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Open AccessReview

Compulsive Buying-Shopping Disorder – A Female Phenomenon?

Published Online:https://doi.org/10.1024/0939-5911/a000861

Abstract

Abstract:Background: There are increasing numbers of studies on compulsive buying-shopping disorder (CBSD), but possible gender differences in prevalence are still unclear. To our knowledge, there is no review that synthesizes the ambivalent findings. Aim: This literature review aims to provide an overview by examining gender differences regarding the prevalence of CBSD. Method: A literature search was carried out in PubMed/Scopus/PubPsych. Inclusion criteria: empirical studies of neurologically healthy adults from 2000 onwards with outcomes related to the prevalence of CBSD and gender difference analysis. Results were synthesized narratively. Results: We included 39 studies in 4 settings with double allocation where multiple samples were included: general population (n=18), purchase-specific (n=3), students (n=17), clinical samples (n=4). There was no gender difference in 19 studies, women were significantly more affected in 19 studies and men in one study. Discussion: As only half of the studies found a gender difference, it cannot be assumed that CBSD is a female-only phenomenon. In those studies, the composition of the sample or cultural aspects (gender roles) may explain this. The studies vary widely regarding questionnaires/sample size. The use of consistent instruments is important for comparable research. Recognition CBSD as a distinct mental disorder is thus essential. There is a need for high-quality research to actually determine if there is a gender difference in prevalence.

Pathologisches Kaufen – Ein weibliches Phänomen?

Zusammenfassung:Hintergrund: Obwohl es immer mehr Studien über pathologisches Kaufen gibt, bleibt unklar, ob es geschlechtsspezifische Unterschiede in der Prävalenz gibt. Es wurden zwar einige Untersuchungen zu geschlechtsspezifischen Unterschieden bei pathologischem Kaufen durchgeführt, aber die Studienlage hierzu ist sehr ambivalent. Unseres Wissens nach gibt es bisher keine Übersichtsarbeit, die die uneinheitlichen Ergebnisse systematisch zusammenfasst. Ziel: Die folgende Studie soll einen Überblick über die geschlechtsspezifischen Unterschiede bei der Prävalenz von pathologischem Kaufen verschaffen, indem die aktuelle Literatur systematisch zusammengefasst wird. Methode: Es wurde eine Literaturrecherche in den Datenbanken PubMed, Scopus, PubPsych durchgeführt. Einschlusskriterien waren Studien an neurologisch gesunden Erwachsenen mit geschlechtsvergleichenden Ergebnissen zur Prävalenz von pathologischem Kaufen. Eingeschlossen wurden empirische Studien in deutscher und englischer Sprache ab dem Jahr 2000, die Analysen zu Geschlechterunterschieden beinhalteten. Die Ergebnisse wurden narrativ zusammengefasst. Ergebnisse: Wir konnten 39 Studien aus 4 Gruppen einschließen, wobei in einigen Fällen, in denen mehrere Stichproben einbezogen wurden, eine doppelte Zuordnung erfolgte: Allgemeinbevölkerung (repräsentativ n=8; nicht repräsentativ n=10), kauf-/shoppingspezifische Stichproben (n=3), Studentenstichproben (n=17), klinische Stichproben (n=4). Keinen Geschlechtsunterschied wiesen 19 der Studien auf. In 19 Studien waren Frauen signifikant häufiger betroffen im Vergleich zu den männlichen Teilnehmern. In einer Studie waren signifikant häufiger Männer im Vergleich zu weiblichen Teilnehmerinnen betroffen. Die Prävalenz von pathologischem Kaufen als Online-Ausprägung wurde in 2 Studien erhoben. Diskussion: Die Ergebnisse zeigen, dass es sich bei pathologischem Kaufen nicht um ein rein weibliches Phänomen handelt, da nur in der Hälfte der Studien ein Geschlechterunterschied festgestellt wurde. In Studien mit Geschlechterunterschieden könnten Rollenbilder und die Zusammensetzung der Stichproben eine Rolle spielen. Die Studien variieren stark in Bezug auf verwendete Erhebungsinstrumente für pathologisches Kaufen und Stichprobengröße. Für eine vergleichbare Forschung ist es wichtig, dass einheitliche Instrumente verwendet werden. In diesem Zusammenhang ist die Anerkennung von pathologischem Kaufen als eigenständige psychische Störung essenziell, sodass einheitliche Diagnosekriterien und Screening-Instrumente entwickelt werden können. Nur 2 Studien haben Online-Formen des pathologischen Kaufens betrachtet. Aufgrund der zu erwartenden Entwicklung des Online-Markts und der Verschiebung zu Online-Käufen, sind hier weitere Studien notwendig. Es müssen insgesamt mehr qualitativ hochwertige Studien durchgeführt werden, um festzustellen, ob es tatsächlich einen Geschlechtsunterschied gibt. Darüber hinaus sollten künftige Studien die Prävalenz mit Hilfe klinischer Interviews erheben.

