Treatment of Compulsive Shopping Disorder
Cognitive-behavioral therapy (CBT) is the first-line treatment for compulsive shopping disorder, with SSRIs (particularly citalopram) as effective pharmacological options either alone or combined with CBT for more severe cases.
Initial Treatment Approach
Begin with individual or group CBT as the primary intervention, as cognitive-behavioral models show the most promise for treating compulsive buying behavior, with structured programs typically consisting of 12 weekly sessions 1, 2, 3
Psychoeducation should be provided at the outset, explaining that compulsive shopping is a recognized disorder with available treatments that can reduce symptoms and improve quality of life 4
Address financial counseling and debt consolidation early in treatment, as these practical interventions are appropriate for the majority of individuals with compulsive shopping disorder 3
Cognitive-Behavioral Therapy Implementation
CBT should include exposure-based components where patients gradually confront shopping triggers while abstaining from compulsive buying behaviors, similar to exposure and response prevention used in OCD 4, 5
Patient adherence to between-session homework exercises is the strongest predictor of good outcomes, so emphasize home-based practice of resisting shopping urges 4, 6
Group CBT formats are particularly promising for this disorder and may provide peer support and shared accountability 2, 3
Pharmacological Treatment
Citalopram is the best-studied SSRI for compulsive shopping, with 71% of patients achieving marked improvement at doses averaging 35.4 mg/day (range 20-60 mg/day) 7
Start citalopram at 20 mg/day and increase by 20 mg every 2 weeks as tolerated, up to 60 mg/day, monitoring for rapid response that typically occurs within the first few weeks 7
SSRIs should be maintained long-term, as discontinuation is associated with higher relapse rates compared to continued medication 7
Other SSRIs like fluvoxamine have shown effectiveness in open-label trials and can be considered as alternatives 7, 3
Combined Treatment Strategy
For severe cases with significant distress or impairment, combine CBT with SSRI treatment from the outset rather than using monotherapy 4, 5
This combined approach is particularly beneficial for patients with substantial psychiatric comorbidity, which is common in compulsive shopping disorder 8, 2
Addressing Comorbidities
Screen for and aggressively treat comorbid mood disorders, anxiety disorders, substance use disorders, and eating disorders, as these occur frequently (affecting the majority of patients) and can interfere with treatment response 8, 2, 3
Evaluate for personality disorders, as the majority of persons with compulsive shopping appear to meet criteria for an Axis II disorder 8
Predictors of Poor Treatment Response
Male patients, those with high depression and obsessive-compulsive symptoms, low anxiety levels, high persistence, high harm avoidance, and low self-transcendence are at higher risk for poor adherence and should receive more intensive monitoring and support 1
The dropout rate from CBT can be as high as 46%, with relapse rates of 47% during treatment, so anticipate these challenges and provide additional support for at-risk patients 1
Adjunctive Interventions
Refer patients to Debtors Anonymous or similar 12-step programs as adjunctive support, particularly for those with severe financial consequences 8, 3
Provide bibliotherapy (self-help books) as supplementary resources to reinforce treatment concepts 8, 3
Consider marital or family therapy when compulsive shopping has created significant familial problems, as family involvement can be crucial for treatment success 8, 4
Common Pitfalls to Avoid
Do not exclude patients with psychiatric comorbidity from treatment, as comorbidity is the rule rather than the exception in compulsive shopping disorder 8, 2
Avoid treating compulsive shopping as simply a financial problem—it requires psychiatric intervention addressing the underlying preoccupations, urges, and behaviors 8, 3
Do not discontinue SSRIs prematurely; maintain treatment long-term as this is typically a chronic disorder with onset in late teens/early twenties 7, 2, 3