The medicalization of compulsive buying

Social Science & Medicine 58 (2004) 1709–1718

The medicalization of compulsive buying

Shirley Lee*, Avis Mysyk

Department of Anthropology, Fletcher Argue Building, University of Manitoba, Winnipeg, Manitoba, Canada R3T 2N2

Abstract

Compulsive buying has recently been the subject of numerous articles from both consumer research and psychiatric

perspectives. Identified by some researchers as a compulsion and by others as an addiction, common solutions to the

problem have included drug treatments, participation in self-help groups and cognitive behaviour therapy. The purpose

of this article is to examine critically the labelling of compulsive buying in terms of medicalization from the perspective

of both medical and non-medical social control of ‘‘deviant’’ consumers. We suggest that the attempt to categorize

compulsive buying as an illness represents the ongoing trend to medicalize behavioural problems which may be better

understood within the wider context of related phenomena such as the fiscal crisis of the 1980s and 1990s and the

consumption-driven economy of North America.

r 2003 Elsevier Ltd. All rights reserved.

Keywords: Compulsive buying; Medicalization; Labelling

Introduction

Compulsive buying is a label which has been used

recently in both psychiatric and consumer research

contexts to refer to the inability to shop or buy

‘‘normally’’ (Faber, O’Guinn, & Krych, 1987; O’Guinn

& Faber, 1989). According to Faber (2000, p. 27), the

study of compulsive buying arose from work on

consumer behaviour that focused on the way in which

individuals learned to be ‘‘good’’ consumers; after years

of research, however, it was clear that many consumers

had developed ‘‘bad’’ spending habits. The prevalence of

compulsive buying has been estimated to range from 1%

to 10% of the population of the United States (Benson,

2000, p. xxi). The labelling of compulsive buying as a

discrete entity along with the aforementioned estimates

of prevalence in the population have implications for the

process of medicalization. What could be considered a

social problem, or ‘‘an extreme case of a generalized

urge to buy in the normal consumer population’’

(d’Astous, 1990, p. 17), is treated as a fairly widespread

medical problem (even a psychiatric illness). Within this

perspective, the social context of consumerism, i.e., that

individuals are encouraged to buy an array of desirable

items, tends not to be addressed. Suggested treatments

range from antidepressants to cognitive behaviour

modification to counselling to participation in self-help

groups.

The purpose of this paper is to examine critically, first,

the labelling of compulsive buying and second, the

implications of labelling for both the medicalization of

compulsive buying and the non-medical social control of

‘‘deviant’’ consumers. We suggest that research into

compulsive buying appeared during the global economic

crisis of the 1980s and 1990s and is associated with

North America’s consumption-driven economy. We

further suggest that the attempt to categorize compul-

sive buying as an illness deflects attention from societal

issues associated with compulsive buying and focuses,

instead, on the individual as the source of the problem

resulting in the use of pharmaceuticals as the preferred

treatment.

What is compulsive buying?

‘‘Oniomaniacs,’’ or buying maniacs, have been of

interest to psychiatrists since Kraepelin first coined the

term in 1915. Along with pyromania, kleptomania, and

ARTICLE IN PRESS

*Corresponding author.

E-mail address: [email protected] (S. Lee).

0277-9536/$ - see front matter r 2003 Elsevier Ltd. All rights reserved.

doi:10.1016/S0277-9536(03)00340-X

alcoholism, Bleuler (1924) later included oniomania

under ‘‘The Reactive Impulses (Impulsive Insanity of

Kraepelin).’’ He described it as follows:

The particular element is impulsiveness; they ‘cannot

help it’y the patients are absolutely incapable to

think differently, and to conceive the senseless

consequences of their act, and the possibilities of

not doing it. They do not even feel the impulse, but

they act out of their nature like the caterpillar which

devours the leaves (Bleuler, 1924, p. 540).

In more recent literature, compulsive buying has been

defined as ‘‘chronic, repetitive purchasing that becomes

a primary response to negative events or feelings’’

(O’Guinn & Faber, 1989, p. 155). It can harm not only

the individual but his/her family and society (Faber,

2000, p. 29; Faber & O’Guinn, 1992, p. 467) and can

result in overspending, extreme indebtedness, and bank-

ruptcy (McElroy, Satlin, Pope, Keck, & Hudson, 1991,

p. 199).

Labels for this behaviour vary. Compulsive shopping,

uncontrolled buying, addictive buying, addictive con-

sumption, excessive buying, shopaholism, and spenda-

holism all have been used to describe this overwhelming

need to buy.

Several reasons can be suggested for this proliferation

of labels. One reason is that some labels are used

synonymously. For example, ‘‘compulsive’’ buying

(d’Astous, 1990; Faber & O’Guinn, 1992; Faber et al.

1987; O’Guinn & Faber, 1989; Valence, d’Astous &

Fortier, 1988) and ‘‘uncontrolled’’ buying (Lejoyeux,

Ad"es, Tassain, & Solomon, 1996) emphasize a lack of

control over such behaviour. Compulsive ‘‘shopping’’

(Krueger, 1988; McElroy, Satlin, Pope, Keck, &

Hudson, 1991) is also used synonymously with compul-

sive ‘‘buying.’’ For these researchers, the difference

between shopping and buying is not important.