Introduction

Buying/shopping is an everyday duty, but for some people, it can be problematic or even pathologically in the sense of a compulsive buying-shopping disorder (CBSD). This affects an estimated 5 % of the population (Maraz et al., 2016). Contrary to the assumption that the phenomenon of CBSD originated as an extreme form of consumerism, it was already first mentioned and described in 1892 (Magnan, 1892). Therefore, CBSD is not only a consequence of consumerism or a product of the modern affluent society. Rather, it is a mental disorder that has been known for decades. Nevertheless, more recent developments, especially in the online-market (e. g., personalized advertising, social commerce), are expected to intensify the phenomenon (Adamczyk, 2021; Hubert et al., 2014).

Despite its early mention, high estimated prevalence, as well as advancing research, CBSD has not yet been listed as a distinct mental disorder in classification systems. It is not listed as such in either the 10th version of the “International Statistical Classification of Diseases and Related Health Problems” (ICD-10; World Health Organization, 2004) or the 5th version of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5; American Psychiatric Association, 2013). But, in the coding tool of the 11th edition of the ICD, “compulsive buying-shopping disorder” can be found as an example of “other specified impulse control disorders” (6C7Y; World Health Organization, 2022). In the previous German draft version of the ICD-11, “pathologisches Kaufen” is accordingly named in the category “sonstige näher bezeichnete Störungen der Impulskontrolle“ (6C7Y; Bundesinstitut für Arzneimittel und Medizinprodukte, 2022). To follow ICD-11 terminology, these terms will also be used for this article. Although it is a step forward that CBSD is mentioned at all, even if not as a distinct disorder, experts tend to argue for its classification as a behavioral addiction (Brand et al., 2020; Müller et al., 2019; Pickering & Norberg, 2022).

The descriptions of CBSD are based on reports of affected persons. Recurrent elements are 1) a strong urge to buy/shop (craving), 2) impaired control over buying/shopping, and 3) preoccupation with aspects of buying/shopping (Laskowski, Trotzke et al., 2021; Müller, Laskowski, Trotzke et al., 2021). The loss of control results in recurrent buying/shopping episodes that are accompanied by excessive consumption (independent of usage). In addition to financial difficulties, this also leads to other enormous negative consequences in the private, social, professional and legal areas (Laskowski, Trotzke et al., 2021; Müller, Laskowski, Trotzke et al., 2021). Despite this, the behavior is continued or even escalated. This leads to enormous distress and suffering, also for the relatives, and even to a reduced quality of life (Williams, 2012; Zhang et al., 2017). Social consequences such as reduced participation, impaired performance and health-related problems also occur in the course of CBSD. The societal consequences make the phenomenon a population-based problem and thus a public health issue.

Reports from patients as well as research have shown, that people affected with CBSD represent a heterogeneous group (Black, 2007, 2022; Laskowski & Müller, 2021). They differed in their preference of purchase locations and goods (Coley & Burgess, 2003; Laskowski & Müller, 2021; Müller et al., 2011), as well as in their personality traits (Granero, Fernández-Aranda, Baño et al., 2016; Otero-López et al., 2021) and psychological comorbidities (Laskowski, Georgiadou et al., 2021). This is also due to the fact that the focus is not on the product itself, but on the relieving or initially rewarding purchasing activity itself (Claes et al., 2016; Laskowski, Trotzke et al., 2021; Müller, Laskowski, Trotzke et al., 2021).

