Compulsive buying

It's become a tradition in my family. After we drop our kids at camp near Augusta, Maine, we stop in Freeport on our drive back to Boston.

Freeport is the home of clothing retailer L.L. Bean, which is open 24 hours a day, 365 days a year. It was a magnet for 'round the clock shoppers decades before the Internet. Freeport is now thick with outlet stores — a perfect place to do "retail therapy" in the hours after you leave your beloved children.

There's no denying the pleasure in purchasing. And advertisers only get more skilled at parting us from our cash. But for some — maybe as many as one in 20 according to one study — shopping is a compulsion or an addiction.

Compulsive shoppers may get some pleasure, but they are also trapped in a terrible cycle. Because shopping is often an irresistible and sometimes senseless impulse, they buy things they don't need and can't afford. And the shopping leads to guilt, conflict in key relationships, trouble at work, and financial difficulty, if not ruin. In some cases, the compulsion leads to criminal activity.

At worst, an individual may commit suicide in response to feeling depressed or humiliated. That is an extreme and rare outcome. But experts are beginning to understand that compulsive buying can cause significant distress.

Compulsive buying is not currently listed in the manual used in American psychiatry to diagnose mental health disorders. But it may appear in the next edition. For now, it's considered a problem of impulse control — the inability to resist an impulse or temptation. There's an increasing sense of arousal or tension before acting and a sense of relief afterwards.

But there are experts who disagree. Some see compulsive buying as an obsessive-compulsive disorder while others see it as an addiction. It's possible that it's not a compulsion or an addiction at all, but a way to soothe painful feelings of depression or loneliness or part of the intense high or euphoria of mania.

Some experts even criticize the idea that we should call compulsive buying a medical or mental disorder. They suggest that the problem is primarily a social one. Credit is too easy to get. Advertisers are too clever at selling us things. And modern shopping opportunities are always available.

The social influence is great, no doubt. But there is evidence of a biological component, too: Compulsive buyers have a relatively good chance of having a mood disorder or some other psychiatric disorder. And their close relatives are more likely than average to have psychiatric disorders like depression, alcoholism, or drug abuse. This suggests a genetic, and therefore a biological link.

Compulsive buying is almost certainly not one illness with one best treatment. Here's what research has shown about possible treatment options:

• In one small study, cognitive behavior therapy was effective at reducing compulsive shopping.
• Antidepressants, which are often used to treat obsessive-compulsive symptoms, have not been proven specifically successful for compulsive buying. But they can help if the person also is depressed.
• If a person has another addiction, it should be treated because other addictions can make matters worse.
• As with most psychiatric disorders, education and family support are key elements of treatment, especially as the problem becomes more severe.

If life is unraveling — the money gone, relationships have been destroyed, work life is damaged, and there are high levels of distress — it may be necessary to try all of these approaches at once. And someone else may have to intervene, for example, by taking away the credit card or shutting off Internet access.

Do you know someone who is a compulsive shopper, or have you experienced this problem yourself? What has helped alleviate the problem?

Dr. Michael Miller has been on staff of the Beth Israel Deaconess Medical Center, a large teaching hospital in Boston, for more than 25 years. He is also an Assistant Professor of Psychiatry at Harvard Medical School.

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