The difference is important, however, for Campbell

(2000, p. 58) who uses the term ‘‘shopaholics’’ to refer to

individuals who find the activity of shopping pleasurable

and the term ‘‘spendaholics’’ to describe individuals who

feel an overwhelming need to actually purchase items.

Krueger (1988, p. 574) combines these activities into one

phrase, ‘‘compulsive shopping and spending,’’ which he

defines as ‘‘the overpowering urge to buy items,

especially clothing, usually in a pattern of shopping

binges.’’

Dittmar (2000, p. 106) prefers to use the term

‘‘excessive’’ buying. Because she conceives of the act of

buying to be located on a continuum ranging from

‘‘ordinary’’ to ‘‘excessive,’’ she concludes that compul-

sive consumers are not qualitatively different from

normal consumers. d’Astous (1990), Dittmar and Drury,

2000 and Scherhorn, Reisch, and Raab (1990) all agree

that viewing compulsive buying as ‘‘an extreme case of a

generalized urge to buy in the normal consumer

population’’ (d’Astous, 1990, p. 17) may be more valid

than dichotomizing compulsive and normal consumers.

Nonetheless, ‘‘compulsive buying’’ is the term most

widely used in the literature. Initially, most of the work

done in this area was undertaken by two consumer

research teams, one in the United States (Faber &

O’Guinn, 1992; Faber et al. 1987; O’Guinn & Faber,

1989) and one in Canada (d’Astous, 1990; d’Astous,

Maltais, & Roberge, 1990; Valence et al. 1988). Both

teams emphasize the actual buying behaviour rather

than simply time spent shopping and both focus on

identifying compulsive buyers and explaining why these

individuals are more at risk of developing this behaviour

than are others (Scherhorn et al., 1990, p. 356).

A second reason for the proliferation of labels is

whether researchers consider such behaviour to be an

‘‘addiction’’ (Elliott, 1994; Scherhorn et al., 1990) or a

‘‘compulsion’’ (McElroy et al., 1991). As we will show,

this distinction has important implications for the

medicalization of compulsive buying. Scherhorn et al.

(1990, p. 355) prefer to identify compulsive buying as an

addiction rather than as an obsessive-compulsive

disorder because, once a behaviour is defined as

abnormal, it tends to be categorized within a medical

framework rather than viewed as a social phenomenon.

According to Scherhorn et al. (1990, p. 381, emphasis

added), ‘‘[it] is caused by society, and it is widely

spread.’’ Many North American consumers ‘‘succumb

to compensatory buying’’ to fill an emptiness within the

self (Scherhorn et al., 1990, p. 382; see also Cushman,

1990, Elliott, 1994, and Dittmar & Drury, 2000). Such

individuals tend to be very unhappy and try to relieve

those negative feelings by buying (Scherhorn et al., 1990,

p. 371), a behaviour which Elliott (1994, p. 163) labels

‘‘addictive consumption’’ and describes as a ‘‘desperate

search for meaning in a disintegrating social order.’’

However, McElroy et al. (1991, p. 203) argue that

compulsive buying ‘‘might be related to mood, obses-

sive-compulsive, or impulse control disorders’’ and

suggest that this disorder should be included within

the Diagnostic and Statistical Manual of Mental

Disorders (DSM). McElroy, Keck, Pope, Smith, and

Strakowski (1994, p. 247) have even formulated criteria

for compulsive buying modelled on existing DSM

criteria for obsessive-compulsive disorders, impulse

control disorders, substance-use disorders, and patho-

logical gambling.

Some researchers state that compulsive buying,

although not formally listed, is included in the DSM-

IV-TR (APA, 2000) as one of many ‘‘Impulse Control

Disorders, Not Otherwise Specified’’ (Bullock, Hartston,

Elliott, D’Andrea and Koran, 2000; Dittmar, 2000, p.

109; Goldsmith & McElroy, 2000, p. 219; Ninan et al.,

2000), in that it entails a ‘‘failure to resist an impulse,

drive or temptation to perform an act that is harmful to

ARTICLE IN PRESSS. Lee, A. Mysyk / Social Science & Medicine 58 (2004) 1709–17181710

the person or to others’’ (APA, 2000, p. 663). However,

there is some confusion about the categorization of

compulsive buying in the DSM-IV-TR. According to

Black, Monahan, Schlosser and Repertinger (2001,

p. 123), ‘‘its classification is uncertain and it is not listed

in the fourth edition’’ of the DSM, although they note

that compulsive buying appears to be similar to

obsessive-compulsive disorders that significantly inter-

fere with an individual’s ability to function in daily life.

O’Guinn and Faber (1989, p. 148) support the idea that

compulsive buying is part of a broader category of

compulsive consumption behaviours such as drug

addiction, alcoholism, and excessive behaviour asso-

ciated with exercise, work, or sex.

