growing tension that can only be relieved by purchasing goods.2 The purchased items are either rarely used or not used at all, but rather they are hidden, hoarded, forgotten, or given away.1 Individuals with compulsive buying use shopping and buying to satisfy emotional and identity-related needs. Therefore, compulsive buying is viewed as a maladaptive emotion regulation strategy with deficient self-control mechanisms.3,4 Prior research has indicated strong links between high material values endorsement, increased impulsivity, depression, and compulsive buying.5 Treatment-seeking patients with compulsive buying experience high psychiatric comorbidity, with the most common comorbid disorders being social anxiety, depression, hoarding disorder, binge eating disorder, and substance use disorders.4,6 In addition, personality disorders are prevalent among patients with compulsive buying; specifically, avoidant, depressive, obsessive-compulsive, and borderline personality disorders have been frequently observed.7

Of special interest for the current article, several studies demonstrated an overlap between compulsive buying and pathological Internet use. In an online survey, consumers with compulsive buying reported more severe excessive Internet use than those without compulsive buying.8 Similarly, students with a diagnosis of compulsive buying presented with higher scores on questionnaires for problematic Internet use.9 Another study showed a positive association between compulsive buying and compulsive Internet use in female patients with eating disorders.10

Although compulsive buying results in psychological distress, familial conflicts, feelings of guilt, interference in social or occupational functioning, and financial embarrassments, the excessive spending continues.1,11 In some cases, fraud (eg, purchasing under a wrong name) and other legal problems may arise to satisfy immense buying impulses, despite major debts. It is noteworthy that the phenomenon cannot be attributed to mania or hypomania.1

A large population-based survey estimated the point prevalence of compulsive buying to be approximately 6% in the United States.12 There is an ongoing debate regarding whether compulsive buying should be considered as a behavioral addiction, similar to gambling disorder.13 Alternatively, the disorder may be classified as an impulse control disorder.4 However, due to limited research, compulsive buying was not included in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders.14 This is worrisome given the increasing prevalence of compulsive buying in the population and the particularly high occurrence in adolescents and young adults.12,15,16

Comparison Between Compulsive Buying and Other Addictive Behaviors

There appears to be substantial overlap between the core features of compulsive buying and proposed diagnostic criteria for other behavioral addictions, such as gambling disorder or Internet gaming disorder.14 For example, the following criteria can be used for diagnosing both compulsive buying and gambling disorder:

  • Persistence and recurrence of the behavior.
  • Irritability, anxiety, or sadness when cutting down or stopping the behavior.
  • Loss of control and repeated unsuccessful attempts to control the behavior.
  • Preoccupation with the behavior.
  • Use of the behavior to escape or relieve a negative mood.
  • Deceiving others regarding the extent of the inappropriate behavior.
  • Jeopardizing or losing a significant relationship, job, educational, or career opportunity.
  • Relying on others to provide money to relieve desperate financial situations caused by the behavior.
  • The behavior is not better explained by a manic episode.

Moreover, neuropsychological pilot data suggested an increased reward responsiveness and reduction in prefrontal control (eg, impaired decision making) in patients with compulsive buying.17–19 The results may indicate a probable neurobiological overlap between compulsive buying and other forms of addictive behaviors or substance use disorders.17,20,21

Online Versus Offline Compulsive Buying

Compulsive buying may occur in different buying environments, including traditional offline buying in stores and online buying on the Internet. One may assume that the lack of social interaction on the Internet represents a limitation of the online shopping environment.22 Regarding treatment-seeking patients with compulsive buying, earlier reports demonstrated that the majority of patients preferred buying in traditional stores.23 The preference for brick-and-mortar–based retailers was related to several features, such as a need for immediate gratification, the possibility to physically touch and inspect consumer goods, or the enjoyment of a stimulating retail environment (eg, music, smells, adulating salespersons). However, clinical experience shows that this has changed substantially over the past decade. More patients with compulsive buying engage in both offline and online shopping or even completely prefer the Internet shopping environment, which is not surprising in light of the increasing online retail market.24

Online compulsive buying is characterized by the same core features as traditional offline compulsive buying: experiencing an extreme preoccupation with buying or shopping, losing control over spending, and continuing buying despite harmful consequences.1,2,25 The main difference between offline and online compulsive buying pertains to the preferred buying/shopping environment and specific features of the Internet that may stimulate buying sprees.

Case Example

Anne, a 30-year-old single mother of two children, suffers from frequent online shopping. During the day, she is very busy with her job and children. In the evening, she feels exhausted, lonely, and depressed. After putting her kids to bed, she usually relaxes by surfing the Web for several hours. Her mood improves while Webrooming and she enjoys unobserved, recreational shopping. Most evenings, she cannot resist the urge to visit the homepage of a special clothing company. She images how good she would look wearing the exclusive dress or how her colleagues would admire her. Anne then accumulates several goods in her online shopping cart and clicks the button to buy. During these moments, she completely fades out that her closets are already crowded with purchases she never used and she hardly bears in mind that her debts have increased substantially due to frequent online buying.

