SpringerLink Header: Shopping Addiction (A Müller & J Mitchell, Section Editors)

New Assessment Tools for Buying Disorder

Astrid Müller1, MD, PhD, James E. Mitchell2, MD, Birte Vogel1, Martina de Zwaan1, MD

1. Hannover Medical School, Department for Psychosomatic Medicine and Psychotherapy,

Germany

2. Neuropsychiatric Research Institute, Fargo, North Dakota, USA

Corresponding author:

Astrid Müller, Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School,

Carl-Neuberg-Str. 1, 30265 Hannover, Germany.

E-mail: mueller.astrid@mh-hannover.de

Keywords: compulsive buying; pathological buying; buying disorder; shopping addiction; assessment;

questionnaire

1

Abstract

Purpose of review: To summarize studies concerning the development and evaluation of assessment

tools for buying disorder (BD) between 2000 and 2016.

Recent findings: There is still a lack of formal diagnostic criteria and field-tested structured

interviews for BD. With regard to questionnaires, the following psychometrically sound instruments

assessing symptoms of BD have been developed within the last decade: 1) the Richmond Compulsive

Buying Scale (RCBS), which conceptualizes BD as an obsessive-compulsive spectrum disorder, 2) the

Bergen Shopping Addiction Scale (BSAS), which regards BD as ‘shopping addiction’, and 3) the

Pathological Buying Screener (PBS), which reflects addictive and impulse-control-disorder aspects of

BD.

Summary: Future studies should make use of the new questionnaires assessing symptoms of BD.

Furthermore, diagnostic criteria for BD should be developed and validated in order to better

establish the diagnosis of BD and to accomplish its recognition as a mental disorder.

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Introduction

There is an ongoing debate as to how best to classify pathological buying behavior. To present, it is

not included in the Diagnostic and Statistical Manual of Mental Disorders [1] or in the International

Classification of Diseases [2], and terms such as compulsive buying, pathological buying, shopping

addiction, and buying disorder are used interchangeably in the literature to name the phenomenon.

Considering the wording for other disorders in the DSM-5 (e.g. gambling disorder, hoarding disorder)

[1], we will use the term buying disorder (BD) hereafter.

Lately, most researchers have conceptualized BD as a behavioral addiction due to its

commonalities with other addictive behaviors and based on research indicating that cue-induced

craving, impaired control, maintenance of shopping and buying regardless of negative consequences,

withdrawal, and other characteristics are of relevance to BD [3-7]. Among experts in the field

agreement exists that the diagnosis of BD at best requires clinical exploration assessing in detail the

functionality of shopping and spending [8]. It is important to note that the diagnosis of BD and the

development of valid screening tools have been hindered by the absence of approved diagnostic

criteria for BD. More than 20 years ago, Susan McElroy and colleagues [9] had proposed diagnostic

criteria for compulsive buying based on reports of 20 psychiatric patients. While these criteria have

provided a workable tool to assess BD over the past several studies, they have never been formally

tested and remain preliminary.

Although face-to-face assessment may be the best option for diagnosing BD, questionnaires

may represent a useful tool to screen for BD or to complement clinical interviews. They are often

convenient to use, cost- and time-saving, and particularly useful in collecting large-scale data sets.

Furthermore, it has to be considered that people tend to be secretive about their spending habits,

particularly if it is inappropriate and associated with indebtedness, family conflicts and mental

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problems. For some individuals, it may be more useful for them to answer an anonymous

questionnaire than to ask them to disclose within an interview.

The aim of this article is to provide an overview concerning assessment tools for BD which

have demonstrated psychometric strengths, focusing on instruments developed since 2000. After a

brief summary of the most widely used measures for BD developed between the late 1980s and

2000, we will detail and discuss new instruments.