Prevalence of compulsive buying

Because most studies of compulsive buying depend on

self-selected samples, its prevalence in the general

population is unknown. In the popular media, estimates

range as high as 10% or 28 million Americans

(Trachtenberg, 1988, p. 40). Dittmar (2000, p. 108)

suggests that excessive (compulsive) buying is on the rise

and, if it were to affect even 2% of adults in the Western

world, this would translate into more than five million

adults in the United States alone. Having acknowledged

the problem of self-selected samples, d’Astous (1990),

Faber (2000), Faber and O’Guinn (1992), O’Guinn and

Faber (1989), and Valence et al. (1988) are trying to

develop a measure to assess more accurately the

prevalence of compulsive buying. Faber (2000, p. 48)

and Faber and O’Guinn (1992, p. 466) estimate its

prevalence to be 1.8% of the population, although

Faber (2000, p. 48) admits that ‘‘this is only a vague

approximation’’ because his sample was too small for a

valid estimate.

Compulsive buying and gender

In recent consumer research, there is an ongoing

debate about the relationship between compulsive

buying and gender. Shopping is described as a gendered

activity, part of ‘‘women’s work’’ in their roles as

housewives (Campbell, 2000, p. 60; Elliott, 1994, p. 160;

Lunt & Livingstone, 1992, pp. 94–96). Women’s

propensity for shopping is related to their ‘‘dependent’’

role, both in relationships and in society (Scherhorn

et al., 1990, p. 374). Women do most of the shopping

because it is one of their main ‘‘leisure activities’’

(Campbell, 2000, p. 60; Elliott, 1994, p. 160) and because

shopping provides them with an ‘‘opportunity to

socialize’’ (d’Astous, 1990, p. 26; Lunt & Livingstone,

1992, p. 96). Women are taught that shopping is

‘‘pleasurable’’ (Faber et al., 1987, p. 134); they use

shopping as a form of ‘‘self-expression’’ (Elliott, 1994,

p. 160) and to ‘‘enhance their self-image’’ (Dittmar,

2000, p. 106; Dittmar, Beattie, & Friese, 1995, p. 507;

Krueger, 1988, p. 581) because society places importance

on their outward appearance. Krueger (1988, p. 581)

suggests that ‘‘women who shop compulsively are driven

to attempt to restore a depleted self’’ (the ‘‘empty self’’

noted by Elliott, 1994; Cushman, 1990; and Scherhorn

et al., 1990), that is, they seek validation of self-worth

through consumption. Dittmar and Drury (2000, p. 138)

suggest that ‘‘consumption patterns are gendered’’ in

that shopping plays ‘‘a much more psychologically and

emotionally encompassing role for women than men’’.

The authors note that, while this is not an innate female

characteristic, the role is likely to persist as long as

cultural norms and social representations frame shop-

ping as linked to gender identity.

Despite general agreement that compulsive buying is a

gender-related disorder (Campbell, 2000; d’Astous,

1990; d’Astous, Maltais, & Roberge, 1990; Dittmar,

2000; Dittmar & Drury, 2000; Elliott, 1994; Faber &

O’Guinn, 1992; Faber, Christenson, de Zwaan, &

Mitchell, 1995; Scherhorn et al., 1990), some researchers

are not entirely convinced of this gender specificity.

Elliott (1994, p. 174), for example, states that individuals

consume not only products but the symbolic meaning of

products and, although he noted a relationship between

gender and compulsive buying as a major leisure activity

and ‘‘a significant form of self expression’’ for women

(p. 160), he found no significant difference between

females and males on his addictive consumption scale

(however, he suggested that this might be due to

sampling error as there were only four men in his

sample). Faber et al. (1987, p. 134) found that, although

they spend money on different items, men as well as

women suffer from compulsive buying, and Faber and

O’Guinn (1992, p. 461) concluded that, ‘‘although

compulsive buying is likely to affect more women than

men, it does not exclusively affect women.’’ Dittmar and

Drury (2000, p. 139) believe that, as roles for men and

women change and an ideal male appearance is

increasingly emphasized, excessive buying will be found

more frequently among male consumers.

Nonetheless, Conrad (1992, p. 222) suggests that

women may be more vulnerable to medicalization than

are men. He bases this judgement on work by Riessman

(1983, p. 7) who notes that women have always been

targeted medically due to ‘‘deviation from some ideal

biological standard’’. Women’s biology (menstruation,

childbirth, menopause) differs from the male standard

and is an obvious place to look when illness strikes. In

addition to this, female biological processes, childbirth

for example, have increasingly been co-opted by

biomedicine and subject to medical intervention. As

more aspects of women’s lives are placed within medical

parameters, women become more susceptible to

ARTICLE IN PRESSS. Lee, A. Mysyk / Social Science & Medicine 58 (2004) 1709–1718 1711

adopting the sick role and will seek treatment from the

medical profession for problems that they face.

In terms of compulsive buying, O’Guinn and Faber

(1989, p. 152) suggest that women are more apt to seek

help for their problems. Because they receive more

information on compulsive buying due to media

exposure targeted specifically at them (for example,

interviews on talk shows and articles in women’s

magazines), this may lead to unequal gender distribution

in compulsive buying studies. In fact, in studies that use

self-selected samples, women are by far the more

representative gender, with figures ranging from 80%

(Scherhorn et al., 1990, p. 374) to 94% (Elliott, 1994,

p. 170). In the study by Scherhorn et al. (1990, p. 357),

the research project was publicized in the mass media

and individuals who had problems with addictive buying

were asked to contact the researchers; Elliott (1994,

p.165) stated that individuals identified themselves as

addictive buyers based on an appeal through a nation-

wide TV show and through articles in newspapers. The

fact that women are more likely to respond to appeals

for volunteers and to become research subjects has

implications for medicalization, an issue that will be

discussed later in the paper.