Features of the Internet That Encourage Online Compulsive Buying

Appropriate online buying refers to goal-directed information search, price comparisons, and efficiency. In contrast, frequent recreational hedonic browsing on Web sites that display consumer goods may end up in uncontrolled buying. Online compulsive buying might occur when an individual with an obsessive passion habitually uses online shopping to deal with negative mood states.26

The Internet provides the ability to shop at any time of the day or night from the convenience of one’s own home, which may encourage impulse buying. For example, easy access, a great variety of goods, online marketing promotions, well-designed and appealing Web site stores, and the ability to pay with a credit card may trigger uncontrolled buying.27–29 The ease to accumulate a large number of items in an online shopping cart may increase the risk for compulsive buying. Privacy policies and the ability to buy unobserved, to avoid face-to-face social contact, and to hide buying activities while shopping and buying online may contribute to the tendency to buy compulsively.24

Specific Psychiatric Aspects of Online Compulsive Buying

As mentioned previously, many patients with compulsive buying have an anxiety or avoidant personality disorder. They may, therefore, prefer shopping in the anonymous and easy accessible Internet instead of in conventional retail stores. Among other psychiatric features, depression, high trait impulsivity, and materialistic values endorsement have been linked to compulsive buying.5,8 Currently, few studies have examined these factors in relation to online compulsive buying. Most prior reports were performed by consumer researchers who focused on materialistic values and identity-related motives for online impulse buying in convenience consumer samples but not in clinical samples.

For example, findings from a student sample suggested that the combination of negative mood and poor self-regulation results in more online buying.30 Another study that was conducted in the United Kingdom indicated that materialistic values endorsement is associated with seeking to enhance positive emotions and improve sense of identity while buying online, which, in turn, may increase the risk for compulsive buying on the Internet.25

Taken together, it is likely that psychiatric aspects that play a role in traditional offline compulsive buying may also be of importance in the development and maintenance of online compulsive buying. Research on online compulsive buying is still relatively sparse. Further studies should address the potential pitfalls of online consumption for the development or worsening of compulsive buying tendencies. The findings could inspire developing specific treatment strategies for online compulsive buying.