It is not conclusively clear whether there are also gender differences in the prevalence of CBSD, as the study situation is very ambivalent. The relevance for gender-sensitive studies arises from the fact that some subgroups of patients respond differently to medical therapies and that the course of disease in different patient groups depends on different factors, e. g., gender. This has also recently been shown in gender-sensitive evaluations of the COVID-19 pandemic (Laskowski et al., 2024).

Possible gender differences in mental disorders in general may be based on biological aspects (Ihle et al., 2007), but can also be explained by the fact that men and women differ in genetic disposition and in physiological and hormonal regulatory mechanisms. Social science explanations see gender differences as rooted in specific living conditions, participation opportunities, and different experiences in school, education, the labor market, family, and health care (Merbach & Brähler, 2016). The reason for a possible difference in prevalence between men and women in CBSD could be the emotions associated with buying/shopping. For example, Gallagher et al. (2017) described that woman are more likely to associate positive emotions with buying and enjoying it more, whereas men associate more negative emotions with buying and enjoying the purchase to a lesser extent.

Some research has been conducted on gender differences in CBSD (Ching et al., 2016; Coley & Burgess, 2003; de Mattos et al., 2016; Dittmar, 2005), but to our knowledge, there is no review that synthesizes and analyzes the ambivalent findings. Consequently, the following study aims to provide an overview by examining gender differences regarding the prevalence of CBSD through a literature review. Research on gender differences can make a decisive contribution to understanding CBSD. For example, gender-specific prevention or even treatment can be developed (Ihle et al., 2007). Addiction research has already shown differences in coping skills and social influences between men and women, which could be relevant in gender-specific programs (Walton et al., 2001). In general, gender-transformative programs appear to be more effective in changing behavior than narrowly defined programs, which emphasizes the relevance of gender-sensitive measures (Barker et al., 2010). As a public health aspect, gender-sensitive approaches can also contribute to decrease gender inequalities in health, as is wished in the European Union’s Gender Action Plan (European Commission, 2023) and by the World Health Organization (Jane, 2023).

Methodology

A literature search was carried out using the databases PubMed, Scopus and PubPsych, the databases were last consulted on August 28th, 2023. The search string used was composed of various terms on the topic of CBSD and gender differences (see Table 1). It should be indicated in the titles or abstracts. Inclusion criteria were studies of neurologically healthy adults with outcomes related to the gendered prevalence of CBSD. Empirical studies in German and English language from the year 2000 onwards were included. The studies also had to include an analysis of gender differences. Exclusion criteria, on the other hand, were studies with children or adolescents and other study types than original articles. Because of the large impact that neurological conditions such as Parkinson’s disease can have on behavioral addictions (Foki, 2020), studies examining neurologically ill patients were excluded. Studies from the gray literature and other languages were also excluded. Since the growing online-market has an impact on the prevalence of CBSD (Adamczyk, 2021; Hubert et al., 2014; Müller, Laskowski, Wegmann et al., 2021), the included literature should not be older than from the year 2000.

Table 1 Search String

Studies were selected by using a two-step procedure. In the first step, titles and abstracts were screened and additional screening of reference lists of the identified studies was performed by GH. Potential doubts were discussed and resolved by all authors. In the second step, the full-text review was performed (GH and NML). In case of potential doubt about exclusion or inclusion, a consensus was made with the assistance of the other authors. The final selection of studies based on full-text reviews was approved by all authors.

The studies were sorted according to sample characteristics (e. g., general population, students) in order to be able to compare the results more reliably and to achieve greater homogeneity of the samples. Result tables include prevalence data when possible. If this information was not provided, the results of the statistical tests or the gender-specific information on the means (M) and standard deviations (SD) of the questionnaire sum scores are reported.