Compulsive buying and class

Despite the ongoing debate about the relationship

between compulsive buying and gender, the literature is

clearer about the relationship between compulsive

buying and class. No one class seems to be immune to

compulsive buying. In those studies in which class is

mentioned specifically, subjects are drawn either exclu-

sively from the lower middle to upper middle classes

(Rook, 1987, p. 192), predominantly from the middle to

upper middle classes (Lunt & Livingstone, 1992, p. 174),

or from the same unidentified class (O’Guinn & Faber,

1989, p. 152). In another, the occupations of subjects

ranged from unskilled to managerial (Dittmar & Drury,

2000, p. 118).

d’Astous (1990, p. 26), the only researcher to address

the relationship between compulsive buying and class in

some detail, found a ‘‘U-inverted relationship between

income and compulsive buying tendencies,’’ which

suggests that the middle class, not the lower or upper

classes, is most likely to suffer from such tendencies.

d’Astous (1990, p. 26) also claims that his findings seem

to converge with those of O’Guinn and Faber (1989,

p. 152) who found ‘‘no significant difference in income

across strata’’ of normal and compulsive buyers. It is

possible that this undefined ‘‘middle class’’ is the same

‘‘middle-income working-class families’’ who are suffer-

ing financial distress as a result of North America’s fiscal

crisis (Foster & McChesney, 2000, p. 6) and to whom we

will return shortly. Thus, while it may be true that ‘‘[the]

very wealthy and those with limited means are equally

represented among compulsive shoppers’’ (Krueger,

1988, p. 574), we will show that the burden of debt

weighs far more heavily on the latter. A recent study by

Black et al. (2001) provides some support for this idea.

They found ‘‘that compulsive buyers with lower incomes

had greater illness severity, and were less likely to have

incomes above the median ($20,500)’’ (Black et al, 2001,

p. 125.) However, the authors noted that their findings

were preliminary as the sample was small and buying

severity was assessed using a single instrument.

Other explanations for compulsive buying

Other reasons—including media influence, individual

predisposition, and easy access to credit—have been

suggested to explain why some individuals, regardless of

gender or class, suffer from compulsive buying. While

the literature does not always discuss the possible

connections between them, the reasons may follow one

from the other.

O’Guinn and Faber (1987, p. 474) suggest that the

media, which are largely responsible for consumer

socialization, teach the consumer those skills that are

useful in making purchasing decisions as well as those

that are not. The latter skills, that encourage the

‘‘material attitudes and motivations for consumption’’

(O’Guinn & Faber, 1987, p. 474), are what create a false

perception of reality. Soap operas and game shows, for

example, often portray excessive opulence and conspic-

uous consumption, while television commercials and

print advertising frequently emphasize the value-expres-

sive and status-conferring qualities of products (Benson,

2000; O’Guinn & Faber, 1987). According to Cushman

(1990, p. 605), advertising portrays a problem-free life if

the consumer accepts the illusion: ‘‘Ads seem to criticize

and condemn the average consumer while glorifying the

model, extolling a standard of beauty and mastery

impossible to achieve.’’ This representation promotes

the idea that shopping (buying) will change a person’s

life by conferring happiness on the individual. ‘‘Shopa-

holism’’ is a term widely used in the popular media and

many websites on the Internet, such as ‘‘Shopaholic

Mall: For Those Who Love to Shop,’’ promote and

reinforce the idea that buying is both easy and good

(Campbell, 2000).

A second and related explanation is that psychologi-

cal factors may predispose certain individuals to

compulsive buying. Low self-esteem (d’Astous, 1990;

Elliott, 1994; Faber, 2000; Faber and Christenson

(1996); Faber & O’Guinn, 1992; Hanley & Wilhelm,

1992; Scherhorn et al., 1990), depression and anxiety

(Christenson et al., 1994; Faber, 2000; Lejoyeux,

Hourtan!e, & Ad"es, 1995; Lejoyeux et al, 1996), and

the use of buying to manage or enhance mood states


(Elliott, 1994; Faber, 2000; Faber & Christenson, 1996;

Scherhorn et al., 1990) have frequently been reported by

compulsive buyers.

Following from this, Dittmar and Drury (2000),

Campbell (2000), Faber and O’Guinn (1988), Lejoyeux

et al. (1996), and Rook (1987) suggest that the

increasingly easy access to credit in a consumer-driven

economy encourages compulsive buying. Credit-card

companies, in particular, tend to ‘‘blanket’’ target

populations with various levels of pre-approved credit

lines to such an extent that even a ‘‘pussy cat in Ohio’’

received a credit card in the mail (Sullivan, Warren, &

Westbrook, 1989, p. 178). One compulsive buyer

reported that ‘‘it never feels like you’re actually spending

money if you use credit cards’’ (Dittmar & Drury, 2000,

p. 131); another reported that ‘‘buying something and

charging it was like getting it for free’’ with ‘‘no future

accounting or consequence’’ (Krueger, 1988, p. 579).

