________________________________________________________________________ Behavioral Addictions
CLINICAL CHARACTERISTICS Compulsive buying is a chronic, repetitive behavior that becomes a primary response to negative events and feelings [286]. Four distinct phases in compulsive buying events are described: anticipation, preparation, shopping, and spend- ing. Negative emotions, such as anger, anxiety, boredom, and self-critical thought, were the most common antecedents to shopping binges, with euphoria or relief from negative emo- tions the most common immediate effects [281]. Unlike ordinary consumers with primary buying motives of value and usefulness, compulsive buyers make purchases to elevate their mood, cope with stress, gain social approval/recog- nition, and/or improve their self-image [287; 288]. Compulsive buying through the Internet is motivated by immediate gratifi- cation, ability to buy unobserved and avoid social interactions, and the vast number of products [22]. Compulsive buying dis- order is driven by mood-modifying motivation—not excessive spending or materialism alone. It can lead to serious adverse outcomes, including substantial debt, relationship problems, elevated risks of criminal behavior, and suicide attempts [289]. Emotional consequences from protracted compulsive buying include shame, guilt, and regret/remorse over purchases and failed efforts to stop [215; 280]. The role of impulsivity in compulsive buying disorder is demonstrated, characterized by novelty-seeking, acting rashly without considering future consequences, and approach behavior triggered by high sensitivity to reward stimuli. Other data suggest correlations between compulsive buying disorder and positive/negative urgency (i.e., the tendency to act rashly while in positive/negative mood) [285]. The purchases of compulsive buyers are seldom used, and patient interest is quickly lost. However, the urge to shop and buy recurs, along with excessive, inappropriate buying sprees the patient is unable to control. Patients with compulsive buying disorder usually spend far beyond their means, lead- ing to distress, debt, interference with employment and social functioning, relationship difficulty, and occasionally, criminal behavior such as fraud or embezzlement [285]. Sociodemographic and personality characteristics may help determine different clinical subtypes of compulsive buying disorder to consider during assessment and treatment plan- ning. Three clusters of compulsive buying disorder were identified among patients attending a specialized treatment program [290]: • Male compulsive buyers: The highest prevalence of comorbid gambling disorder and the lowest levels of reward dependence • Female, low dysfunctional: Mainly employed women, with the highest level of education, the oldest age of onset, the lowest scores in harm avoidance, and the highest levels of persistence, self-directedness, and cooper-ativeness
• Female, highly dysfunctional: The youngest age of onset, the highest levels of comorbid psychopathology and harm avoidance, and the lowest scores in self- directedness Comparisons with Other Behavioral Addictions A study compared characteristics of patients seeking treatment for compulsive buying disorder, gambling disorder, Internet gaming disorder, Internet addiction, or sexual addiction. The results show that although compulsive buying disorder could likely be related to other addictive behaviors, significant differ- ences in its phenomenology exist. Compulsive buying disorder is characterized by a higher proportion of women, older age of onset, poorer general psychopathologic state, higher levels of novelty seeking and harm avoidance, and moderate levels of reward dependence, persistence, and cooperativeness. In this sense, patients with compulsive buying disorder could be described as curious, easily bored, impulsive, and active seekers of new stimuli and reward. At the same time, these patients show pessimism and worry in anticipation of upcom- ing challenges [280]. Clinical differences were lower compared with sex addiction and higher compared with gambling disorder and Internet gaming disorder. Compulsive buying disorder and sexual addiction showed similar profiles, with their psychopathologic symptoms and personality scores being clearly worse than for gambling and Internet gaming disorder. In behavioral addictions, impulsivity is a core feature, but multiple studies also show high levels of compulsivity [291; 292]. This study showed the combination of impulsive/compulsive symptoms is especially prominent in compulsive buying disorder and sex addiction [280]. In hoarding, one of the most commonly reported symptoms is acquiring behavior, and other studies have identified numerous similarities between hoarding and compulsive buying disorder [293]. Gambling disorder and compulsive buying disorder share features, including the urge to achieve immediate gratification or relieve negative emotion through impulsive/compulsive behavior, early onset of problematic addictive behavior, and impaired money management skills [280]. The inability to resist an impulse, drive, or temptation to perform a harmful act is an essential feature of most behavioral addictions [46]. Online compulsive buying disorder was studied in 240 female subjects. The relationship between excitability from shopping and pathologic online buying was partially mediated by expec- tancies for online shopping (i.e., the expectation that online buying will satisfy urges for excitement, distress relief, or mood elevation). Craving and pathologic online buying were strongly correlated, and increased cue-reactivity (i.e., craving after pre- sentation of online shopping images) was observed solely in individuals scoring high for online compulsive buying disor- der. This mediation model explained most of the variance for tendency to develop online compulsive buying disorder [294].
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