Assessment Tools for Buying Disorder Developed Prior to 2000

Questionnaires

There are several self-rating instruments published in the late 1980s and early 1990s (see Table 1)

[10-15]. The most widely used questionnaire is the Compulsive Buying Scale (CBS), which was

developed in the United States by Faber and O’Guinn [13]. The 7 items of this unidimensional scale

refer to impulse-control deficits while shopping and buying, distress at the thought of others’

knowledge of the individual’s spending behavior, tension when not shopping, shopping and buying to

regulate mood, and unreasonable use of credit cards or checks. Lower scores on this scale indicate

more BD symptoms.

In Europe, most studies have utilized the German Addictive Buying Scale (GABS) [11, 12]. The

GABS was modeled on the Canadian Compulsive Buying Measurement Scale [10], leading to a 16-

item unidimensional scale which was subsequently translated into other languages. Given that this

instrument is theoretically based on the concept that BD represents a non-substance-related

addiction, it consists of items assessing craving to buy something in addition to items pertaining to

post-purchase guilt, hiding of purchased goods or consumption of products one cannot afford. The

CBS and the GABS were both created by consumer and marketing researchers. Surveys using these

scales generated a number of significant findings concerning the prevalence and correlates of BD [16-

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20]. Nevertheless, the scales are not without criticism with regard to potentially outdated items or

perhaps offering a restricted view of BD [21-23].

Structured Interviews

Research studies often made use of structured clinical interviews developed in the field of psychiatry

in the early 1990s, particularly the Minnesota Impulse Disorder Interview (MIDI) [24] and the

“Impulse Control Disorders Not Elsewhere Classified” module of the Structural Clinical Interview for

DSM-IV-TR (SCID-ICD)[25]. Both instruments include specific sections for BD. To our knowledge,

information on the validity of the BD module of the SCID-ICD is not available. The BD module of the

MIDI showed a sensitivity of 100% and a specificity of 96.2% for BD when comparing the instrument

to the above mentioned preliminary diagnostic criteria proposed by McElroy et al. 1994 [9, 26].

(Table 1 about here)

Assessment Tools for Buying Disorder Developed Since 2000

The Richmond Compulsive Buying Scale

The Richmond Compulsive Buying Scale (RCBS) was developed by marketing researchers in the

United States using the theoretical foundation of obsessive-compulsive-spectrum disorders [27]. The

final version of the RCBS contains 6 items reflecting obsessive-compulsive (“My closet has unopened

shopping bags in it. / Others might consider me a ‘shopaholic. / Much of my life centers around

buying things.”) and impulse-control-disorder (“ I buy things I don’t need. / I consider myself an

impulse purchaser. / I buy things I did not plan to buy.”) aspects of BD. All items are answered on a

7-point Likert scale rating the level of agreement or frequencies, whereas higher scores indicate

greater severity of BD. Individuals who score higher than midpoint on all six items can be defined as

‘compulsive buyers’ [27]. Cronbach’s alpha coefficients for the total scale ranged between .81

and .84 [27].

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To create the questionnaire, 121 initial items were developed based on a literature review

and brainstorming. These items were then examined by three consumer researchers. The authors

aimed at, “identifying underlying behavioral tendencies rather than potential consequences” [27,p.

623] of BD. They argued that BD should not be measured with regard to precursors or consequences.

Accordingly, items considering the latter aspects were excluded, together with items with wording

problems or ambiguous items. The remaining 15 items were subjected to an exploratory factor

analysis in 352 undergraduate students and subsequent confirmatory factor analyses in 551

university staff members and 309 customers of an Internet women’s retailing store [27].

In our opinion, the omission of items considering the consequences of BD is questionable

given that harmful consequences of inappropriate shopping and spending on patients’ lives (e.g.,

psychological distress, financial problems, social conflicts) are part of the clinical diagnosis of BD [9].

Not reflecting the consequences of BD, the RCBS is likely to overestimate the occurrence of BD. This

concern is supported by the elevated estimates of BD reported by Ridgway et al., who reported point

prevalence rates of 15.5% in students, 8.9% in university staff respondents, and 16% in participants in

an online survey [27]. In contrast, findings from a Hungarian study that investigated the validity of

different BD measures suggested that the RCBS may underestimate the prevalence of BD because it

captures BD mainly from a cognitive perspective, which might not fit for certain individuals with

addictive shopping [23]. These conflicting results point to the need to further investigate the

construct validity of the RCBS.

