Prevalence and correlates of hoarding behavior in a community-based sample

Little is known about the prevalence and correlates of hoarding behavior in the community. We estimated the prevalence and evaluated correlates of hoarding in 742 participants in the Hopkins Epidemiology of Personality Disorder Study. The prevalence of hoarding was nearly 4% (5.3%, weighted) and was greater in older than younger age groups, greater in men than women, and inversely related to household income. Hoarding was associated with alcohol dependence; paranoid, schizotypal, avoidant, and obsessive-compulsive personality disorder traits; insecurity from home break-ins and excessive physical discipline before 16 years of age; and parental psychopathology. These findings suggest that hoarding may be relatively prevalent and that alcohol dependence, personality disorder traits, and specific childhood adversities are associated with hoarding in the community.

The economic and social burden of compulsive hoarding

The aim of the present study was to determine the economic and social burden of compulsive hoarding in a large sample of individuals with self-identified hoarding, as well as a separate sample of family members of individuals who hoard. Self-identified hoarding participants (N=864, 94% female, 65% met research criteria for clinically relevant compulsive hoarding) and family informants (N=655, 58% described a relative who appeared to meet research criteria for compulsive hoarding), completed an internet survey. Questions were derived in part from those used in the National Comorbidity Survey (NCS), and when possible, hoarding participants were compared to NCS participants. Compulsive hoarding was associated with an average 7.0 work impairment days in the past month, equivalent to that reported by individuals with psychotic disorders and significantly greater than that reported by female NCS participants with all other anxiety, mood, and substance use disorders. Severity of hoarding predicted the degree of work impairment after controlling for age, sex, and non-psychiatric medical conditions. Hoarding participants were nearly three times as likely to be overweight or obese as were family members. Compared to female NCS participants, hoarding participants were significantly more likely to report a broad range of chronic and severe medical concerns and had a five-fold higher rate of mental health service utilization. Eight to 12% had been evicted or threatened with eviction due to hoarding, and 0.1-3.0% had a child or elder removed from the home. These results suggest that compulsive hoarding represents a profound public health burden in terms of occupational impairment, poor physical health, and social service involvement.

"Just right" perceptions associated with compulsive behavior in Tourette's syndrome

OBJECTIVE

Tourette's syndrome is a chronic disorder of childhood onset that is characterized by motor and phonic tics and a broad range of associated behavior including obsessive-compulsive symptoms. Less well appreciated are the sensory and other perceptually tinged mental phenomena associated with both tic and compulsive behavior. This cross-sectional study evaluated the "just-right" phenomena commonly associated with compulsive behavior in subjects with tic disorders.

METHOD

A total of 134 subjects with tic disorders, aged 9 to 71 years, completed a questionnaire concerning their current and past tic symptoms. Subjects were also asked to describe their "just right" perceptions. The Yale-Brown Obsessive Compulsive Scale was used to assess severity of current obsessive-compulsive symptoms.

RESULTS

Eight-one percent of the subjects with both Tourette's syndrome and obsessive-compulsive disorder (N = 31) and 56% of the subjects with Tourette's syndrome and obsessive-compulsive symptoms (N = 61) reported being aware of a need to perform compulsions until they were "just right." This awareness most commonly referred to visual or tactile (as opposed to auditory) features of the compulsive act or its consequences. Three-quarters of the subjects with these perceptions reported that they usually were aware of them immediately before or concurrently with the initiation of compulsions.

CONCLUSIONS

While epidemiological studies of tic disorders and obsessive-compulsive disorder have yet to incorporate questions concerning "just right" perceptions, these results suggest that such perceptions may be commonplace in adolescent and adult subjects with both obsessive-compulsive disorder and tic disorders. They also implicate brain regions involved in the processing of sensorimotor information in the pathobiology of tic disorders.

Age-related differences in restricted repetitive behaviors in autism spectrum disorders

Restricted repetitive behaviors (RRBs) were examined in a large group of children, adolescents and adults with ASD in order to describe age-related patterns of symptom change and association with specific contextual factors, and to examine if the patterns of change are different for the various types of RRBs. Over 700 individuals with ASD were rated on the Repetitive Behavior Scale-Revised. RRBs were less frequent and less severe among older than younger individuals, corroborating that autism symptoms abate with age. Our findings further suggest that repetitive behaviors are a heterogeneous group of behaviors, with the subtypes of RRBs having their own individual patterns across the lifespan, and in some cases, a differential association with age depending on intellectual functioning.

