- Email: [email protected]
Pathological buying and partnership status
Psychiatry Research 239 (2016) 122–123
Contents lists available at ScienceDirect
Psychiatry Research journal homepage: www.elsevier.com/locate/psychres
Short communication
Pathological buying and partnership status Astrid Müller a,n, Martina de Zwaan a, James E. Mitchell b, Tanja Zimmermann a a b
Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany Neuropsychiatric Research Institute, Fargo, ND, USA
art ic l e i nf o
a b s t r a c t
Article history: Received 21 August 2015 Received in revised form 15 December 2015 Accepted 6 March 2016 Available online 8 March 2016
This pilot study investigated the partnership status and the level of pathological buying (PB) in 157 female patients with PB and 1153 women from a German population-based sample. Slightly more than half of both samples were currently living with a partner. The results suggest a protective effect of being in a couple relationship in the representative sample. In contrast, having a partner was not related to the severity of PB among patients. Future studies should address the question of whether the characteristics and quality of partnership have an impact on the severity and course of PB, and vice versa. & 2016 Elsevier Ireland Ltd. All rights reserved.
Keywords: Pathological buying Partnership
1. Introduction Pathological buying (PB) is characterized by extreme preoccupation with shopping and strong urges to buy resulting in repetitive, uncontrolled purchasing of consumer goods (McElroy et al., 1994). The maladaptive spending serves as a way to deal with negative feelings and low self-esteem (Müller et al., 2012). In the long run, PB contributes to the exacerbation or the de novo development of psychiatric comorbidity, indebtedness, and family stress (Müller et al., 2015). Although PB is typically considered an individual phenomenon, it often occurs in an interpersonal context which can both impact and be impacted by PB. According to our clinical experience, many patients report relationship discord that contributes to PB. Given the centrality that intimate relationships have in the lives of most people as well as the strong association between relationship functioning and individual well-being and mental health (Whisman and Baucom, 2012), it seems necessary to consider both relationship and psychopathology simultaneously. In a large population-based sample the co-occurrence between psychopathology and relationship discord was found for a range of disorders, including depression, schizophrenia or obsessive-compulsive disorder (Whisman, 2007). There is also evidence that relationship discord may increase the risk for substance use disorders (Whisman et al., 2006) and contributes to couple difficulties in gambling disorder (e.g. anger, blame, loss of trust) (Bertrand et al., 2008) possibly leading to separations (Abbott et al., 1995). In contrast, relationship factors such as enhanced intimacy and help by partner in developing coping strategies may have a buffering effect, for example on depressive symptoms (Barbato and D’Avanzo, 2008). n
Corresponding author. E-mail address: [email protected] (A. Müller).
http://dx.doi.org/10.1016/j.psychres.2016.03.013 0165-1781/& 2016 Elsevier Ireland Ltd. All rights reserved.
Population-based studies including male and female participants did not report a link between marital status and the diagnosis of PB (Koran et al., 2006; Müller et al., 2010; Otero-López and Villardefrancos, 2014). Also, a recent examination of a large shopping-specific sample (i.e. male and female shopping mall visitors) did not find an association between family status and being classified as having PB (Maraz et al., 2015). To our knowledge, no studies to date have considered PB and its association with partnership status in a clinical sample. It remains unclear if being in a couple relationship has a protective or a negative effect on PB. Therefore, this pilot study aimed at exploring the possible link between the presence or absence of a partnership and the level of PB in patients seeking treatment for PB and in a population-based sample. Since the majority of treatment-seeking patients with PB are women, this study included only female participants. While we expected to find a difference in PB severity between women with and without partnership, the direction of the assumed relationship was unclear, although we posited a protective effect.
2. Methods We conducted a secondary analysis of data that we had collected within earlier studies: n ¼48 (Müller et al., 2008), n ¼55 (Müller et al., 2013), n ¼ 25 (Voth et al., 2014). Additionally, we included data from 29 patients who participate in an ongoing study resulting in a sample of 157 women aged between 19 and 71 years. This clinical group was compared with 1153 women within the same age range who had participated in an earlier representative study (Müller et al., 2010). The protocols were approved by the Institutional Ethics Committees, and all participants gave written informed consent. In all
A. Müller et al. / Psychiatry Research 239 (2016) 122–123
patients, PB was diagnosed using clinical interviews. The Compulsive Buying Scale (CBS; Faber and O’Guinn, 1992) was used to measure symptoms of PB. Lower scores indicate a higher level of PB. Partnership status was self-reported. Women with and without a partner were compared with regard to CBS total scores using ttests. To analyze a potential moderator effect of age, hierarchical moderated regression analyses were performed for each sample (i.e. clinical and population-based) with age, partnership status, and the interaction of age and partnership status as predictors and the CBS as dependent variable.