The Bergen Shopping Addiction Scale

Conceptualizing BD as ‘shopping addiction’, Andreassen et al. developed the Bergen Shopping

Addiction Scale (BSAS) [28]. This scale consists of seven items reflecting the following core elements

of addiction originally proposed by Brown [29] and modified by Griffiths [30]: 1) salience (“I think

about shopping/buying things all the time.”), 2) mood modification (“I shop/buy things in order to

change my mood.”), 3) tolerance (“I feel I have to shop/buy more and more to obtain the same

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satisfaction as before.”), 4) withdrawal (“I feel bad if I for some reason are prevented from

shopping/buying things.”), 5) conflict (“I shop/buy so much that it negatively affects my daily

obligations.”), 6) relapse (“I have decided to shop/buy less, but have not been able to do so.”), and 7)

resulting problems (“I shop/buy so much that it has impaired my well-being.”). All items are

answered on a 5-point Likert scale from 0 (completely disagree) to 4 (completely agree). Higher

scores indicate greater severity of BD.

Initially, four items for each construct were created based on diagnostic criteria for gambling

disorder [1], the Game Addiction Scale [31] and a literature review, resulting in an initial version with

28 items. A questionnaire package including these 28 items, the Compulsive Buying Measurement

Scale [10], questions concerning sociodemographic variables, and some other collateral measures

was distributed via the online editions of five newspapers in Norway. In total, 23,537 individuals (65%

women, age M = 35.8, SD = 13.3 years) participated in the study. To identify the best items to retain

in the final questionnaire, a set of factor analyses was conducted. Confirmatory factor analyses

indicated a good to excellent fit of a one-factor solution. The instrument showed good internal

consistency (α = .87). Convergent validity was indicated by the strong correlation (r = .80) between

the total score of the BSAS and the Compulsive Buying Measurement Scale [10]. In line with past

research [16], women scored higher on the BSAS than men, and BSAS scores were inversely related

to age. The study did not attempt at validating a BSAS threshold value for shopping addiction.

Strengths and limitations of the scale and the study summarized above were discussed by the

authors [28]. The use of web-based data, the self-selected sample and the strong theoretical

restriction may be viewed as shortcomings that may have biased the results. However, the shortness

and good psychometric quality of the BSAS and the large sample size of the study are strengths.

The Pathological Buying Screener

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Table 2 displays the Pathological Buying Screener (PBS) [21]. This questionnaire represents another

new, psychometrically sound measure to assess symptoms of BD, which was developed in Germany.

The questionnaire contains 13 items, belonging to the subscales loss of control / consequences (10

items; e.g. cannot stop buying things despite financial problems. / having problems at work or school

or in other areas due to buying behavior / hiding buying habits from other people / cannot stop

thinking about buying) and excessive buying behavior (3 items; buying more than had planned /

buying more things than needed / spending more time buying than intended). In addition, the scale

contains three supplementary items. The first supplementary item refers to symptoms of mania /

hypomania that should be differentiated from BD [9], the second item asks for symptoms of hoarding

disorder that are common in BD [32-34], and the third item pertains to buying with the primary goal

of personal enrichment.

All items are answered on a 5-point Likert scale ranging from 1 (“never”) to 5 (“very

frequently”). Based on the 13 main items, a tentative PBS total score cutoff point of 29 or above was

suggested to categorize those with probable BD, which needs further investigation [21].