Psychiatric comorbidity and compulsive/impulsive traits in compulsive sexual behavior

In recent years there has been an increase in identifying and treating a clinical syndrome that has been given many different names, including compulsive sexual behavior (CSB). The purpose of this study was to determine the prevalence of psychiatric disorders in a sample of individuals with CSB, as evaluated by a structured psychiatric interview. A secondary focus of this research was to determine if individuals with CSB exhibit obsessive-compulsive characteristics or exhibit impulse control problems. Participants were 23 men and two women who responded to newspaper advertisements and met criteria for CSB according to diagnostic criteria established and assessed by expert clinicians. The Structured Clinical Interview for DSM-III, patient version (SCID-P) and the Structured Clinical Interview for Axis II Disorders (SCID-II) were used to interview all participants. To study compulsive or impulsive traits the authors developed a semistructured interview. Standardized rating scales were also administered. Eighty-eight percent of the sample met diagnostic criteria for an axis I disorder at the time of the interview, and 100% of the sample met criteria for an axis I disorder at some time in their lives. The most common diagnoses were mood and anxiety disorders. The sample exhibited more traits of impulsivity than compulsivity. The data are consistent with the suggestion proposed by others that argues for conceptualizing these disorders as impulsive/compulsive spectrum disorders. Attention must be given to addressing these traits, as well as to the treatment of other axis I and axis II disorders, when treating CSB.

Estimated prevalence of compulsive buying behavior in the United States

OBJECTIVE

Compulsive buying (uncontrolled urges to buy, with resulting significant adverse consequences) has been estimated to affect from 1.8% to 16% of the adult U.S. population. To the authors' knowledge, no study has used a large general population sample to estimate its prevalence.

METHOD

The authors conducted a random sample, national household telephone survey in the spring and summer of 2004 and interviewed 2,513 adults. The interviews addressed buying attitudes and behaviors, their consequences, and the respondents' financial and demographic data. The authors used a clinically validated screening instrument, the Compulsive Buying Scale, to classify respondents as either compulsive buyers or not.

RESULTS

The rate of response was 56.3%, which compares favorably with rates in federal national health surveys. The cooperation rate was 97.6%. Respondents included a higher percentage of women and people ages 55 and older than the U.S. adult population. The estimated point prevalence of compulsive buying among respondents was 5.8% (by gender: 6.0% for women, 5.5% for men). The gender-adjusted prevalence rate was 5.8%. Compared with other respondents, compulsive buyers were younger, and a greater proportion reported incomes under 50,000 US dollars. They exhibited more maladaptive responses on most consumer behavior measures and were more than four times less likely to pay off credit card balances in full.

CONCLUSIONS

A study using clinically valid interviews is needed to evaluate these results. The emotional and functional toll of compulsive buying and the frequency of comorbid psychiatric disorders suggests that studies of treatments and social interventions are warranted.

Characteristics of 36 subjects reporting compulsive sexual behavior

OBJECTIVE

The authors describe the sociodemographic features, phenomenology, and psychiatric comorbidity of 36 subjects reporting compulsive sexual behavior.

METHOD

Twenty-eight men and eight women who responded to advertisements for "persons ... who have a problem with compulsive sexual behavior" completed structured and semistructured assessments, including the Diagnostic Interview Schedule for DSM-III-R disorders (axis I) and the Structured Interview for DSM-III-R Personality Disorders, Revised (axis II).

RESULTS

The typical subject was a 27-year-old man who reported experiencing compulsive sexual behavior for nearly 9 years. Sexual behavior was described as excessive and poorly controlled and was associated with either subjective distress or impairment in interpersonal or occupational functioning or as overly time-consuming. Fourteen subjects (39%) reported a history of major depression or dysthymia, 15 (42%) a history of phobic disorder, and 23 (64%) a history of substance use disorder. Personality disorders were quite frequent, particularly the paranoid, histrionic, obsessive-compulsive, and passive-aggressive subtypes. The compulsive sexual behavior was quite varied and included both paraphilic (e.g., cross-dressing) and nonparaphilic (e.g., compulsive masturbation) types.