Results

Inclusion and Exclusion Process

A total of 39 studies (N = 60 158) could be identified through database searching as shown in the flow diagram in Figure 1. The studies included populations from 19 different countries, but most were from the United States, Germany and China (n = 6 each). Fifteen different survey instruments (plus 2 interviews) were used, most frequently the Compulsive Buying Scale (CBS; n = 10; Faber & O’guinn, 1992), followed by the Richmond Compulsive Buying Scale (RCBS; n = 5; Ridgway et al., 2008).

The following double allocations can be found in the results, as these studies included several types of samples: The study by Hubert et al. (2014) included two samples of the general population (representative) from two different countries whose results were evaluated separately. The study from Müller et al. (2010) included samples of the general population (representative), a student sample and a clinical sample. The study from He et al. (2018) included a sample of the general population (not representative) and a student sample.

Figure 1 Flow Chart. The number of studies in the thematic allocation differs from the total number of studies, as some studies included several different samples.

General Population

Eight studies examined the prevalence in the general population (representative samples; see Table 2) of which four found no significant gender differences regarding the prevalence (Adamczyk, 2018; Adamczyk et al., 2020; Koran et al., 2006; Müller et al., 2010). The prevalence of the female sup-groups ranged from 3.2 % to 9.7 %, of the male sup-groups from 1.9 % to 7.5 %. Three of the studies found a significant gender difference in the prevalence of CBSD with the result that women are more often affected (Claes et al., 2016; Otero-López & Villardefrancos, 2014; Ünübol et al., 2022). The study by Hubert et al., (2014) showed no difference in the German, but in the Danish population (with women being more frequently affected). In six studies, the gender distribution was roughly equally distributed with 0.2 % to 4.2 % difference (in two studies there was no information on gender distribution).

Ten other studies also examined the general population, but these were nonrepresentative samples, mostly recruited online (see Table 3). No significant difference was found in seven of these studies (Biolcati, 2017; He et al., 2018; Leite et al., 2013; Müller, Claes et al., 2021; Müller et al., 2011; Roberts et al., 2014; Zarate et al., 2022). The prevalence in women here vary between 8.8 % and 28.4 %, in men between 8.6 % and 29.8 %. Three studies found a higher prevalence in women (De Pasquale et al., 2022; Rocha et al., 2023). Etxaburu et al. (2023) examined CBSD in adolescents (14–18 years) from Ecuador, in this population, boys showed higher levels of CBSD compared to girls. In six out of these studies there were significantly more women in the sample (16.6 % to 24.3 % more), in one study there were 17.5 % more men. In the other studies, the genders were somewhat equally distributed with a difference of 3.8 % and 6 % respectively.

Table 2 Included Studies General Population (representative)
Table 3 Included Studies General Population (not representative)

Buying/Shopping Specific Groups

Three studies were included that examined populations recruited in shopping malls (see Table 4). In all three studies, women were more frequently affected (Ahmed Moon & Attiq, 2018; Bani-Rshaid & Alghraibeh, 2017; Maraz et al., 2015). The prevalence in women was reported to be 6.5 %/10.7 % and in men 2.9 %/5.2 %. In one study, an equal number of men and women were surveyed; in the other two, there were 11.4 % and 13 % more women in the sample.

Table 4 Included Studies General Population in Shopping Malls

Student Samples

Seventeen studies examined populations of students (see Table 5). Six of these studies found no gender difference in prevalence (Billieux et al., 2008; Bohne, 2010; Lee & Workman, 2018; Lejoyeux et al., 2011; Li et al., 2023; Müller et al., 2010). The study by Duroy et al. (2014) assessed online-buying/-shopping, but there was no gender difference as well. Estimated prevalence of 0.3 % to 17.4 % in women and 0.5 % to 9.0 % in men were found. The ten other studies consistently showed that women had a higher prevalence (Dal Santo et al., 2022; Harvanko et al., 2013; He et al., 2018; Liu, Bi et al., 2022; Odlaug & Grant, 2010; Otero-López et al., 2021; Perales et al., 2021; Unger et al., 2014; Villardefrancos & Otero-López, 2016) including another study assessing online-CBSD (Liu, Unger et al., 2022). In five of these studies, the genders were roughly equally distributed, in the others there were between 6.9 % and 17.9 % more women in the sample (in one there was no information on gender distribution).

