Compulsive buying has no formal diagnostic home in either DSM-5-TR or ICD-11. There are no validated diagnostic criteria, no formal diagnostic thresholds, and no recognized diagnostic category under which this condition can be coded without resorting to residual or NOS categories. ICD-11’s closest available code is “Other specified impulse-control disorder” (6C7Y), requiring clinical narrative to specify the behavioral content. The DSM-5-TR equivalent is “Other Specified Disruptive, Impulse-Control, and Conduct Disorder” (F91.8), similarly requiring accompanying narrative.
This diagnostic absence has been a consistent feature of compulsive buying’s relationship with formal psychiatry throughout its modern clinical history. McElroy and colleagues proposed formal diagnostic criteria in a 1994 paper that remains among the most cited in the literature. The research base that followed was sufficient to characterize the condition phenomenologically but has not yet met the evidentiary standard that DSM and ICD revision processes require for formal recognition. The most recent opportunity for DSM inclusion was the DSM-5 revision process, in which compulsive buying was not included in any form — a decision reflecting the working group’s assessment of evidence rather than skepticism about clinical reality.
Compulsive buying research faces a measurement challenge that has limited the coherence of its evidence base. The two most widely used instruments — the Compulsive Buying Scale (CBS; Faber & O’Guinn, 1992) and the Bergen Shopping Addiction Scale (BSAS; Andreassen et al., 2015) — were developed within different conceptual frameworks and operationalize the construct differently. They do not yield comparable prevalence estimates and have not been cross-validated against each other or against clinical diagnostic thresholds. The result is a literature in which studies using different instruments are not directly comparable, and prevalence estimates ranging from 1% to 16% cannot be interpreted as reflecting true population variability. Until an instrument validated against formally defined and clinically defensible diagnostic criteria is available, prevalence estimates and research findings should be treated as provisional.
The increasing use of “shopping addiction” as both a clinical and popular descriptor carries genuine utility and genuine risk. The utility: the addiction framework resonates with patient experience, reduces self-blame, and provides access to peer support infrastructure (Debtors Anonymous, Spenders Anonymous) offering genuine mutual aid independent of theoretical validity. The risk: neurobiological evidence for the reward-sensitization and craving patterns that define addiction in established categories is limited in compulsive buying. The tolerance and withdrawal features characterizing substance use disorders and present in gambling disorder have limited empirical support here. The addiction label, applied without adequate neurobiological evidence, risks generating treatment expectations that outpace the evidence base and expanding the category to encompass presentations that reflect high engagement or financial stress rather than the functional impairment and loss of control that anchor the clinical threshold.
Documentation for clinical purposes should use the most specific available residual code (ICD-11: 6C7Y; DSM-5: F91.8) accompanied by clinical narrative specifying the behavioral pattern, functional impairment domains, duration, and evidence of failed self-regulatory attempts. Patients who present with strong prior identification with the ‘shopping addiction’ label — often through online communities or popular media — may resist reframing. Clinicians should validate genuine functional impairment without endorsing theoretical claims about neurobiological addiction status that exceed current evidence. The distinction between ‘this framing is useful for you’ and ‘this is established neurobiological fact’ can be maintained respectfully. The research literature on compulsive buying has a significant demographic skew toward women, with female-to-male ratios ranging from approximately 3:1 to 9:1 across studies. This may reflect genuine sex differences, differential help-seeking, or measurement bias. Clinicians should maintain awareness that compulsive buying in male patients may present through different product categories and behavioral contexts than those described in most published literature.