CONCLUSIONS

Compulsive sexual behavior may be a clinically useful concept, but it describes a heterogeneous group of individuals with substantial psychiatric comorbidity and diverse behavioral problems.

Hoarding by elderly people

Although hoarding has been studied in adults, little is known about problems of hoarding by elderly people. This study used a structured telephone interview with elder services providers to investigate hoarding behaviors in relation to functional impairment, cognitive deficits, and physical and psychological conditions in 62 elderly clients. Most elderly hoarders were female, unmarried, and lived alone. Extensive clutter was associated with significant impairment, interfering with basic hygiene, and posing a serious physical threat for many elderly clients. Clients were rarely insightful about their collecting and often resisted change, rendering interventions generally ineffective. Never-married status was associated with more severe hoarding and greater impairment and possibly with worse outcomes of intervention efforts. Health and mental health implications of hoarding by elderly people and implications for treatment are discussed.

Compulsive buying - a growing concern? An examination of gender, age, and endorsement of materialistic values as predictors

Compulsive buying is an understudied, but growing, dysfunctional consumer behaviour with harmful psychological and financial consequences. Clinical perspectives treat it as a psychiatric disorder, whereas recent proposals emphasize the increasing endorsement of materialistic values as a cause of uncontrolled buying (e.g. Dittmar, 2004b; Kasser & Kanner, 2004). The present research aims to improve understanding of compulsive buying through examining gender, age, and endorsement of materialistic values as key predictors in three UK questionnaire studies, which sampled individuals who had contacted a self-help organization and residentially matched 'controls' (N = 330), consumer panelists from a multinational corporation (N = 250), and 16- to 18-year-old adolescents (N = 195). The results confirmed previously documented gender differences, and showed that younger people are more prone to compulsive buying. The central findings were that materialistic value endorsement emerged as the strongest predictor of individuals' compulsive buying, and that it significantly mediated the observed age differences.

Psychogenic excoriation. Clinical features, proposed diagnostic criteria, epidemiology and approaches to treatment

Psychogenic excoriation (also called neurotic excoriation, acne excoriée, pathological or compulsive skin picking, and dermatotillomania) is characterised by excessive scratching or picking of normal skin or skin with minor surface irregularities. It is estimated to occur in 2% of dermatology clinic patients and is associated with functional impairment, medical complications (e.g. infection) or substantial distress. Psychogenic excoriation is not yet recognised in the DSM. We propose preliminary operational criteria for its diagnosis that take into account the heterogeneity of behaviour associated with psychogenic excoriation and allow for subtyping along a compulsivity-impulsivity spectrum. Psychiatric comorbidity in patients with psychogenic excoriation, particularly mood and anxiety disorders, is common. Patients with psychogenic excoriation frequently have comorbid disorders in the compulsivity-impulsivity spectrum, including obsessive-compulsive disorder, body dysmorphic disorder, substance use disorders, eating disorders, trichotillomania, kleptomania, compulsive buying, obsessive-compulsive personality disorder, and borderline personality disorder. There are few studies of the pharmacological treatment of patients with psychogenic excoriation. Case studies, open trials and small double-blind studies have demonstrated the efficacy of selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors in psychogenic excoriation. Other pharmacological treatments that have been successful in case reports include doxepin, clomipramine, naltrexone, pimozide and olanzapine. There are no controlled trials of behavioural or psychotherapeutic treatment for psychogenic excoriation. Treatments found to be effective in case reports include a behavioural technique called 'habit reversal'; a multicomponent programme consisting of self-monitoring, recording of episodes of scratching, and procedures that produce alternative responses to scratching; and an 'eclectic' psychotherapy programme with insight-oriented and behavioural components.

Impulse control disorders in eating disorders: clinical and therapeutic implications

OBJECTIVE

Few studies have explored impulse control disorders (ICDs) in women with bulimia nervosa (BN). We explored the prevalence of lifetime ICDs in women with BN, compared the severity of eating disorder symptoms in women with BN with and without ICD, and compared their personality profiles to females with one form of ICD, namely, pathologic gambling.

METHOD

A total sample of 269 female patients consecutively admitted to our unit participated in the current study (173 BN without comorbid ICD [BN - ICD]; 54 BN with comorbid ICD [BN + ICD]; and 42 pathologic gamblers [PG]). All participants were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria.

EVALUATION

Assessment measures included the Symptom Checklist-90 revised and the Temperament and Character Inventory-revised, as well as a number of other clinical and psychopathologic indices.