Table 5 Included Studies Student Population

Clinical Samples

In addition, studies with clinical samples were also considered, four studies were included. In all of them, women were more frequently diagnosed with CBSD (75.7 % to 86 %). But in three of the studies, no gender comparison was calculated, so no conclusion about significant gender differences can be drawn (Granero, Fernández-Aranda, Steward et al., 2016; Laskowski, Georgiadou et al., 2021; Müller et al., 2010). Only one study by Wölfling et al. (2022) showed a significant gender difference (20.1 % in females, 11.4 % in males). In all studies, the proportion of women in the sample was higher than the male.

Discussion

Different genders react differently to therapies and in some cases also exhibit different courses of the disease (e. g., with COVID-19; Laskowski et al., 2024). The extent to which this applies to CBSD is almost unexplored. For this reason, this review aimed to provide more insight into a possible gender difference in the prevalence of CBSD. The results are relevant for identifying further research gaps and can be starting points for demonstrating the relevance of gender-specific therapies and prevention programs.

It was possible to include 39 studies in four different settings, with double allocation in some cases where multiple samples were included. Analysis of these studies shows that 19 of the included studies reported no gender difference. In 19 studies, women are more commonly affected. In total, there were four studies in which the prevalence of men was higher than in women without a significant difference (Bohne, 2010; He et al., 2018; Leite et al., 2013; Roberts et al., 2014), one study showed a significant higher prevalence in men (Etxaburu et al., 2023). A possible gender difference can therefore not be conclusively demonstrated, and while there is evidence that women may be more commonly affected, it is definitely not an exclusively female phenomenon.

The prevalence in the general population all fall within a similar range among the representative studies (Maraz et al., 2016). In the convenient samples, it is striking that the prevalence is noticeably higher. This could be explained by the fact that open studies are more likely to include individuals who engage frequently in buying/shopping and thus have a higher risk of CBSD. It can be seen that some prevalence appeared unrealistically high – which is probably mainly due to the fact that questionnaires were mainly used for screening, and thereby also false positives must be considered. Studies on gaming disorder have shown that this could possibly lead to an overpathologization of normal behavior (King et al., 2020).

Among student samples, the study by Bohne (2010) showed the lowest overall prevalence at <1 %. Here, overall, the highest variance is in the prevalence data, but also in the number of instruments used for the assessment, which may be seen as a factor influencing the prevalence. Future studies should further examine whether assessment instruments affect prevalence.

It is also possible that the student samples differ highly in personality traits, gender distribution etc., depending on the type of university studied. Future studies should examine here whether such influences affect prevalence.

It appears that in all studies from Spain, women were more frequently affected than men, which could be due to a culturally specific distribution of gender roles (Li et al., 2014). The same explanation was provided by Bani-Rshaid and Alghraibeh (2017) for the sample from the Arab region. Thus, the origin of the subjects could have an influence on gender differences in CBSD. However, further research is needed to clearly identify the cultural influencing factors and to determine possible moderating or mediating effects. Moreover, it can be concluded that the influence of further socio-demographic characteristics cannot be clearly excluded. In addition, the number of subjects in the studies varies from 84 to 24 380 participants. This also influences the results, since a larger sample also usually leads to more reliable estimates.

Future research should examine different age groups, as some studies have shown that gender differences seem to disappear in younger populations (Maraz et al., 2016; Müller et al., 2022). This could not be demonstrated in the studies reviewed here, with only one study examining populations <18 years (with boys being more affected; Etxaburu et al., 2023).

It cannot be clearly ruled out that in the studies that found a gender difference, this is at least partly due to methodological reasons; for example, the setting could also have an influence. The studies with buying-/shopping-specific populations all showed a gender difference, but did not always describe exactly in which type of malls they recruited. It is possible that there were not enough male-specific stores and that the gender distribution was distorted.