(Table 2 about here)

Within the process of item generation, 33 items were generated based on a facet theoretical

approach. These items reflected characteristics of both behavioral addictions and impulse-control

disorders and considered the following aspects of BD: preoccupation / craving, impaired control,

emotion regulation, not using purchased goods / hiding purchases / lying about spending /

deception, degree of suffering, interference with other life aspects and financial aspects /

consequences, and resistance against excessive spending. These initial items were modified based on

the results of pretests in a predefined sample of 119 participants (mainly students) and a sample of

19 treatment–seeking patients with BD, leading to a preliminary 20-item pool. The 20 preliminary

items, the three supplementary items, questions regarding sociodemographic aspects, and the

German translation of Faber and O’Guinn’s Compulsive Buying Scale [17] were answered by a

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representative German sample (N = 2,403; 53% women; age M = 49.2, SD = 17.7 years). A set of

exploratory and confirmatory factor analyses in different subgroups of the total sample was utilized

to extract the number of factors, to select items for the final version, and to confirm the factor

structure. The findings indicated a final version with 13 items (without supplementary items), loading

on the two subscales relating to loss of control / consequences and excessive buying behavior. It is

noteworthy that hierarchical regression analyses in the total sample with Faber and O’Guinn’s CBS as

the dependent variable and the two subscales of the new instrument as the predictors indicated

incremental validity of the two factors in adults aged < 65 years. Particularly the subscale excessive

buying behavior added significant variance explanation within the model. This suggested that the PBS

provides some information that is not captured by the CBS. Accordingly, the correlation between the

PBS total score and the CBS was only moderate (r = -.57), indicating an overlap (convergent validity)

as well as differences between the two measures. Reliability of the PBS total score as well as the two

subscales was good to excellent with Cronbach’s α coefficients ranging from .83 to .95 [21]. Similar to

studies using other BD measures [16, 18, 20], the PBS had women and younger individuals tending to

score more highly.

The use of a representative, large-scale sample and the methodological approach are

strengths of this study. An advantage of the PBS is that the items reflect a broad range of BD facets.

Furthermore, clinicians may profit form the inclusion of the supplementary items, whereas the

validity of these three items needs further investigation. As with other studies, the development and

validation of the PBS had several limitations; e.g., the absence of external data such as purchasing

records and the lack of information on divergent validity. Further evaluation of the construct validity,

the PBS dimensions, and the preliminary cutoff for BD is currently being conducted in clinical

samples.

Questionnaires specifically assessing Internet-shopping disorder

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All of the above-described instruments approach BD in different environments (e.g., in bricks-and-

mortar-based stores and paper catalogues and on TV-shopping channels and the Internet). As more

costumers engage in both offline and online shopping, or even completely prefer the Internet,

instruments should be re-evaluated over time. According to several authors, the addictive use of

online shopping sites could be considered one type of specific Internet addiction [35], but

questionnaires particularly assessing Internet-shopping disorder are still lacking. Some studies have

made use of existing measures, by adding or replacing specific words within these scales. For

example, in a study investigating pathological buying via the Internet [36], the terms “Internet” and

“online” were replaced by “Internet shopping sites” or “online shopping activity” in the short version

[37] of Young’s Internet Addiction Test [38].

Recently, Manchiraju et al. [39] introduced the Compulsive Online Shopping Scale (COSS).

The study focused on the validation of the COSS, which was created by simply adding the word

“online” to each of the preliminary 28 items of the BSAS described above [28]. This approach was,

however, questioned by Griffiths who argued “that the COSS is not really an adaptation of the BSAS

but an almost identical instrument based on the original 28-item pool” of the BSAS [40, p. 1107].

Structured Interviews

The literature review did not reveal publications concerning new structured interviews specifically

developed for diagnosing BD. Also, we are not aware about modifications and evaluations of the BD

modules of the MIDI [24] or the SCID-ICD [25].

Conclusion

Within the last decade, new questionnaires for BD have been developed that are to some degree

psychometrically sound. The development of these scales was based on different theoretical

10

considerations. The RCBS [27] was created viewing BD as an obsessive-compulsive-spectrum

disorder, the BSAS [28] conceptualizing BD as ‘shopping addiction’, and the PBS [21] incorporating

characteristics of both behavioral addictions and impulse-control disorders. Future studies

investigating BD should make use of the new questionnaires. Due to the inclusion of items referring

to harmful consequences of BD that are clinically relevant, the BSAS and the PBS seem to be superior

for use in mental health settings, but their clinical utility and screening ability (i.e. sensitivity and

specificity) are still unknown.