RESULTS

In BN, the observed lifetime prevalence of ICD was 23.8%. Lifetime compulsive buying (17.6%) and intermittent explosive disorder (13.2%) were the most frequently reported ICD. Bulimia nervosa subtype was not significantly associated with lifetime ICD (P = .051) or with ICD subtype (P = .253). After using multinomial regression models, we observed that BN + ICD and PG showed the highest scores on novelty seeking (P < .0001). But BN + ICD women had the lowest scores on self-directedness (P < .03) and higher scores on general psychopathology (P < .01) and drug abuse (P < .01).

CONCLUSIONS

Individuals with BN + lifetime ICD presented more extreme personality profiles, especially on novelty seeking and impulsivity, and general psychopathology than individuals with BN without ICD. On some personality traits, those BN + ICD more closely resembled individuals with PG than those with BN without ICD.

Age of onset of compulsive hoarding

Although compulsive hoarding appears to be a chronic, progressive disorder, little is known about its onset and course. The current study employed retrospective assessment of 51 individuals with compulsive hoarding difficulties to determine onset of various hoarding symptoms (clutter, acquisition, difficulty discarding), as well as the individual's degree of recognition of the problem at various times throughout his or her life. Participants were asked to describe life events from each decade that occurred at the time hoarding symptoms were developing. Symptoms of clutter and difficulty discarding appeared to begin at approximately the same age, whereas acquiring problems began slightly later. Recognition of the problem developed significantly later than any of the symptoms themselves. A portion of participants reported that their hoarding symptoms were reduced at some point in their lives, but few reported full remission of hoarding at any point. Survival analysis of age of onset of hoarding symptoms indicated that individuals who reported a stressful event when saving behavior started had a significantly later age of onset than those who reported no events at the age of onset. Perhaps for some individuals compulsive hoarding is a lifelong characterological phenomenon, whereas for others hoarding behavior develops later as a reaction to stress or loss.

Impulse control disorders and attention deficit disorder in pathological gamblers

Little systematic research has been done on psychiatric comorbidity of pathological gambling, an impulse control disorder. This report describes the occurrence of attention deficit disorder and impulse control disorders in 40 pathological gamblers in treatment for gambling problems and 64 controls. Diagnoses were made by structured interviews which utilized operationalized diagnostic criteria. An impulse control disorder other than pathological gambling was noted in 35% of the pathological gamblers, compared to 3% of the controls (p < .001). Compulsive buying (p < .001) and compulsive sexual behavior (p < .05) were significantly higher in pathological gamblers than controls. A strong association was seen among pathological gambling, attention deficit, and other impulse control disorders. Attention deficit disorder was seen in 20% of the pathological gamblers. Rates of impulse control disorders did not differ by gender. Implications of these high rates of comorbidity are discussed.

Clarifying exercise addiction: differential diagnosis, co-occurring disorders, and phases of addiction

This paper sets out to clarify the unique features of exercise addiction. It begins by examining how this addiction can be distinguished from compulsions and impulse control disorders both of which, like an addiction, involve excessive behavior that creates adverse effects. Assessment of exercise addiction also requires that clinicians be attuned to other forms of excessive behavior, especially eating disorders that can co-occur with exercise. Finally in an effort to clarify exercise addiction, this paper uses the four phases of addiction to examine the attributes of exercise that define it as a healthy habit distinct from an addiction. The paper ends with a discussion of the implications of these topics for effective assessment and treatment.

Predicting Compulsive Internet Use: It's All about Sex!

The objective of this research was to assess the predictive power of various Internet applications on the development of compulsive Internet use (CIU). The study has a two-wave longitudinal design with an interval of 1 year. The first measurement contained 447 adult heavy Internet users who used the Internet at least 16 h per week and had Internet access at home for at least 1 year. For the second measurement, all participants were invited again, of whom 229 responded. By means of an online questionnaire, the respondents were asked about the time spent on various Internet applications and CIU. On a cross-sectional basis, gaming and erotica seem the most important Internet applications related to CIU. On a longitudinal basis, spending a lot of time on erotica predicted an increase in CIU 1 year later. The addictive potential of the different applications varies; erotica appears to have the highest potential.

