The need to consume: Hoarding as a shared psychological feature of compulsive buying and binge eating
Introduction
Compulsive buying behavior is defined as frequent buying episodes or impulses to buy that are experienced as irresistible or senseless [1]. Compulsive buying affects approximately 4.9% of the general population [2] and is associated with marked personal, social, and occupational impairment, as well as distress and financial difficulties [3]. Compulsive buying is also commonly associated with psychiatric comorbidity, with approximately 90% of individuals with compulsive buying reporting at least one other lifetime psychiatric disorder [4]. Of interest to the present research, binge eating is a psychiatric co-morbidity that has commonly been found to co-occur with compulsive buying [5].
Binge eating episodes are defined as episodes in which an individual consumes an objectively large amount of food within a discrete time period, accompanied by a sense of loss of control over the binge eating behavior [6]. Recurrent binge eating is the core symptom of binge eating disorder, which is estimated to occur in 2.8% of the general population [7]. Binge eating episodes may also occur within the context of bulimia nervosa and anorexia nervosa binge/purge subtype [8]. Previous research has found that people with compulsive buying behavior are significantly more likely than those without compulsive buying behavior to report recurrent episodes of binge eating (33.3% vs 4.2%) [7]. In fact, as many as 35% of people with compulsive buying may have a co-morbid diagnosis of an eating disorder [1]. Similarly, compulsive buying is the most prevalent impulse control disorder among people with eating disorders, co-occurring in 11.8% [9] of people with eating disorders in general and in 17.6% [10] of people with bulimia nervosa. Further highlighting the association between these two psychiatric disorders, studies have found a strong bivariate relationship between compulsive buying and bulimia-related symptoms (i.e. binge eating) [11].
Hoarding, which is characterized by accumulation of possessions and the inability to discard objects resulting in cluttered living spaces and significant distress and/or impairment, has been found to be frequently associated with both compulsive buying [12,13,14,15,16,17] and binge eating [18,19,20]. Hoarding is conceptualized to be a multifaceted construct with several key dimensions, including the acquisition of a large number of possessions (acquisition), difficulty discarding possessions (difficulty discarding), which then precludes the use of living spaces (clutter) [13]. Indeed, people with hoarding disorder have a tendency to excessively acquire items that are not needed. The nature of the items that are acquired varies greatly, although clothes, newspapers and magazines tend to be most common [15]. Many of the items are never used, do not leave their packaging, and are often mixed with trash [21]. Once items are acquired, people with a hoarding disorder show an inability to give or throw the items away [22]. Any attempts to discard items, which do not have sentimental value and/or are worn out, are met with significant distress [22]. A potential reason for this is that people with hoarding disorder report greater emotional attachment to items and may come to anthropomorphize items [21,23]. Lastly, the inability to use living spaces for their intended purposes constitutes the hallmark consequence of excessively acquiring and storing items [21]. Cluttered living spaces is one of the most recognizable symptoms of hoarding and one that is associated with the greatest concern [21]. The cluttered living space makes it difficult to find important items and can lead to significant safety issues such as the attraction of animals that can spread diseases, living in non-sanitary conditions, as well as fire and tripping hazards [24,25,26].
In regard to the relationship between hoarding, compulsive buying and binge eating, the extant literature has found that 39% of people with compulsive buying [27] and 26.7% of people with binge eating disorder or bulimia nervosa also present with co-morbid hoarding disorder [28]. Furthermore, hoarding has been found to exacerbate the symptoms of both compulsive buying behavior [29] and binge eating behavior [18]. The association between hoarding with both compulsive buying and binge eating suggests that hoarding may constitute a shared feature between these two conditions and may partly account for the co-morbidity between compulsive buying and binge eating. This is because both compulsive buying and binge eating are characterized by the psychological need to excessively acquire and gather resources [14,29,30]. Indeed, acquisition is the dimension of hoarding most associated with compulsive buying behavior [29] and binge eating behavior [30]. However, the way in which this psychological need manifests likely differs between compulsive buying (i.e., goods, items) and binge eating (i.e., food, nutrients and calories). Consistent with this possibility, hoarding has been conceptualized as a symptom of multiple disorders across diagnostic categories [12,18,31], rather than a unique disorder despite its current status in the 5th version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) [6].
In sum, the empirical literature has demonstrated that compulsive buying behavior, binge eating behavior and hoarding frequently co-occur. However, it is unknown whether hoarding, specifically its key dimensions of acquisition, difficulty discarding and clutter constitutes a shared feature that may account for the co-occurrence of compulsive buying and binge eating. The aim of the present research was to address this empirical gap in a large sample of people seeking treatment for compulsive buying.
Section snippets
Participants and procedure
The participants were 434 consecutive patients who voluntarily sought treatment at Hospital das Clinicas of Faculdade de Medicina of Universidade de São Paulo in Brazil from 2007 to 2017. Individuals seeking treatment for their compulsive buying were first screened using the Portuguese adapted version of the Compulsive Buying Scale [3]. Patients whose scores indicated the possible presence of compulsive buying disorder were seen by a registered psychiatrist specialized in impulse control
Preliminary analyses
Examination of the data revealed that not all of the participants completed our assessment measures of interest. Specifically, of the 434 patients, 306 completed the self-report measure of compulsive buying severity, 300 completed the measure of binge eating severity and 306 completed the measure of hoarding with 207 completing measures of all three. As such, we conducted Little's Missing Completely at Random test to determine whether the data was missing completely at random. The results
Sample characteristics
The sample consisted of 56 males and 378 females with a primary diagnosis of compulsive buying disorder. The average age of the sample was 40.38 (SD = 10.86). The large majority of the sample identified as Caucasian (71.8%) and reported being employed (70.6%). Marital status was roughly equally split, with 48.7% of the sample reporting being single. The mean monthly household income of the sample was US$2246.82 (SD = $2120.33), and the mean of years of formal education was 14.81 (SD = 3.61).
Discussion
It is well established that compulsive buying is related to both binge eating and hoarding [9,12,13,15,16,17]. The aim of the present research was to add to our growing understanding of the relationship between these psychiatric conditions by exploring whether dimensions of hoarding (acquisition, difficulty discarding, and clutter) represented a shared feature that may account for the relationship between compulsive buying and binge eating.
In this sample of people seeking treatment for their
Limitations
The present study has several limitations. First, the sample consisted of people seeking treatment for compulsive buying disorder, whose buying symptoms were more severe or distressing than their binge eating or hoarding behavior. Therefore, our conclusions may only apply to individuals for whom compulsive buying is their primary disorder. Additional research examining whether hoarding accounts for the relationship between compulsive buying severity and binge eating severity among individuals
Conclusion
Compulsive buying is a highly prevalent and impairing disorder that is closely related to binge eating and hoarding symptoms. Our results suggest that the drive to excessively gather and store resources, either goods or calories, may constitute a shared feature between compulsive buying and binge eating. These findings may guide future longitudinal explorations of hoarding as shared processes in the manifestation of compulsive buying and binge eating, as well as the potential of targeting
Acknowledgment
The authors are grateful to the staff of the Compulsive Buying Outpatient Unit of the Institute and Department of Psychiatry, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo for their help with data collection.
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