In most studies there were more women in the sample than men (up to 24 % difference), only in one study there were about 18 % more men in the sample. Nevertheless, it is not apparent that the studies with a higher proportion of women are also the ones that found a gender difference. Only two studies assessed gender alongside men/women, with a total of seven responses. Future studies should pay attention to assess other genders, besides the binary expressions.

Noticeable were the results of the clinical samples. Here it was shown that a large proportion of patients are female. It should be investigated why fewer men seek treatment or whether they seek help for other symptoms, as men are more often deterred from seeking help by stereotypical role models (Faltermaier & Hübner, 2016). Similar problems with other perceived “women’s diseases” are already known, e. g., men with eating disorders seek help significantly less often (Laskowski et al., 2023; Halbeisen et al., 2024). It also cannot be ruled out that specific male aspects are underrepresented in the questionnaires used, so that they screen more women as pathological than men. However, it remains unclear whether and in what way specific male aspects are expressed. In addition, the people affected are often very uncomfortable with their derailed buying/shopping behavior, and many are ashamed to talk openly about it. Thus, CBSD may also be frequently overlooked in all genders (Laskowski & Müller, 2021).

Surprisingly, only two studies have looked at online-CBSD (Duroy et al., 2014; Liu, Unger et al., 2022). This low number of online-specific studies could be related to the discussion on whether the online versions of behavioral addictions should be regarded as a separate disorder or as another form in addition to the offline variant (Baggio et al., 2022; Müller, Laskowski, Wegmann et al., 2021). Given the expected development of the online-market, the related shift from offline purchases to online-purchases, and thus the presumably increasing prevalence of CBSD (Adamczyk, 2021; Hubert et al., 2014), we also expect an increase in future studies looking specifically at online-CBSD. Future research should also include online-CBSD and/or survey the populations studied to determine which form of CBSD is preferred (Müller et al., 2023).

In summary, the following explanations for a possible gender aspect can be given:

1) biological aspects, although these did not play a role in the studies included in this review, 2) methodological aspects, e. g., recruitment type and questionnaires used: It cannot be ruled out that the instruments, which may be validated on more female participants, also diagnose more women, and underrepresent specific male aspects. Also, in non-representative studies, it cannot be ruled out that the same people are more likely to participate who also buy/shop more, which may be more likely to be women due to 3) prevailing gender role distributions and cultural influence (social aspects). 4) In addition, it cannot be ruled out that other as yet unknown factors have an influence on a possible gender difference in CBSD.

Of course, some limitations must be mentioned. Only English- and German-language literature was examined, and only three publication forums were searched, which may have had an influence on the selection of studies. On a positive note, however, a hand search was able to identify additional relevant studies and thus provide a larger overview of the literature. The last point that should be mentioned is, that the way CBSD was assessed (interview, questionnaire, etc.) may of course have an influence on the results. In the studies included here, 15 different survey instruments were used. Future studies of gender differences in the prevalence of CBSD should use clinical interviews rather than questionnaires. It remains therefore unclear to what extent the measures take into account gender roles and the different buying/shopping behavior of men and women. It has to be considered that the different existing questionnaires may have different constructs bases. The items of the different questionnaires therefore partly differ in essential points and this may also affect the gender differences. However, for comparable research, it is important that consistent instruments are used. In this context, it is of substantial importance that CBSD be recognized as a distinct disorder and, consequently, that questionnaires be developed based on consistent diagnostic criteria.

Implications for the Practical Field

  • A high prevalence of compulsive buying-shopping disorder (CBSD) can be assumed and it is a growing public health problem. To ensure uptake of preventive and intervention programs, greater awareness about this mental disorder should be created.
  • A possible gender difference could not be conclusively disproved. It appears that CBSD is not an exclusively female problem. However, it can be assumed that women more often seek treatment.
  • Preventive and/or curative interventions should therefore explicitly address not only women. In particular, consideration should be given to low-threshold options that also address males.
  • In practice, patients of any gender should be asked directly about possible problems, as problematic buying/shopping behavior often causes feelings of shame. Derailed consumption should be taken seriously and those affected should be passed on if it is severe.

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