Alcohol craving predicts drinking during treatment: an analysis of three assessment instruments

OBJECTIVE

The purpose of this investigation was to examine the utility of thee craving instruments to predict drinking during treatment. The three assessments used were the Penn Alcohol Craving Scale (PACS), the Alcohol Urge Questionnaire (AUQ) and Items 1-6 of the Obsessive subscale (OBS) of the Obsessive Compulsive Drinking Scale (OCDS).

METHOD

The three instruments were administered during the course of a 9-month, double-blind, placebo-controlled trial of 100 mg/day of naltrexone, and a manual-based psychosocial intervention using the BRENDA manual conducted at the University of Pennsylvania's Treatment Research Center. Participants (133 men and 50 women at the initiation of the study) used these instruments to self-report craving on a weekly or biweekly basis. The weekly number of drinks was reported using the Timeline Followback interview. The data were analyzed with generalized estimating equations using craving scores at 1 week as the independent variable and number of drinks in the subsequent treatment week as the dependent variable.

RESULTS

Each of the three scales predicted drinking during the subsequent treatment week. The PACS was the strongest predictor followed closely by the OBS and then the AUQ. Most important, craving as measured by the three scales was a stronger predictor of subsequent drinking than was drinking during the prior treatment week.

CONCLUSIONS

Craving assessment provides a useful means of predicting drinking during treatment. Such information would be helpful in designing clinical trials and for many treatment modalities.

Compulsive buying. Demography, phenomenology, and comorbidity in 46 subjects

Compulsive buying has been generally ignored in the psychiatric literature, although it is apparently frequent, underrecognized, and can lead to severe financial and legal consequences for its sufferers. The current investigation was designed to assess the overall life-style and problems of subjects identified as compulsive shoppers. Forty-six compulsive buyers were assessed for comorbid psychiatric disorders with the Diagnostic Interview Schedule, the Structured Interview for DSM-III-R Personality Disorders, and a semistructured interview to assess buying behavior. The typical shopper was a 31-year-old female who had developed compulsive buying at age 18 years. Subjects spent their money on clothing, shoes, and records/compact discs. The average debt load accrued was $5,422 out of an average yearly income of $23,443. More than two-thirds met lifetime criteria for a major (Axis I) mental disorder, most commonly anxiety, substance abuse, and mood disorders. Nearly 60% were found to meet criteria for a DSM-III-R personality disorder, most commonly the obsessive-compulsive, borderline, and avoidant types. The authors conclude that compulsive buying is a definable clinical syndrome which can cause its sufferers significant distress and is associated with significant psychiatric comorbidity.

The medicalization of compulsive buying

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.

Clinical features, psychiatric comorbidity, and health-related quality of life in persons reporting compulsive computer use behavior

BACKGROUND

We sought to examine the demographic and clinical features and psychiatric comorbidity in persons reporting compulsive computer use.

METHOD

Sixteen men and 5 women were recruited by advertisement and word-of-mouth. All reported excessive computer use that interfered with social or occupational functioning or caused personal distress. The subjects completed structured and semistructured assessments, including a computer version of the Diagnostic Interview Schedule (DIS), the Minnesota Impulsive Disorders Interview, the Personality Diagnostic Questionnaire-Revised (PDQ-R), and a brief version of the Medical Outcome Study Short Form-36 (SF-36).

RESULTS

The typical subject was a 32-year-old single white man with a mean yearly income of $27,000; problem computer use began at age 29 and consumed 27 hours each week. Eleven subjects (52%) reported school or academic problems resulting from their computer use, and 12 (57%) reported that family members had confronted them about it. Thirteen subjects (62%) had tried to cut back on their computer usage. Nine subjects (43%) reported missing work or school owing to their computer use. According to DIS results, 7 subjects (33%) had a lifetime mood disorder, 8 subjects (38%) had a substance use disorder, and 4 subjects (19%) had a lifetime anxiety disorder. According to the PDQ-R results, 11 subjects (52%) met criteria for at least one personality disorder, the most frequent being the borderline, antisocial, and narcissistic types. Impulse-control disorders were also common, particularly compulsive buying. On the SF-36, subjects showed impaired mental health functioning compared with a normative sample.

CONCLUSION

The results show that persons reporting compulsive computer use suffer substantial psychiatric comorbidity and show evidence of emotional distress. While the disorder appears to be increasing in prevalence, more work is needed to determine its relationship with other disorders and to determine its risk factors, family history, psychosocial complications, and natural history.