123
concerning men, and by the cross sectional design that does not allow for causal interpretations. Moreover, we cannot exclude that the lack of differences between treatment-seeking patients with and without partnership was due to the high level of CBS means in the clinical sample (i.e. ceiling effect). Nevertheless, this work makes a first attempt to investigate the role of partnership in PB. In conclusion, the simple fact of having a partner was not associated with the level of PB in women seeking treatment for this condition. Future studies should address the question of whether the characteristics and quality of partnership have an impact on the severity and course of PB, and vice versa.
3. Results Although the age range was the same in both groups (i.e. 19 to 71 years), the clinical sample was on average younger than the population-based sample (MClin ¼ 42.5, SDClin ¼ 10.9 and MPop ¼46.1, SDPop ¼14.2, df¼1308, t¼ 3.02, p¼ 0.003, d¼ 0.28). This is probably due to the fact that the age distribution in the treatmentseeking sample was not representative for the German population. The percentage of women currently living with a partner was almost the same in both groups (Clin: 56.1%, Pop: 55.8%, χ2 ¼0.004, p ¼0.945). CBS scores did not differ between patients with and without a partner in the clinical sample (Mwith ¼ 4.0, SDwith ¼ 1.8 and Mwo ¼ 4.5, SDwo ¼1.9, n.s., d¼ 0.27). In the population-based sample, women with a partner reported higher CBS scores indicating less PB (Mwith ¼2.5, SDwith ¼1.6 and Mwo ¼2.1, SDwo ¼1.9, df¼ 1151, t¼ 3.86, p o0.001, d¼ 0.23). The results of moderated regression analyses for each sample did not indicate a significant interaction effect between age and partnership status in predicting CBS scores.
4. Discussion The results of the present pilot study suggest that women seeking treatment for PB were similarly often living with a partner as women from the general population. It appears that the presence of a couple relationship had a protective effect on PB tendencies in women from the population-based sample but not on the severity of PB in treatment seeking patients, which we found surprising. Unfortunately, no information was available about the characteristics and quality of existing partnerships. It is well known that addictive behaviors such as pathological gambling may create conflicts and hostility in partnerships and that couple relationships can both positively and negatively influence gambling habits (Poirier-Arbour et al., 2014). Therefore, some authors have assumed that it could be beneficial to integrate gamblers’ spouses into treatment (Bertrand et al., 2008). This approach is in line with prior research indicating that individualbased psychotherapy may be less effective for patients with additional relationship problems (Whisman and Baucom, 2012), and could also be considered for the treatment of PB. The present pilot study is limited by the lack of detailed information on the quality of the partnerships, by missing data
References Abbott, D.A., Cramer, S.L., Sherrets, S.D., 1995. Pathological gambling and the family: practice implications. Fam. Soc.: J. Conte. Hum. Serv. 76, 213–218. Barbato, A., D’Avanzo, B., 2008. Efficacy of couple therapy as a treatment for depression: a meta-analysis. Psychiatr. Q. 79 (2), 121–132. Bertrand, K., Dufour, M., Wright, J., Lasnier, B., 2008. Adapted couple therapy (ACT) for pathological gamblers: a promising avenue. J. Gambl. Stud. 24 (3), 393–409. Faber, R.J., O’Guinn, T.C., 1992. A clinical screener for compulsive buying. J. Consum. Res. 19 (3), 459–469. Koran, L.M., Faber, R.J., Aboujaoude, E., Large, M.D., Serpe, R.T., 2006. Estimated prevalence of compulsive buying behavior in the United States. Am J. Psychiatry 163, 1806–1812. McElroy, S.L., Keck Jr., P.E., Pope Jr., H.G., Smith, J.M., Strakowski, S.M., 1994. Compulsive buying: a report of 20 cases. J. Clin. Psychiatry 55 (6), 242–248. Maraz, A., van den Brink, W., Demetrovics, Z., 2015. Prevalence and construct validity of compulsive buying disorder in shopping mall visitors. Psychiatry Res. 228 (3), 918–924. Müller, A., Mitchell, J.E., Crosby, R.D., Gefeller, O., Faber, R.J., Martin, A., Bleich, S., Glaesmer, H., Exner, C., DE Zwaan, M., 2010. Estimated prevalence of compulsive buying in Germany and its association with Sociodemographic characteristics and depressive symptoms. Psychiatry Res. 180 (2–3), 137–142. Müller, A., Mueller, U., Silbermann, A., Reinecker, H., Bleich, S., Mitchell, J.E., de Zwaan, M., 2008. A randomized, controlled trial of group cognitive-behavioral therapy for compulsive buying disorder: posttreatment and 6-month follow-up results. J. Clin. Psychiatry 69 (7), 1131–1138. Müller, A., Arikian, A., de Zwaan, M., Mitchell, J.E., 2013. Cognitive-behavioural group therapy versus Guided self-help for compulsive buying disorder: a preliminary study. Clin. Psychol. Psychother. 