I met a self-confessed shopaholic and hoarder last Sunday and it made for a fascinating discussion as she explained why she bought a second freezer when she already had an adequate one that’s fully functional. “I wanted an upright freezer,” she explained, and to me it made sense. But to our mutual friend who was telling of the massive collection of costume jewelry, to which the shopper is allergic, but which she continues to buy, the utensils stored away, never to be used, and other such issues, there seemed to be a problem. I concurred, chiming in confidently and with the authority of a clinician (which I’m not), “That’s a disease!” Then our mutual friend said she’s convinced some type of illness possesses a single woman who owns five beds, two refrigerators, over 100 plates, four coffee-makers, a battery of small kitchen appliances, boxes of stuff not seen for years, and more. To that I agreed with even more gusto—until I realised she was describing my home, and then we all broke out in peals of laughter. There began my serious contemplation of the distinction, if any, between a personality disorder and mental illness.
Shopaholics and hoarders
Dr April Benson, a therapist who works with compulsive shoppers, describes a shopaholic as “one who practises chronic, repetitive purchasing that provides immediate short-term gratification, but ultimately causes harm to the individual or others.” Shopping, she says, may be an attempt to fill an inner void, manage feelings, repair mood, or pursue a “perfect” image. Hoarders, on the other hand, can feel that an item is extremely special—almost like a part of them—and develop an unhealthy attachment to it. Benson says the difference is that the overshopper accumulates and buys items to feel better, the hoarder holds on to things that easily can be regarded as trash. I’ve carried so many labels that until this lively exchange, but never felt it important to ask whether one can have a personality disorder, like hoarding, without being considered mentally ill. And while I’ve gone through a range of diagnoses on many spectrums of mental illnesses and personality disorders, have lots of “stuff” and was once considered a “shopanista,” I never considered myself one or the other of these two personalities. I began questioning whether overshopping and hoarding are personality disorders, and only that, disorders—a disorder seen as turmoil or chaos, but not necessarily an illness of the mind. My searches for definition/distinction are proving extremely enlightening and increasingly confusing.
In practice, bellaonline.com says, reaching a diagnosis is not so straightforward. It’s based on a combination of clinical experience and expertise, knowledge, and established “objective” criteria, as well as feedback from detailed assessments, questions and observations within the individual context of each patient.
Disorder or mental illness?
But globally, there aren’t any “established objective criteria” in the way mental disorders are assessed, defined, diagnosed or treated. Therefore, in any expert opinion these two disorders can be listed as mental illnesses and, as you become more confident about that position, the argument is debunked. This conflict of criteria for what constitutes mental illness is compounded by some who say personality disorders are not diseases but instead, are based on value judgments in the diagnosis of people who behave differently from the norm. Mental Health America (MHA) says personality disorders must fulfil several criteria, such as a deeply ingrained, inflexible patterns of relating, perceiving, and thinking serious enough to cause distress and impaired functioning, and that it’s recognisable by adolescence or earlier, continues throughout adulthood, and become less obvious throughout middle age. It also says, that although they feel their behaviour patterns are “normal” or “right,” people with personality disorders tend to have a narrow view of the world and find it difficult to participate in social activities.
Leaning towards pathology, MHA concludes that: “The more you learn about personality disorders the more you will understand that they are illnesses, with causes and treatments.” British psychiatrists being more ambivalent than most about whether to regard personality disorders as mental illnesses, the British Journal of Psychiatry (BJP) writes that personality disorders are distinguished from mental illness by their enduring, potentially lifelong nature and by the assumption that they represent “extremes of normal behaviour.” Thus far, I’m with the BJP on this one, concluding that because the term “mental illness” has no agreed meaning, it is impossible to decide whether or not personality disorders are mental illnesses. I’m in agreement too that the question cannot usefully be discussed until agreement has been reached on the implications of the term “mental disorder.” And I happily conclude that whether being a shopaholic or a hoarder are illnesses or disorders, those two at least bring one immense pleasure. I’ve also found a simple solution to one of those problems—once my employment status changed and my disposable income disappeared.