Not surprisingly, those who are prone to overspending

use more credit cards than those who are not

(Christenson et al., 1994, p. 8; d’Astous, 1990, p. 25;

Faber & O’Guinn, 1992, p. 465; O’Guinn & Faber, 1989,

p. 155) and consequently have a higher debt load.

The medicalization of compulsive buying

The actual labelling of compulsive buying as a

‘‘problem’’ is not an issue in either consumer or

psychiatric research. We suggest, however, that labelling

is crucial because, if behaviour is classified as a

‘‘compulsion’’ rather than as an ‘‘addiction,’’ it can be

formally identified as a psychiatric disorder with which

individuals can readily identify and under which

individuals can be targeted for drug treatment. In fact,

the debate over whether compulsive buying is an

addiction as opposed to an impulse control or obses-

sive-compulsive disorder is key to its formal identifica-

tion as a psychiatric disorder (Black, 1996; Black,

Monahan, & Gabel, 1997; Christenson et al., 1994;

Lejoyeux et al., 1996; Lejoyeux, Ad"es, & Solomon, 1997;

McElroy et al., 1991, 1994). ‘‘Addiction’’ in the context

of our argument does not refer only to physiological

dependence on particular substances (listed in the DSM

as substance abuse disorders), but is used in a broad

sense to include social causation. In other words,

labelling compulsive buying as a psychiatric illness

constructs a framework for the medicalization of

compulsive buying.

Conrad (1992, p. 209) defines medicalization as ‘‘a

process by which nonmedical problems become defined

and treated as medical problems, usually in terms of

illnesses or disorders.’’ Waxler (1980, p. 283) adds that

‘‘each society has its own peculiar definitions for the

kinds of behaviors, dysfunctions, even feelings, that are

to be called and treated as ‘illnesses’.’’

Much of the psychiatric research on compulsive

buying is framed within a clinical trial approach using

antidepressant treatment, usually selective serotonin

reuptake inhibitors (SSRIs). However, SSRIs are ‘‘active

across a range of conditions other than just depression,

such as obsessive-compulsive disorders and panic

disorders’’ (Healy, 1997, p. 176). The results of clinical

trials on SSRIs and other drug treatments have been

inconclusive. McElroy et al. (1991, p. 199) found that

the antidepressants fluoxetine (prozac), bupropian, and

nortriptyline (the latter two are not SSRIs) were useful

in treating compulsive buying. Black et al. (1997, p. 160)

conducted a trial using fluvoxamine and found that nine

out of ten subjects improved; however, in a placebo-

controlled study of fluvoxamine, Ninan et al. (2000,

p. 365) found that, while fluvoxamine reduced compul-

sive buying, the administration of placebo had the same

effect. The latter finding was confirmed in a double-

blind comparison of fluvoxamine versus placebo con-

ducted by Black, Gabel, Hansen and Schlosser (2000,

p. 209) who found that, because both groups improved

substantially, there appeared to be no significant

differences between the two treatments. However, in a

pilot study on citalopram treatment, Bullock, Hartston,

Elliott, D’Andrea and Koran (2000) found that this

SSRI was effective in reducing compulsive behaviour.

Clinical trials that focus on the use of SSRIs as the

main treatment for compulsive buying ignore the

problem of psychiatric comorbidity which appears to

be an underlying feature of compulsive buying. Various

authors (Black, Repertinger, Gaffney, & Gabel, 1998;

Black et al. (1997); Black, 1996; Bullock et al., 2000;

Christenson et al., 1994; Faber, Christenson, de Zwaan,

& Mitchell, 1995; Lejoyeux et al., 1995, 1996; McElroy

et al., 1991, 1994) have reported that binge eating and

bulimia, depression, mood disorders, anxiety disorders,

psychoactive substance-use disorders, eating disorders,

and/or impulse control disorders seem to occur in

combination with compulsive buying.

While Black et al. (1997) tried to select individuals

who were neither depressed nor suffering from obses-

sive-compulsive disorders or mood disorders, they noted

that five of their 10 subjects had either an Axis I or Axis

II comorbidity such as obsessive-compulsive disorder,

phobias, and generalized anxiety disorder, and eight out

of 10 had a history of related disorders such as

depression, alcohol or substance abuse, an eating

disorder, a panic disorder, or an attention-deficit

disorder. In a study of 20 cases, McElroy, Keck, Pope,

H., Smith and Strakowski (1994), p. 242) reported that

19 had ‘‘lifetime diagnoses of major mood disorders,’’ 16

had ‘‘lifetime diagnoses of anxiety disorders,’’ eight had

‘‘impulse control disorders,’’ and seven ‘‘had eating

disorders.’’ Lejoyeux et al. (1995, p. 38) reported that

compulsive buying was often related to depression and

that, when depression was treated, compulsive buying


disappeared. Furthermore, Lejoyeux et al. (1997,

p. 1630) suggested that compulsive buying may be

related to ‘‘the obsessive-compulsive disorder spec-

trum.’’ In fact, Black, Gabel and Schlosser (1997,

p. 1629) conclude that ‘‘primary uncontrolled buyers

(i.e., without comorbidity) must be rare.’’ Given the

likelihood of comorbidity, it seems curious that the goal

of much of the psychiatric research is to disassociate

compulsive buying from other disorders and to identify

it as a definable syndrome (Black, 1996; Bullock et al.,

2000; Christenson et al., 1994; Lejoyeux et al., 1996;

McElroy et al., 1994).