20 (1), 28–35. Müller, A., Mitchell, J.E., Crosby, R.D., Cao, L., Johnson, J., Claes, L., de Zwaan, M., 2012. Mood States preceding and following compulsive buying episodes: an ecological momentary assessment study. Psychiatry Res. 200 (2–3), 575–580. Müller, A., Mitchell, J.E., de Zwaan, M., 2015. Compulsive buying. Am. J. Addict. 24 (2), 132–137. Otero-López, J.M., Villardefrancos, E., 2014. Prevalence, Sociodemographic factors, psychological distress, and coping strategies related to compulsive buying: a cross sectional study in Galicia, Spain. BMC Psychiatry 14 (1), 101. Poirier-Arbour, A., Trudel, G., Boyer, R., Harvey, P., Goldfarb, M.R., 2014. Correlates of depressive symptom severity in problem and pathological gamblers in couple relationships. J. Gambl. Stud. 30 (1), 173–185. Voth, E.M., Claes, L., Georgiadou, E., Selle, J., Trotzke, P., Brand, M., de Zwaan, M., Müller, A., 2014. Reactive and regulative temperament in patients with compulsive buying and non-clinical controls measured by self-report and performance-based tasks. Compr. Psychiatry 55 (7), 1505–1512. Whisman, M.A., 2007. Marital distress and DSM-IV psychiatric disorders in a population-based national survey. J. Abnorm. Psychol. 116 (3), 638–643. Whisman, M.A., Baucom, D.H., 2012. Intimate relationships and psychopathology. Clin. Child. Fam. Psychol. Rev. 15 (1), 4–13. Whisman, M.A., Uebelacker, L.A., Bruce, M.L., 2006. Longitudinal association between marital dissatisfaction and alcohol use disorders in a community sample. J. Fam. Psychol. 20 (1), 164–167.
Contents lists available at ScienceDirect
Psychiatry Research journal homepage: www.elsevier.com/locate/psychres
Short communication
Pathological buying and partnership status Astrid Müller a,n, Martina de Zwaan a, James E. Mitchell b, Tanja Zimmermann a a b
Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany Neuropsychiatric Research Institute, Fargo, ND, USA
art ic l e i nf o
a b s t r a c t
Article history: Received 21 August 2015 Received in revised form 15 December 2015 Accepted 6 March 2016 Available online 8 March 2016
This pilot study investigated the partnership status and the level of pathological buying (PB) in 157 female patients with PB and 1153 women from a German population-based sample. Slightly more than half of both samples were currently living with a partner. The results suggest a protective effect of being in a couple relationship in the representative sample. In contrast, having a partner was not related to the severity of PB among patients. Future studies should address the question of whether the characteristics and quality of partnership have an impact on the severity and course of PB, and vice versa. & 2016 Elsevier Ireland Ltd. All rights reserved.
Keywords: Pathological buying Partnership
1. Introduction Pathological buying (PB) is characterized by extreme preoccupation with shopping and strong urges to buy resulting in repetitive, uncontrolled purchasing of consumer goods (McElroy et al., 1994). The maladaptive spending serves as a way to deal with negative feelings and low self-esteem (Müller et al., 2012). In the long run, PB contributes to the exacerbation or the de novo development of psychiatric comorbidity, indebtedness, and family stress (Müller et al., 2015). Although PB is typically considered an individual phenomenon, it often occurs in an interpersonal context which can both impact and be impacted by PB. According to our clinical experience, many patients report relationship discord that contributes to PB. Given the centrality that intimate relationships have in the lives of most people as well as the strong association between relationship functioning and individual well-being and mental health (Whisman and Baucom, 2012), it seems necessary to consider both relationship and psychopathology simultaneously. In a large population-based sample the co-occurrence between psychopathology and relationship discord was found for a range of disorders, including depression, schizophrenia or obsessive-compulsive disorder (Whisman, 2007). There is also evidence that relationship discord may increase the risk for substance use disorders (Whisman et al., 2006) and contributes to couple difficulties in gambling disorder (e.g. anger, blame, loss of trust) (Bertrand et al., 2008) possibly leading to separations (Abbott et al., 1995). In contrast, relationship factors such as enhanced intimacy and help by partner in developing coping strategies may have a buffering effect, for example on depressive symptoms (Barbato and D’Avanzo, 2008). n
Corresponding author. E-mail address: [email protected] (A. Müller).
http://dx.doi.org/10.1016/j.psychres.2016.03.013 0165-1781/& 2016 Elsevier Ireland Ltd. All rights reserved.