Compelled to consume: The Implicit Association Test and automatic alcohol motivation

The Implicit Association Test (IAT; A. G. Greenwald, D. E. McGhee, & J. L. K. Schwartz, 1998) has recently been used to assess the role of alcohol-affect associations in drinking behavior. The current study examined the validity of an alcohol IAT with 88 hazardous-drinking college students who completed measures of drinking behavior, an explicit measure of alcohol motivation, and an IAT that assessed alcohol-motivation associations. Regression analyses indicated that IAT scores correlated with binge drinking and cue reactivity, replicating T. P. Palfai and B. D. Ostafin's (2003) results. Results also indicated convergent validity (the IAT was related to an explicit measure of alcohol motivation) and incremental validity (IAT scores were correlated with alcohol behavior after controlling for the explicit measure). Implications for understanding the self-regulation of drinking are discussed.

Hoarding in obsessive-compulsive disorder: a report of 20 cases

BACKGROUND

We describe the demographic characteristics, hoarding phenomenology, comorbid disorders, family histories, and treatment response of 20 adult obsessive-compulsive disorder (OCD) patients exhibiting hoarding behavior.

METHOD

We utilized the Structured Clinical Interview for DSM-III-R, the Yale-Brown Obsessive Compulsive Scale, and a semistructured interview to gather data.

RESULTS

We studied 9 women and 11 men. Their hoarding began from age 5 years to age 46 years (mean +/- SD age at onset = 20 +/- 11 years); hoarding was evident before the onset of other OCD symptoms in 9 patients. The most commonly hoarded items were newspapers and magazines, junk mail, old clothes, notes or lists, and old receipts. Hoarded material occupied from one room plus most or all closets to more than one room plus all closets, the garage, and yard. Seven patients rented additional storage space for hoarded items. Eighty-four percent of patients reported a family history of hoarding, and 80% grew up in a household where someone else hoarded. The most frequent primary motives for hoarding were fears of discarding something useful and discarding something that would be needed in the future. Lifetime prevalence of major depression and of impulse-control disorders, especially compulsive shopping, were high; only 3 patients met DSM-IV criteria for obsessive-compulsive personality disorder. Response of hoarding to selective serotonin reuptake inhibitors was less robust than is expected for obsessive-compulsive disorder.

CONCLUSION

Whether hoarding behaviors mark a subset of obsessive-compulsive disorder patients with a different pathophysiology or functional anatomy deserves investigation.

Study of compulsive buying in depressed patients

BACKGROUND

Compulsive buying is defined by the presence of repetitive impulsive and excessive buying leading to personal and familial distress. Patients with this disorder also suffer from mood disorder in 50% to 100% of the cases studied, and antidepressants help to decrease the frequency and the severity of uncontrolled buying. To define the correlation between compulsive buying and depression, we assessed this behavior among 119 inpatients answering to DSM-III-R criteria for major depressive episode. Additionally, we evaluated for comorbidity in the patients suffering from compulsive buying and in those free from this disorder. Impulsivity and sensation seeking were also compared in the two groups.

METHOD

Diagnosis of compulsive buying was made using standardized criteria and a specific rating scale. Diagnosis of depression and assessment of comorbidity were investigated using the Mini International Neuropsychiatric Interview and a modified version of the Minnesota Impulsive Disorders Interview. All patients answered the Zuckerman Sensation-Seeking Scale and the Barrat Impulsivity Rating Scale.

RESULTS

The prevalence of the disorder was 31.9%; 38 of the 119 depressed patients were diagnosed as compulsive buyers. Patients from the compulsive buying group were younger in age, more often women than men, and more frequently unmarried. They presented more often than others with recurrent depression (relative risk = 1.4), disorders associated with deficits in impulse control such as kleptomania (relative risk = 8.5) or bulimia (relative risk = 2.8), benzodiazepine abuse or dependence disorder (relative risk = 4.7), and two or more dependence disorders (relative risk = 1.99). Subscores for experience seeking using the Zuckerman Sensation-Seeking Scale were significantly higher (p = .04) and scores of impulsivity were much higher (p < .0001) than corresponding scores in the group without compulsive buying behavior.

CONCLUSION

Compulsive buying is frequent among depressed patients. In most cases, the behavior is associated with other impulse control disorders or dependence disorders and a high level of impulsivity.

