Medicalizing a behavior?
When Koran and colleagues' recent article was published, there was an accompanying editorial by Eric Hollander, MD, and Andrea Allen, PhD.10 Some critics, Hollander and Allen said, have warned that classifying compulsive buying as a psychiatric disorder is like medicalizing a "moral" problem or creating a new disorder to sell more pharmaceuticals. When asked about the criticism, Koran responded: "The same can be said about alcoholism and gambling. These are behaviors that meet the criteria of causing substantial distress and dysfunction." Compulsive buying, he added, seems to meet criteria that would be used to classify other behaviors as mental disorders. As with those disorders, the question of whether there is a legal responsibility connected with compulsive buying, such as whether compulsive buyers should be allowed to declare bankruptcy, is a social consensus decision.
In their editorial, Hollander and Allen acknowledged that viewing compulsive buying from a medical perspective and as a diagnosable mental disorder has some advantages.
"It might facilitate routine screening for the condition by mental health professionals and perhaps even inclusion of the disorder in national prevalence surveys, which would help define the true prevalence of the disorder," they said. "It might also lead to the study of vulnerability factors for the development of the disorder, better characterization of brain-based circuits, and development of effective psychosocial and medication treatments."10
Asked about the controversy concerning which category compulsive buying should be under in the proposed DSM-V, Koran told Psychiatric Times it should remain as an impulse control disorder, since it has the phenomenologic qualities of this type of disorder.
"It is associated with tension beforehand, pleasure or gratification during the act, and then remorse, regret, or guilt afterward because of the problems it creates," he explained.
To further research compulsive buying, Koran said that he and his team will be looking at whether a biologic abnormality can be identified in the people who have the disorder or in those who have the disorder and respond to medication, as opposed to ones who do not respond to medication.