Population-based studies including male and female participants did not report a link between marital status and the diagnosis of PB (Koran et al., 2006; Müller et al., 2010; Otero-López and Villardefrancos, 2014). Also, a recent examination of a large shopping-specific sample (i.e. male and female shopping mall visitors) did not find an association between family status and being classified as having PB (Maraz et al., 2015). To our knowledge, no studies to date have considered PB and its association with partnership status in a clinical sample. It remains unclear if being in a couple relationship has a protective or a negative effect on PB. Therefore, this pilot study aimed at exploring the possible link between the presence or absence of a partnership and the level of PB in patients seeking treatment for PB and in a population-based sample. Since the majority of treatment-seeking patients with PB are women, this study included only female participants. While we expected to find a difference in PB severity between women with and without partnership, the direction of the assumed relationship was unclear, although we posited a protective effect.
2. Methods We conducted a secondary analysis of data that we had collected within earlier studies: n ¼48 (Müller et al., 2008), n ¼55 (Müller et al., 2013), n ¼ 25 (Voth et al., 2014). Additionally, we included data from 29 patients who participate in an ongoing study resulting in a sample of 157 women aged between 19 and 71 years. This clinical group was compared with 1153 women within the same age range who had participated in an earlier representative study (Müller et al., 2010). The protocols were approved by the Institutional Ethics Committees, and all participants gave written informed consent. In all
A. Müller et al. / Psychiatry Research 239 (2016) 122–123
patients, PB was diagnosed using clinical interviews. The Compulsive Buying Scale (CBS; Faber and O’Guinn, 1992) was used to measure symptoms of PB. Lower scores indicate a higher level of PB. Partnership status was self-reported. Women with and without a partner were compared with regard to CBS total scores using ttests. To analyze a potential moderator effect of age, hierarchical moderated regression analyses were performed for each sample (i.e. clinical and population-based) with age, partnership status, and the interaction of age and partnership status as predictors and the CBS as dependent variable.
123
concerning men, and by the cross sectional design that does not allow for causal interpretations. Moreover, we cannot exclude that the lack of differences between treatment-seeking patients with and without partnership was due to the high level of CBS means in the clinical sample (i.e. ceiling effect). Nevertheless, this work makes a first attempt to investigate the role of partnership in PB. In conclusion, the simple fact of having a partner was not associated with the level of PB in women seeking treatment for this condition. Future studies should address the question of whether the characteristics and quality of partnership have an impact on the severity and course of PB, and vice versa.
3. Results Although the age range was the same in both groups (i.e. 19 to 71 years), the clinical sample was on average younger than the population-based sample (MClin ¼ 42.5, SDClin ¼ 10.9 and MPop ¼46.1, SDPop ¼14.2, df¼1308, t¼ 3.02, p¼ 0.003, d¼ 0.28). This is probably due to the fact that the age distribution in the treatmentseeking sample was not representative for the German population. The percentage of women currently living with a partner was almost the same in both groups (Clin: 56.1%, Pop: 55.8%, χ2 ¼0.004, p ¼0.945). CBS scores did not differ between patients with and without a partner in the clinical sample (Mwith ¼ 4.0, SDwith ¼ 1.8 and Mwo ¼ 4.5, SDwo ¼1.9, n.s., d¼ 0.27). In the population-based sample, women with a partner reported higher CBS scores indicating less PB (Mwith ¼2.5, SDwith ¼1.6 and Mwo ¼2.1, SDwo ¼1.9, df¼ 1151, t¼ 3.86, p o0.001, d¼ 0.23). The results of moderated regression analyses for each sample did not indicate a significant interaction effect between age and partnership status in predicting CBS scores.
