Are hoarding disorder and buying-shopping disorder behavioural addictions? A conceptual review.

Abstract

There is considerable conceptual debate about how hoarding disorder (HD) and buying-shopping disorder (BSD) can be best classified. In this article, we reason that these disorders may represent behavioral addictions by mapping evidence to the Components Model of Addiction and the Interaction of Person-Affect-Cognition-Execution (I-PACE) model for addictive behaviors. Our review identifies phenomenological, psychological, and neurobiological evidence to support both disorders as behavioral addictions. However, limitations of the extant literature prevent strong conclusions from being made about the conceptual status of HD and BSD as behavioral addictions. By applying addiction theory to HD and BSD, we generate testable predictions for future research and open potential new avenues for psychological treatment advances. Public Health Significance StatementThe classification of hoarding disorder and buying-shopping disorder as behavioral addictions has significant implications for how these mental disorders are understood and treated. This review article highlights potentially fruitful new areas for research and novel applications of addiction treatments that could improve outcomes for individuals suffering from these debilitating and chronic conditions.

Addictive behaviors in the context of buying–shopping and hoarding disorders: Integrating components and psychological processes.

“…Wrapping up, when examining the evidence for considering BSD and HD behavioral addictions, as done in the conceptual review by Pickering and Norberg (2022), we argue that it is important to not only look at a specific theoretical model and consider all the components equally, but to put the individual elements in a logical and hierarchical structure in order to check which comparisons (e.g., gaming disorder with BSD and HD) are permissible at which level (e.g., core criteria versus clinical features or core criteria versus driving factors). When we consider the above mentioned ideas of structuring components into those related to ICD-11 criteria and which are recognized by experts (e.g., within the Delphi study on BSD) compared with perhaps more “secondary” components (clinical features, driving factors), the conclusion by Pickering and Norberg (2022) to consider BSD and HD behavioral addictions would be even stronger. The components of the model by Griffiths (2005), for which Pickering and Norberg (2022) only found limited or reasonable evidence (tolerance, withdrawal, relapse), are those which are apparently not considered the core components relevant for the diagnosis by most experts.…”

“…What might be the difference between excessive behaviors in the context of OCD (and note that HD is classified currently in the category of obsessive-compulsive or related disorders in ICD-11) versus excessive behaviors in the context of a behavioral addiction? Addressing this question leads us to the second model that Pickering and Norberg (2022) considered interesting in their conceptual review, the I-PACE model (Brand et al, 2019). Particularly in the early stages of addictive behaviors, it is assumed that striving motivations and rewarding experiences linked to specific behaviors (such as gaming, buying–shopping, using pornography) result in positive reinforcement.…”

“…The article by Pickering and Norberg (2022) on addictive components and processes of Buying-Shopping Disorder (BSD) and Hoarding Disorder (HD) addresses an important, timely topic that is of highest clinical relevance and has unfortunately received less attention than it deserves in the past. In their conceptual review, they use the much respected and highly cited components model of addiction by Griffiths (2005) as a basis for evaluating the evidence for considering BSD and HD as behavioral addictions.…”

“…In addition, they use the Interaction of Person–Affect–Cognition–Execution (I-PACE) model in its most recent version (Brand et al, 2019), which has also been used in recent past by some researchers in the behavioral addiction field. Pickering and Norberg (2022) review the current empirical evidence to examine narratively the assumptions of the two models for their potential validity for BSD and HD. And indeed, they find at least reasonable evidence for most but not all assumptions of both models.…”

“…The I-PACE model does not define the core elements in terms of symptoms, but it tries to focus on psychological (and neurobiological) processes and potential mechanisms underlying the symptoms of behavioral addictions. Pickering and Norberg (2022) have evaluated separately the validity of the models’ assumptions regarding core components (components model) and considering psychological processes (I-PACE model) for BSD and HD. While this approach is sufficiently conservative, it is most appropriate as a starting point for discussion.…”