Clinical assessment ought to inquire about functionality of BD and all aspects that are typical

for it; e.g., excitability from shopping cues, preoccupation with shopping, the use of shopping and

spending to regulate mood, the rare use of purchased merchandises, the over-accumulation of

possessions and debts, family problems due to inappropriate spending, and in severe cases credit

card misuse and deception to continue spending regardless of financial problems. Furthermore,

considering the chronic, repetitive course [41] and the high psychiatric comorbidity of BD [42-45], its

history and concomitant mental illnesses warrant examination.

Taken together, diagnostic criteria and adequately tested structured interviews for

diagnosing BD are needed. They would support clinical assessments and could serve as an

appropriate reference standard to validate self-rating instruments. Moreover, diagnostic criteria

would promote research of BD and its recognition as mental disorder.

Compliance with Ethics Guidelines

Conflict of Interest

Dr. Astrid Müller, Dr. James E. Mitchell, Birte Vogel, and Dr. Martina de Zwaan declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent11

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Table 1: Self-rating Instruments for Buying Disorder

TitleNumber

of Items

Subscales (number of items) Validation Samples Year Reference

Canadian Compulsive Buying Measurement Scale

13 n/a

Individuals with self-identified BD (n = 38)Convenience sample (n = 38)

1988 [10]

German Addictive Buying Scale (GABS)

16 n/a

Representative samples(n = 1,527; n = 1,017)

1990 [11,12]

Compulsive Buying Scale (CBS)

7 n/a

Individuals with self-identified BD (n = 388)Convenience sample (n = 292)

1992 [13]

Edwards Compulsive Buying Scale (ECBS)

13

1. Tendency to spend (5)2. Compulsion/drive to

spend (2)3. Feelings about

shopping and spending (2)

4. Dysfunctional spending (2)

5. Post-purchase guilt (2)

Individuals with self-identified BD (n = 104) Convenience sample (n = 101)

1993 [14]

Questionnaire about Buying Behavior (QABB)

19 n/a Convenience sample (n = 143) 1994 [15]

Richmond Compulsive Buying Scale (RCBS)

6

1. Impulse control disorder aspects (3)

2. Obsessive-compulsive aspects (3)

Undergraduate students (n = 352)University staff members (n = 551)Customers of an Internet women’s retailing store (n = 309)

2008 [27]

Bergen Shopping Addiction Scale (BSAS)

7 n/aParticipants of an online survey (n = 23,537)

2015 [28]

Pathological Buying Screener (PBS)

13

1. Loss of control / consequences (10)

2. Excessive buying behavior (3)

Representative sample (n = 2,403)

2015 [21]

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Table 2: The Pathological Buying Screener (PBS) [21]

Please carefully read the following questions regarding your buying habits. From the five alternative responses, please select the one that is the most appropriate for you (based on the last 6 months). There are no right or wrong answers. It is important that you choose the responses that most accurately reflect your situation.

How often does it occur … Never Rarely Sometimes Frequently Very frequently

1 ...that you can’t stop thinking about buying?

2...that you feel embarrassed when

others ask you about your buying behavior?

3 ...that you have financial difficulties due to your buying habits?

4 ...that you spend more time buying than you intended?

5 ...that you suffer distress from your buying habits?

6...that you have problems at work or

school or in other areas due to your buying behavior?

7 ...that you buy more things than you need?

8...that at times you don’t feel good and

that you feel better when you go buying?

9 ...that you hide your buying habits from others?

10 ...that you buy more than you had planned?

11 ...that you cannot stop buying things despite financial problems?

12 ...that you try to limit your buying and can’t?

13 ...that you have problems with other people due to your buying habits?

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SUPPLEMENTARY QUESTIONS

How often does it occur … Never Rarely Sometimes Frequently Very frequently

S1...that you are in a high mood, and

that you get into difficulties when this happens?

S2 ...that you cannot get rid of things, so that clutter develops?

S3 ...that you buy something in order to resell it for a profit?

19