Concurrence of compulsive buying and sexual addiction

Abstract

COMPULSIVE BUYING AND sexual addiction share common core clinical features such as repetitive or compulsive engagement in a behavior despite negative consequences, and diminished control over the problematic behavior.1 To our knowledge there is only one report of comorbid sexual addiction in patients with compulsive buying. McElroy et al. reported that two out of 20 patients with compulsive buying had lifetime but not current diagnosis of paraphilia and sexual addition.2 We describe here a 30-year-old man who suffered concurrent symptoms of compulsive buying and sexual addiction for many years without any treatment. A 30-year-old married man visited the outpatient service of Tri-Service General Hospital, Taipei, for help. According to the patient his parents divorced when he was 7 years old and he had lived with his grandmother from the age of 7 to 15 years. During this period the patient had some conduct problems such as truancy, fighting, and running away from home. He was therefore sent to Japan by his grandmother where his father worked as a chef. The patient's father, however, lost his job and was not able to pay for his son's schooling after the age of 17. Since that time the patient had earned his living by working as a waiter. Since the age of 19 he had spent all of his salary on purchasing clothing, shoes, video games, pornography, and adult videos every month. He spent a lot of time in shopping and would buy things that he did not need. The patient admitted that he felt nervous and anxious before each purchase and euphoric and excited when the act was completed, but these moods would be followed by negative feelings such as sadness, regret, depression, and guilt. As a result, he had taken on several jobs, owned many credit cards, or borrowed money to pay his debts. In the previous 3 years the patient had been deeply involved in compulsive sexual activities in addition to his compulsive buying. He spent an excessive amount of time engaged in sexual behavior, which included visiting massage parlors for paid sex, engaging in extramarital affairs, and changing acquainted sexual partners, despite the fact that the patient maintained a satisfied sexual relationship with his wife. He noted that sexual experiences provided his only coping mechanism for his work responsibilities and financial stress, but he always had feelings of guilt and remorse after his sexual acts as well, and tried, unsuccessfully, to stop this behavior many times. To this end he visited the outpatient department for help. Unfortunately the patient did not return for a follow-up visit after his initial assessment. No personality disorder was diagnosed although the patient reported some conduct problems during his adolescence. The patient did have some obsessive–compulsive characters, however, such as perfectionism, perseverance, and indecisiveness. He denied having any history of depression, hypomania/mania, anxiety disorders, or child/sexual abuse. There was no history of alcohol or substance abuse but the patient's mother had a history of bipolar disorder and his sister had a history of major depression. There was no history of compulsive buying or sexual addition in his family members. Most patients with behavioral addictions seldom search for medical service actively.1 Likewise, the present patient showed up at the clinic for help only once. The one visit by the patient limits this report. First, his clinical history should have been further confirmed by his family. Second, we should have made an assessment on his personality. Nevertheless, this unique case has provided evidence in support of phenomenological links between compulsive buying and sexual addiction. More studies are warranted to better understand the similarities and differences of these two behavioral addictions. This report was partially funded by a research grant from the Tri-Service General Hospital, Taipei, Taiwan (TSGH-C96-59).