Treatment Options for Compulsive Buying Disorder
Cognitive-behavioral therapy (CBT) is the primary treatment for compulsive buying disorder, with selective serotonin reuptake inhibitors (SSRIs) serving as the pharmacological option when medication is needed. 1, 2
First-Line Treatment Approach
Start with cognitive-behavioral therapy as the foundation of treatment. Group CBT models have shown particular promise for this disorder, addressing the core preoccupations with shopping, prepurchase tension, and the relief-seeking behavior that maintains the compulsive cycle 3, 4. Individual CBT is also effective and should focus on:
- Identifying triggers for shopping urges and developing alternative coping strategies 2
- Challenging distorted cognitions about shopping and spending 3
- Implementing behavioral strategies to avoid shopping situations 4
Pharmacological Treatment
If pharmacotherapy is warranted, citalopram is the best-studied SSRI for compulsive buying disorder. In an open-label trial, citalopram at doses of 20-60 mg/day (mean 35.4 mg/day) produced rapid and sustained improvement, with 71% of patients achieving much or very much improved status 1. Treatment should be:
- Started at 20 mg/day and increased by 20 mg every 2 weeks as tolerated 1
- Continued long-term, as discontinuation led to higher relapse rates during 6-month follow-up 1
- Monitored for response within the first few weeks, as improvements occurred rapidly in responders 1
Other SSRIs have less robust evidence. Fluvoxamine failed to show efficacy in placebo-controlled trials, and escitalopram showed benefit in open-label but not double-blind phases 5. Fluoxetine has only case report support 5.
Essential Adjunctive Interventions
Financial counseling and debt consolidation are critical components that must not be overlooked. Most patients have been shopping compulsively for two decades or more by the time they seek treatment, resulting in substantial financial consequences 1, 2. Address:
- Credit counseling to manage accumulated debt 2
- Practical strategies like removing credit cards and limiting cash access 4
- Family involvement when financial problems affect household stability 4
Alternative and Supportive Options
Consider these evidence-based adjuncts:
- 12-step programs (Debtors Anonymous) provide peer support and accountability 2, 4
- Simplicity circles offer group support focused on reducing consumption 3, 4
- Bibliotherapy using self-help books may benefit motivated patients 2
- Marital or family therapy when relationship problems are prominent 4
Treatment Algorithm
Screen for psychiatric comorbidity first. Compulsive buying disorder has high rates of comorbid mood disorders (especially depression), anxiety disorders, substance use disorders, eating disorders, and personality disorders 3, 4. Treat active major depression, bipolar disorder, or substance abuse before or concurrently with compulsive buying treatment 1.
Initiate group or individual CBT as primary treatment for all patients regardless of severity 2, 3.
Add citalopram if CBT alone provides insufficient benefit after 8-12 weeks, or if severity is marked at presentation (shopping consuming multiple hours daily with severe functional impairment) 1, 2.
Implement financial counseling concurrently with psychological/pharmacological treatment 2, 4.
Plan for long-term management, as this is typically a chronic disorder with onset in late teens/early twenties 3, 4.
Important Clinical Pitfalls
Do not confuse compulsive buying with obsessive-compulsive disorder. While there are phenomenological similarities, patients with OCD should be excluded from compulsive buying treatment protocols as they require different management 1. The shopping behavior in compulsive buying is ego-syntonic (pleasurable initially) rather than ego-dystonic like OCD compulsions 4.
Screen carefully for bipolar disorder before starting SSRIs. Patients with unrecognized bipolar disorder are at risk for mood destabilization with antidepressant monotherapy 1. The high comorbidity with mood disorders makes this screening essential 3, 4.
Recognize the gender presentation may be misleading. While 80-95% of clinical samples are women, this may reflect help-seeking bias rather than true prevalence differences 2, 3. Men with compulsive buying may present differently or be underdiagnosed 3.
Evidence Limitations
The evidence base remains limited, with no placebo-controlled trials showing definitive efficacy for any medication 5. The strongest pharmacological evidence comes from open-label trials of citalopram 1, while CBT has more consistent support across multiple studies despite lack of large randomized trials 2, 3, 4. Given these limitations, CBT should be the default first-line treatment, with SSRIs reserved for cases requiring additional intervention.