The above discussion on the comorbidity of compul-

sive buying, or even whether it is itself a discrete entity,

raises an important theoretical issue. The key to

medicalization is the degree to which the behaviour in

question is considered an individual (even psychiatric)

problem or a societal one. According to Scherhorn et al.

(1990, p. 384), if compulsive buying is a societal problem

and thus an addiction, then treatment options should

centre on consumer education in the form of self-help

groups so that individuals can resist this influence. The

problem is not solely internal to the individual because

external societal influences are equally responsible. We

argue that the attempt to categorize compulsive buying

as a psychiatric disorder furthers the reductionist goals

of biomedicine in that it ‘‘focuses on the individual and

diverts attention from the social and economic causes of

disease’’ (Baer, 2001, p.35). Treatments that seek to

counter the effects of the disorder (i.e., pharmaceutical

treatments) become the preferred mode of practice.

Dittmar (2000, p. 128) thinks that ‘‘a substantial

proportion of excessive buyers are without psychiatric

comorbidity and may well lead fairly ‘normal’ and

reasonably successful lives apart from their buying

behaviour.’’ She refers to these individuals as ‘‘excessive

impulse buyers’’ who do not exhibit extreme buying

behaviour (Dittmar, 2000, p. 128). Because, for such

individuals, buying is related to problems of self-image,

Dittmar (2000, p. 128) and Dittmar et al. (1995, p. 508)

recommend treatment options which reevaluate the

individual’s self-concept or self-discrepancies. Burgard

and Mitchell (2000, p. 367) and Elliott (1994, p. 174)

favour the treatment option of group therapy which

focuses on cognitive behaviour modification. Elliott

(1994, p. 161) advocates cognitive behavioural ap-

proaches because ‘‘addictions can best be understood

as learned adaptive behaviour in the context of personal

and environmental factors.’’ Levine and Kellen (2000)

and Brazer (2000) support Debtors Anonymous, a

twelve-step program similar to Alcoholics Anonymous.

This is not to say that psychiatric research ignores the

benefits of group therapy or self-help groups. Black et al.

(1997) p. 163) think that, because the group therapy

option has not been thoroughly studied, it could prove

to be beneficial, either as a sole treatment option or in

conjunction with medication (also suggested by Black,

1996; Christenson et al., 1994; Faber et al., 1995;

Lejoyeux et al., 1996). Black (1996, p. 55) also concedes

that he does not advocate medical intervention for

everyone who suffers from problematic buying beha-

viour, but for only a core group of individuals who are

‘‘very much impaired.’’

The issue of who should receive medical intervention

lies at the heart of the medicalization debate. Are the

individuals who participate in clinical trials qualitatively

the same as the majority of overspenders who fall within

the category of normal consumers, or are they at the

extreme end of that continuum? This is an important

question in terms of the labelling of compulsive

buying. Once it gains societal acceptance, then all

those who have problems with overspending have a

label with which to identify and for which to seek

treatment. As noted earlier, women tend to be targeted

since they are more subject to medicalization in general,

and succumb more readily to discourse that identifies

abnormal behaviour (note the appeals for volunteers for

clinical trials on compulsive buying—‘Are you a

compulsive buyer?’). If a pill can ‘cure’ their disorder

then there is no reason to try to modify spending

behaviour, or question the consumer-driven economy of

Western society. This deflects attention from social and

economic issues.

Non-medical social control and the ‘‘deviant’’ consumer

Despite the debate over the factors that contribute to

compulsive buying and who, exactly, fits the profile of

the compulsive buyer, spending beyond one’s means can

have serious consequences for the individual. It can lead

to unmanageable debt loads, personal distress, family

disruption, and even personal bankruptcy. As we will

show, a brief but critical examination, first, of bank-

ruptcy in Canada and, second, of the fiscal crisis of the

1980s and 1990s, takes us beyond the realm of the

individual into the wider socioeconomic context.

To the majority of consumers, it simply ‘‘makes

sense’’ to try to maintain a balance between personal

income and personal expenditures. To declare bank-

ruptcy is to be accused of ‘‘carelessness and profligacy’’

(Workman, 1996, p. 74). However, not all bankrupts

become such through compulsive buying; hence, not all

can be blamed for their financial problems. Some simply

may ‘‘lack the skills necessary to live within their means’’

(Faber & O’Guinn, 1988, p. 98); others may have

experienced ‘‘catastrophic occurrences’’ (Faber &

O’Guinn, 1988, p. 98) such as ‘‘the loss of a family’s

second income, a major illness or even an unexpected

expense, such as a car repair’’ (Kisluk, 1996, p. 2) which

catch them unprepared to meet their existing credit

obligations.


What seems obvious today was not always so. When

the personal bankruptcy rate in Canada rose by 33%

between 1981 and 1982 (Sands, 1999, p. 1), the assumed

aberration was steeped in the metaphor of illness. It is

worth quoting at length the discourse surrounding

personal bankruptcy at the time.