Family history and psychiatric comorbidity in persons with compulsive buying: preliminary findings

OBJECTIVE

The authors explored the family history and psychiatric comorbidity of a group of compulsive buyers who volunteered for medication studies. Compulsive buying is characterized by inappropriate shopping and spending behavior that leads to impairment.

METHOD

Thirty-three subjects who met the criteria of McElroy and colleagues for compulsive buying, and who scored more than two standard deviations above the mean on the Compulsive Buying Scale, were recruited. Twenty-two comparison subjects were recruited in the course of another study, and the presence of obsessive-compulsive disorder was the only reason for exclusion. Both groups were administered the Structured Clinical Interview for DSM-III-R disorders. The Family History Research Diagnostic Criteria were used to collect information about psychiatric disorders in first-degree relatives.

RESULTS

Compulsive buyers had a mean age of 40 years; two (6%) were men. Comparison subjects had a mean age of 39 years; six (27%) were men. The two groups differed in gender distribution but not in age, marital status, or educational achievement. Compulsive buyers were more likely than comparison subjects to have lifetime mood disorders (especially major depression) and to have more than one psychiatric disorder. First-degree relatives of compulsive buyers were more likely than comparison relatives to suffer from depression, alcoholism, and a drug use disorder and to suffer more psychiatric disorders in general.

CONCLUSIONS

These results indicate that persons who report compulsive buying behavior, and their first-degree relatives, are more likely to have a higher prevalence of psychiatric disorder than are comparison subjects.

Prevalence of compulsive buying among customers of a Parisian general store

Compulsive buying is defined by the presence of repetitive impulsive and excessive buying, leading to personal and family distress. The objective of this study is to assess the prevalence of compulsive buying among "normal consumers" and to describe the specificities in the buying style of compulsive buyers. We tried to answer several questions. (1) Does compulsive buying occur more often during sales or periods of sales campaigns? (2) Is compulsive buying more impulsive and unplanned than normal buying? (3) Are compulsive buyers more "affectively" involved in their purchases (preference for specific brands they have a narcissistic relationship with, tendency to consider purchases as exceptional special occasions)? (4)Do women who buy compulsively use shopping Web sites and the Internet in general more than controls? We interviewed 200 women successively entering Les Galeries Lafayette, a famous Parisian department store. We diagnosed compulsive buying with standardized criteria and a specific rating scale. All subjects answered an additional questionnaire assessing their buying behavior. We also rated their duration of connection to the Web, the number of e-mails sent and received, and the time spent speaking on a cellular phone. Prevalence of compulsive buying was 32.5%. The proportion of married women was lower among compulsive buyers (66%) than in controls (85%). Compulsive buyers do not seek sales more than controls. Their decision to buy is more often made during their stay in the shop (48% vs 24%, chi(2) = 117, P < .001). Women buying compulsively consider more often their purchases as opportunities not to be passed by (33.7% vs 23.1%, P = .006). They have a higher tendency to use items less than expected (23.4% vs 14.4% in the control group, P < .001). They more often make purchases to impress others (6.5% vs 2.5%, P = .04) and consider more often their purchases as personally gratifying (44% vs 23%, P < .001). Their connections to online shopping sites are longer and more frequent. They spend significantly more time than controls speaking on their cellular phones.

Characterizing the hoarding phenotype in individuals with OCD: associations with comorbidity, severity and gender

Hoarding frequently occurs in obsessive-compulsive disorder (OCD), and some evidence suggests that it constitutes a distinct OCD subtype, with genetic contributions. This study investigated differences between OCD patients with and without hoarding symptoms. Of the 473 OCD patients studied, 24% were classified as hoarders according to combined interviewer and self-ratings, which were validated with the Savings Inventory-Revised in a subsample. Hoarders suffered from significantly more severe OCD symptoms, (especially compulsions) and had greater impairment and dysphoria. Hoarders also had more comorbid psychiatric disorders. Further study revealed that many of these differences were attributable to the female subjects: Compared to female non-hoarders, female hoarders were more likely to suffer from bipolar I, substance abuse, panic disorder, binge-eating disorder, and had greater OCD severity. Male hoarders had an increased prevalence of social phobia compared to non-hoarding males. These results suggest that there are gender-specific differences in the hoarding sub-phenotype of OCD.