References

  1. McElroy SL, Keck PE Jr, Pope HG Jr, Smith JM, Strakowski SM. Compulsive buying: a report of 20 cases. J Clin Psychiatry. 1994; 55(6):242–248.
  2. Müller A, Mitchell JE, Crosby RD, et al. Mood states preceding and following compulsive buying episodes: an ecological momentary assessment study. Psychiatry Res. 2012; 200(2–3):575–580.
  3. Kellett S, Bolton JV. Compulsive buying: a cognitive-behavioural model. Clin Psychol Psychother. 2009;16(2):83–99.
  4. Müller A, Mitchell JE, de Zwaan M. Compulsive buying [published online ahead of print October 4, 2013]. Am J Addict. doi:10.1111/j.1521-0391.2013.12111.x [CrossRef].
  5. Müller A, Claes L, Georgiadou E, et al. Is compulsive buying related to materialism, depression or temperament? Findings from a sample of treatment-seeking patients with compulsive buying. Psychiatry Res. 2014;216(1):103–107. doi:10.1016/j.psychres.2014.01.012 [CrossRef].
  6. Mueller A, Mitchell JE, Black DW, Crosby RD, Berg K, de Zwaan M. Latent profile analysis and comorbidity in a sample of individuals with compulsive buying disorder. Psychiatry Res. 2010;178(2):348–353. doi:10.1016/j.psychres.2010.04.021 [CrossRef].
  7. Schlosser S, Black DW, Repertinger S, Freet D. Compulsive buying. Demography, phenomenology, and comorbidity in 46 subjects. Gen Hosp Psychiatry. 1994;16(3):205–212.
  8. Mueller A, Mitchell JE, Peterson LA, et al. Depression, materialism, and excessive Internet use in relation to compulsive buying. Compr Psychiatry. 2011; 52(4):420–424. doi:10.1016/j.comppsych.2010.09.001 [CrossRef].
  9. Mazhari S. Association between problematic Internet use and impulse control disorders among Iranian university students. Cyberpsychol Behav Soc Netw. 2012;15(5):270–273. doi:10.1089/cyber.2011.0548 [CrossRef].
  10. Claes L, Müller A, Norré J, Van Assche L, Wonderlich S, Mitchell JE. The relationship among compulsive buying, compulsive Internet use and temperament in a sample of female patients with eating disorders. Eur Eat Disord Rev. 2012;20(2):126–131. doi:10.1002/erv.1136 [CrossRef].
  11. Christenson GA, Faber RJ, de Zwaan M, et al. Compulsive buying: descriptive characteristics and psychiatric comorbidity. J Clin Psychology. 1994;55(1): 5–11.
  12. Koran LM, Faber RJ, Aboujaoude E, Large MD, Serpe RT. Estimated prevalence of compulsive buying behavior in the United States. Am J Psychiatry. 2006;163(10):1806–1812.
  13. Lejoyeux M, Weinstein A. Compulsive buying. Am J Drug Alcohol Abuse. 2010;36(5):248–53.
  14. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.
  15. Mueller A, Mitchell JE, Crosby RD, et al. Estimated prevalence of compulsive buying in Germany and its association with sociodemographic characteristics and depressive symptoms. Psychiatry Res. 2010;180(2–3):137–142. doi:10.1016/j.psychres.2009.12.001 [CrossRef].
  16. Neuner M, Raab G, Reisch L. Compulsive buying in maturing consumer societies: an empirical re-inquiry. Journal of Economic Psychology. 2005;26:509–522.
  17. Derbyshire KL, Chamberlain SR, Odlaug BL, Schreiber LRN, Grant JE. Neurocognitive functioning in compulsive buying disorder. Ann Clin Psychiatry. 2014;26(1):57–63.
  18. Raab G, Elger CE, Neuner M, Weber B. A neurological study of compulsive buying behaviour. Journal of Consumer Policy. 2011;34:401–413.
  19. Voth EM, Claes L, Georgiadou E, et al. Reactive and regulative temperament in patients with compulsive buying and non-clinical controls measured by self-report and performance-based tasks [published online ahead of print May 27, 2014]. Compr Psychiatry. doi:10.1016/j.comppsych.2014.05.011 [CrossRef].
  20. Brand M, Young KS, Laier C. Prefrontal control and Internet addiction: a theoretical model and review of neuropsychological and neuroimaging findings. Front Hum Neurosci. 2014;8:375. doi:10.3389/fnhum.2014.00375 [CrossRef].
  21. Grant JE, Brewer JA, Potenza MN. The neurobiology of substance and behavioral addictions. CNS Spectr. 2006;11(12):924–930.
  22. Grewal D, Iyer GR, Levy M. Internet retailing: enablers, limiters and market consequences. Journal of Business Research. 2004;57(7):703–13.
  23. Silbermann A, Henkel A, Müller A, de Zwaan M. The application of ecological momentary assessment to the study of compulsive buying [article in German]. Psychother Psychosom Med Psychol. 2008;58(12):454–461. doi:10.1055/s-2007-986352 [CrossRef].
  24. Kukar-Kinney M, Ridgway NM, Monroe KB. The relationship between consumers’ tendencies to buy compulsively and their motivations to shop and buy on the Internet. Journal of Retailing. 2009;85(3):298–307.
  25. Dittmar H, Long K, Bond R. When a better self is only a button click away: associations between materialistic values, emotional and identity-related buying motives, and compulsive buying tendency online. Journal of Social and Clinical Psychology. 2007;26(3):334–361.
  26. Wang CC, Yang HW. Passion for online shopping: the influence of personality and compulsive buying. Social Behavior and Personality. 2008;36(5):693–706.
  27. Koski N. Impulse buying on the Internet: encouraging and discouraging factors. Frontiers of e-Business Research. 2004;23–35.
  28. LaRose R. On the negative effects of e-commerce: a sociocognitive exploration of unregulated online-buying. Journal of Computer-Mediated Communication. 2001;6(3): doi:10.1111/j.1083-6101.2001.tb00120.x [CrossRef].
  29. San Martin S, Camarero C. Consumer trust to a website: moderating effect of attitudes toward online shopping. Cyberpsychology Behav. 2008;11(5):549–554.
  30. LaRose R, Eastin MS. Is online buying out of control? Electronic commerce and consumer self-regulation. Journal of Broadcasting & Electronic Media. 2002;46(4):549–564. doi:10.1207/s15506878jobem4604_4 [CrossRef].
Authors

Astrid Müller, MD, PhD, is Research Scientist, Department of Psychosomatic Medicine and Psychotherapy, Hannover School of Medicine. James E. Mitchell, MD, is Professor and Chair, Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, and President, Neuropsychiatric Research Institute.

Address correspondence to: Astrid Müller, MD, PhD, Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany; email: mueller.astrid@mh-hannover.de.

Disclosure: The authors have no relevant financial relationships to disclose.

10.3928/00485713-20140806-06

Sign up to receive

Journal E-contents