The purpose of [properly used] bankruptcy law...is to

serve as a financial hospital for people sick with debt.

If hospital admissions rise dramatically, there are at

least two explanations for the increase. It may be that

doctors have started admitting patients who are not

seriously ill and who could be treated as outpatients.

Or the crowded hospital wards may simply reflect a

breakdown of health in the community. If the

hospital population suddenly rose, no sensible person

would close the hospital doors and announce that the

problem had been solved. Instead, medical research-

ers would examine the patients to find out if they

were really sick and, if so, why (Sullivan, Warren, &

Westbrook, 1989, p. 6).

The worst malingers were the ‘‘credit card junkies’’

(Sullivan et al., p. 184), those who abused credit, who

did not or could not use credit responsibly. What types

of people were these? Impulsive and compulsive buyers,

dreamers, and chronic gamblers and alcoholics who

needed not only legal but psychological help (Kaplan,

1979, p. 16).

As personal bankruptcy rates in North America

continued to climb throughout the 1980s and showed

little sign of declining in the 1990s, the metaphor of the

‘‘sick’’ bankrupt all but disappeared from use. Instead,

as unemployment rates soared along with bankruptcy

rates, especially during the recessions of 1981–1982 and

1991–1993, many observers began to wonder whether

those who extended credit so easily might not be the

‘‘authors of their own misfortune’’ (Sands, 1999, p. 3).

In the Canadian bankruptcy process today, ‘‘insolvent’’

wage-earners (note, here, the reference to class) have

various options (Kisluk, 1996). With help from a bank-

ruptcy trustee, insolvents may file a ‘‘consumer proposal’’

which informs their ‘‘unsecured creditors’’ (such as credit-

card companies) of their inability to meet their financial

obligations as they come due. In the proposal, insolvents

offer to pay their creditors a fixed amount each month for

several years and to undergo mandatory credit counsel-

ling sessions. If the creditors reject the proposal,

insolvents may have no choice but to declare ‘‘summary

bankruptcy’’ and their creditors may recover even less

than the amount offered in the consumer proposal.

If personal bankruptcy rates continue to rise, how-

ever, the financial loss to unsecured creditors could be

staggering. In 1977, 8.2 million active credit cards

accounted for $1.4 billion in credit-card debt in Canada

alone; by 1996, these figures had risen to 30 million

active credit cards and accounted for $15 billion in

credit-card debt (Kisluk, 1996, p. 2). This is why credit-

card companies, in their ‘‘desperate search for profits,’’

are demanding that total-repayment plans replace the

cancellation of personal debt through bankruptcy

(Foster & McChesney, 2000, pp. 8, 10). According to

Waller (2001, p.875), their goal is ‘‘to make the most

profitable form of lending in the credit industry even

more profitable.’’

Although the metaphor of the ‘‘sick’’ bankrupt is no

longer used, the moral imperative to ‘‘recover’’ remains.

The bankrupt is cautioned to remember that, once he/

she has been discharged from debt, the goal of obtaining

new credit is only to establish a good credit rating. ‘‘It is

to this end that...you must never allow yourself to be

again caught in the debt spiral that you have worked out

of’’ (Kisluk, 1996, pp. 85–86, emphasis added).

Even though all compulsive buying does not end in

bankruptcy, it is important to examine the wider

socioeconomic context within which personal bank-

ruptcy rates rose and academic interest in compulsive

buying developed.

The fiscal crisis and the metaphor of health and illness

Academic interest in labelling both bankruptcy and

compulsive buying as illnesses in the 1980s roughly

coincided with the wider discourse leading up to and

surrounding North America’s fiscal crisis of the 1980s

and 1990s. During the global recession which began in

the 1970s, the Bank of Canada launched an attack on

inflationary pressures through high interest rates

(McQuaig, 1995, p. 257). While high interest rates

increase the return on financial investments, they also

lead to slow economic growth and massive unemploy-

ment, and drive up a government’s debt and deficits

(McQuaig, 1995, pp. 259, 273). Based upon the World

Bank’s clever acronym for severely indebted countries

(SIC), the metaphor of health and illness was seized

upon by right-wing think tanks and media outlets to

criticize government ‘‘overspending.’’ The Fraser In-

stitute, for example, claimed that, at both federal and

provincial levels, the whole of Canada qualified for the

World Bank’s SIC-list (Richardson, 1995, p. 34). The

Globe and Mail criticized the Canadian government’s

proposal to increase taxes to solve its fiscal crisis as being

analogous to alcoholism (‘‘You do not help a man with a

drinking problem by refilling his glass’’) and likened the

American government’s attempts to bring its debt crisis

under control to the insanity of a psychopath (‘‘Stop me

before I kill [spend] again’’) (Workman, 1996, p. 51).

The result of the Bank of Canada’s high interest rate

policy was an almost 10-year long recession during

which time ‘‘[thousands] of Canadians lost their homes

due to skyrocketing mortgage rates’’ and ‘‘the average


unemployment ratey roughly doubled, from about 5%

to almost 10%’’ (Stanford, 1998, p. 40). Such a high

unemployment rate, which disciplines labour and

restores profits to capital, was said to be ‘‘good’’ for

Canada’s economy (Stanford, 1998, p. 42).