4. Discussion The results of the present pilot study suggest that women seeking treatment for PB were similarly often living with a partner as women from the general population. It appears that the presence of a couple relationship had a protective effect on PB tendencies in women from the population-based sample but not on the severity of PB in treatment seeking patients, which we found surprising. Unfortunately, no information was available about the characteristics and quality of existing partnerships. It is well known that addictive behaviors such as pathological gambling may create conflicts and hostility in partnerships and that couple relationships can both positively and negatively influence gambling habits (Poirier-Arbour et al., 2014). Therefore, some authors have assumed that it could be beneficial to integrate gamblers’ spouses into treatment (Bertrand et al., 2008). This approach is in line with prior research indicating that individualbased psychotherapy may be less effective for patients with additional relationship problems (Whisman and Baucom, 2012), and could also be considered for the treatment of PB. The present pilot study is limited by the lack of detailed information on the quality of the partnerships, by missing data
References Abbott, D.A., Cramer, S.L., Sherrets, S.D., 1995. Pathological gambling and the family: practice implications. Fam. Soc.: J. Conte. Hum. Serv. 76, 213–218. Barbato, A., D’Avanzo, B., 2008. Efficacy of couple therapy as a treatment for depression: a meta-analysis. Psychiatr. Q. 79 (2), 121–132. Bertrand, K., Dufour, M., Wright, J., Lasnier, B., 2008. Adapted couple therapy (ACT) for pathological gamblers: a promising avenue. J. Gambl. Stud. 24 (3), 393–409. Faber, R.J., O’Guinn, T.C., 1992. A clinical screener for compulsive buying. J. Consum. Res. 19 (3), 459–469. Koran, L.M., Faber, R.J., Aboujaoude, E., Large, M.D., Serpe, R.T., 2006. Estimated prevalence of compulsive buying behavior in the United States. Am J. Psychiatry 163, 1806–1812. McElroy, S.L., Keck Jr., P.E., Pope Jr., H.G., Smith, J.M., Strakowski, S.M., 1994. Compulsive buying: a report of 20 cases. J. Clin. Psychiatry 55 (6), 242–248. Maraz, A., van den Brink, W., Demetrovics, Z., 2015. Prevalence and construct validity of compulsive buying disorder in shopping mall visitors. Psychiatry Res. 228 (3), 918–924. Müller, A., Mitchell, J.E., Crosby, R.D., Gefeller, O., Faber, R.J., Martin, A., Bleich, S., Glaesmer, H., Exner, C., DE Zwaan, M., 2010. Estimated prevalence of compulsive buying in Germany and its association with Sociodemographic characteristics and depressive symptoms. Psychiatry Res. 180 (2–3), 137–142. Müller, A., Mueller, U., Silbermann, A., Reinecker, H., Bleich, S., Mitchell, J.E., de Zwaan, M., 2008. A randomized, controlled trial of group cognitive-behavioral therapy for compulsive buying disorder: posttreatment and 6-month follow-up results. J. Clin. Psychiatry 69 (7), 1131–1138. Müller, A., Arikian, A., de Zwaan, M., Mitchell, J.E., 2013. Cognitive-behavioural group therapy versus Guided self-help for compulsive buying disorder: a preliminary study. Clin. Psychol. Psychother. 20 (1), 28–35. Müller, A., Mitchell, J.E., Crosby, R.D., Cao, L., Johnson, J., Claes, L., de Zwaan, M., 2012. Mood States preceding and following compulsive buying episodes: an ecological momentary assessment study. Psychiatry Res. 200 (2–3), 575–580. Müller, A., Mitchell, J.E., de Zwaan, M., 2015. Compulsive buying. Am. J. Addict. 24 (2), 132–137. Otero-López, J.M., Villardefrancos, E., 2014. Prevalence, Sociodemographic factors, psychological distress, and coping strategies related to compulsive buying: a cross sectional study in Galicia, Spain. BMC Psychiatry 14 (1), 101. Poirier-Arbour, A., Trudel, G., Boyer, R., Harvey, P., Goldfarb, M.R., 2014. Correlates of depressive symptom severity in problem and pathological gamblers in couple relationships. J. Gambl. Stud. 30 (1), 173–185. Voth, E.M., Claes, L., Georgiadou, E., Selle, J., Trotzke, P., Brand, M., de Zwaan, M., Müller, A., 2014. Reactive and regulative temperament in patients with compulsive buying and non-clinical controls measured by self-report and performance-based tasks. Compr. Psychiatry 55 (7), 1505–1512. Whisman, M.A., 2007. Marital distress and DSM-IV psychiatric disorders in a population-based national survey. J. Abnorm. Psychol. 116 (3), 638–643. Whisman, M.A., Baucom, D.H., 2012. Intimate relationships and psychopathology. Clin. Child. Fam. Psychol. Rev. 15 (1), 4–13. Whisman, M.A., Uebelacker, L.A., Bruce, M.L., 2006. Longitudinal association between marital dissatisfaction and alcohol use disorders in a community sample. J. Fam. Psychol. 20 (1), 164–167.