However, under prolonged conditions of job loss and

stagnant wages, ‘‘[objective] insecurity gives rise to a

generalized subjective insecurity which is now affecting

all workers in our highly developed economy’’ (Bour-

dieu, 1998, p. 83). By making the whole future uncertain,

objective insecurity ‘‘pervades both the conscious and

unconscious mind’’ of those who have been affected as

well as of those who apparently have been ‘‘spared,’’ and

‘‘prevents all rational anticipation’’ of the future

(Bourdieu, 1998, p. 82). The effects of objective

insecurity—low self-esteem, fear, anxiety, depression

(indeed, many of the psychological problems associated

with compulsive buying)—are further exploited by

‘‘insecurity-inducing strategies’’ (Bourdieu, 1998,

p. 84), such as the constant threat of ‘‘down-sizing,’’

‘‘right-sizing,’’ and ‘‘out-sourcing’’ in the workplace.

As the phrase suggests, Canada’s ‘‘jobless recovery’’

(McQuaig, 1995, p. 260) was not accompanied by an

increase in full-time employment nor by a rise in real

wages for the working and middle classes (Foster &

McChesney, 2000, p. 3; Stanford, 1998, p. 44). Rather,

while interest rates remained high, the federal govern-

ment’s eventual economic surpluses were used to pay

down the country’s deficit, providing ‘‘a safe, secure,

guaranteed income for financial investors who are

reluctant to put their money ‘to work’ in real economic

activity’’ (Stanford, 1998, p. 46). Economic recovery,

then, was not investment-driven on the part of business

but consumption-driven by those who were least able to

afford it (Foster & McChesney, 2000, p. 3).

Under these conditions, the working and middle

classes find themselves living on credit either ‘‘to make

ends meet’’ or ‘‘in a desperate attempt to inch up their

living standards’’ (Foster & McChesney, 2000, p. 3).

This, perhaps, is key to the problem of ‘‘compulsive

buying.’’ Obviously, ‘‘the very wealthy’’ will not be as

adversely affected by high interest rates as ‘‘those with

limited means’’ because the debt burden (the ratio of

total debt service payments to total income) would be

far lower for the former than for the latter (Foster &

McChesney, 2000, p. 4). According to Kisluk (1996, pp.

17, 2), not only is personal bankruptcy ‘‘an integral part

of [our] economic system’’ but ‘‘credit cards will

continue to flood our system and the potential for

over-extension of credit and bankruptcy will remain

high.’’ In a thinly veiled attempt to blame the victim for

his/her financial problems, the Minister of Supply and

Services Canada. (1989, p. 1), emphasis added), in a

publication entitled Are You Heading for Consumer

Bankruptcy?, admonished Canadians that ‘‘[consumer]

credit is not a right; it is a privilege.’’

Conclusion

Caplan (1995, p. 272) states: ‘‘The act of naming is an

act of power. To assign a name is to act as though you

are referring to something that exists, something real.’’

Based upon the recent proliferation of studies from

consumer-research and psychiatric perspectives, it is

obvious that some individuals are experiencing the

problem of overspending. It is not our intent in this

paper to suggest that such research is gratuitous or

misleading. What our critique addresses is the issue of

labelling such behaviour as compulsive buying and then

legitimizing this label by conducting clinical trials on

pharmaceutical treatments.

We live in a consumption-driven society in which

compulsive buying is ‘‘a significant feature’’ (Lejoyeux

et al., 1996, p. 1527). In conjunction with the process of

socialization, the fiscal crisis of the 1980s and 1990s, and

media messages that encourage people to buy, purchasing

items becomes a way to increase one’s status and self-

esteem and/or a mechanism to achieve self-fulfillment. As

Belk (2000, p. 76) comments in terms of the symbolic

content of consumption: ‘‘We are what we have and

possess.’’ Why, then, is the consumer who overspends

being singled out for clinical trials which necessitate drug

treatments to ‘‘cure’’ this behavior? What we are

witnessing is the medical social control of the ‘‘deviant’’

consumer through pharmaceuticals and the non-medical

social control through the punitive bankruptcy process.

As drug treatments become popularized through

media coverage, individuals are led to believe that all

‘‘overspending’’—whether mild, moderate, or severe—is

actually compulsive buying and is treatable with

antidepressants. A pill becomes the panacea. This

indiscriminate emphasis on the individual isolates

buying behaviour from other elements of people’s lives

such as general unhappiness, low self-esteem, depres-

sion, and anxiety which may derive from the wider social

context that, on the one hand, encourages people to

consume and, on the other, stigmatizes them for doing

so. Perhaps compulsive buying could be better ad-

dressed, first, by studies which focus on ways to

encourage consumers to resist the powerful messages

to buy (e.g., self-help groups and counselling) and,

second, by examining those social forces (e.g., the North

American fiscal crisis and class inequalities) that

eventually trap the consumer in a downward spiral

leading to bankruptcy.

Acknowledgements

The authors wish to thank Ellen Judd, Department of

Anthropology, University of Manitoba and Robert

Chernomas, Department of Economics, University of

Manitoba, for their helpful comments and suggestions.


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