INTRODUCTION
The issue of behavioral addictions is of great interest to both researchers and practitioners. While the last 20 years have seen the publication of a number of papers reporting their occurrence, they have not been included in the classifications of disorders, with the exception of pathological gambling. The International Classification of Diseases 11th Revision (ICD-11) introduced the category “Disorders due to addictive behaviors” and included, in addition to pathological gambling, disordered offline and online gaming – 6C51 Gaming disorder [1]. In turn, compulsive buying and shopping disorders are included in the ICD-11 under other specified impulse control disorders. In the DSM-5, compulsive buying-shopping disorder is mentioned under “hoarding disorder” [2]. Due to their similarity with substance addictions, these are widely referred to as addictions [3]. It should be emphasized that such behaviors are also referred to using other terms, both the specific ones related to a given type of behavior, and more general ones, such as compulsive or impulsive behaviors [3, 4]. In general, these are repetitive actions that a person cannot control, and which can lead to many unfavorable health-related, social and material consequences [5].
Among the various types of behavioral addictions, less attention has been paid to compulsive eating, which can lead to food or eating addiction, and excessive shopping, which is a risk factor for shopping addiction.
The terms food addiction and eating addiction, although similar, do not mean the same thing. According to some researchers, food addiction may encompass both behavioral and substance addiction [6, 7]. Hebebrand et al. [8] criticize the term food addiction as misleading and propose using the term eating addiction instead to emphasize the behavioral nature of the addiction. Hauck et al. [6] also point out to the lack of consensus on this issue and the need for further research, distinguishing between food addiction, referring to high-calorie foods rich in sugars, fats and salt, and eating addiction, concerning the act of uncontrolled eating itself.
Eating addiction that referred to as overeating, compulsive (binge) eating, or harmful (dysfunctional) eating behaviors, is treated as a type of eating disorder that involves the uncontrolled consumption of large amounts of food, despite the lack of an objective feeling of hunger. It is emphasized that the essence of eating addiction is primarily excessive eating of a compulsive nature, the basis of which is compulsion and loss of control over the act of eating, and, especially, the amount of food consumed [3, 5]. It should be noted that the symptoms of eating addiction include not only overeating, but also persistent thinking about food, experiencing emotions related to food, abandoning interests, and neglecting other activities and relationships with the environment. Furthermore, as foods containing large amounts of sugar, fat and salt have high metabolic efficiency, they are inherently highly addictive [3, 9].
Excessive shopping is described by various terms, including compensative, compulsive, impulsive, unplanned and uncontrolled buying, compulsive consumption, dysfunctional, compensatory buying, shopping mania or shopping/buying addiction [5, 10, 11]; however, it is most commonly referred to compulsive buying/shopping. A characteristic aspect of compulsive buying is the presence of compulsion and lack of control, which provides a rationale for treating these behaviors as addictions [3, 12, 13]. Impulsive buying also plays an important role in the development of shopping addiction; Grzegorzew-ska and Cierpiałkowska [3] interpret this as an impulsive tendency, associated with the inability to refrain from the need to buy that arises to reduce unpleasant feelings. This means that excessive buying is not so much triggered by the need for pleasure, but rather by fear and the need to reduce tension and negative emotions. In Poland, the number of compensative buyers seems to be increasing, and this applies especially to Generation Z [11].
One of the many factors that may condition the occurrence of behavioral addictions, including compulsive eating and excessive buying, is the experience of trauma [14]. It is worth noting that both shopping and eating disorders occur more frequently in women than in men [2, 5, 11]; however, caution should be exercised as gender differences have not been fully documented.
The relationship between trauma and eating and shopping addiction
The experience of trauma promotes the occurrence of both substance-based and behavioral addictions. The self- medication model assumes that addictions, particularly those associated with psychoactive substances, as being secondary to post-traumatic stress disorder (PTSD) [15, 16]. A similar situation may apply to behavioral addictions, insofar as excessive involvement in the act of eating or shopping may be a form of escape from the experienced traumatic situations and be treated as a way of dealing with their consequences. In such cases, an essential factor may be trauma experienced in childhood, especially if it was the result of violence. Mitchel and Wolf [17] indicate that exposure to trauma, parti-cularly childhood sexual abuse, is considered a non- specific risk factor for the development of eating disorders, including eating or food addiction.
Various studies have found eating or food addiction to be positively associated with trauma, especially that experienced in childhood, with examples being given among nurses [18], obese women [19], women with diabetes [20], and war veterans [21]. Fewer studies involved the exploration of the links between trauma and shopping addiction. However, existing data suggests on the whole that early childhood traumatic experiences may present a risk factor for the development of addiction.
A cross-sectional study of obstetrics/gynecology patients examined the influence of five types of childhood trauma, experienced before the age of 12 (i.e. witnessing violence, physical neglect, emotional abuse, physical abuse, sexual abuse), on compulsive buying [22]. All forms of trauma demonstrated significant correlations with compulsive buying. A selective review of literature published between 2000 and 2022 on compulsive buying disorder conducted by Elbarazi [23] yielded a substantial link between early exposure to stressful experiences and the development of a compulsive shopping habit in adulthood. It is worth noting that in Poland, the relationship between experiencing trauma and the risk of developing eating and buying addictions is a new research area.
The aim of the present study was to establish the links between experienced trauma and the intensity of addi-ctive behaviors related to eating and shopping, and to determine whether trauma plays a role of a predictor of addiction. Three trauma indicators were considered: the number of traumatic events experienced (directly and indirectly) and the presence of symptoms of PTSD.
The controlled variables were the age and marital status of the respondents. It was assumed that the indicators of trauma, i.e. the number of traumatic events experienc-ed, as well as PTSD symptoms, would be positively associated with the two types of the behaviors analyzed and that the main predictor of the risk of addiction, both to eating and shopping, will be the presence of symptoms of PTSD.
METHODS
A non-clinical group of 110 women was recruited for an online study, using Microsoft Forms. After applying the inclusion criterion, i.e., the prior experience of at least one traumatic event, 90 respondents qualified for the study. None were undergoing treatment for any addictions. The age of the respondents ranged from 20 to
56 (M = 33.86, SD = 8.93). The majority were single women (n = 48 women; 53.3%), with 42 (46.7%) being in a relationship. The respondents had experienced various traumatic events, with the most frequently mentioned being a road accident, unwanted or unpleasant sexual experiences, physical assault, and life-threatening illness or injury. The participants completed a survey developed for the study, containing questions about age, marital status and addiction treatment, as well as four standard measurement tools with the following characteristics:
The Eating Preoccupation Scale (EPS) is used to assess the intensity of compulsive eating and the risk of developing an eating addiction [5]. It includes 18 statements (e.g. “Food clearly improves your mood”) that fall within three factors, which are: 1) absorption in and concentration on the act of eating, 2) eating to provide pleasure and improve mood, and 3) eating as a result of compulsion and loss of control. A score below 40 points indicates a low level of risk, 40-48 indicates a medium level, and above 48 indicates a high level of risk of food addiction. The tool has satisfactory psychometric properties; Cronbach’s α coefficient is 0.89.
The Shopping Behavior Scale (SBS) allows for the de- termination of the intensity of compulsive buying and the risk of developing shopping addiction [5]. It consists of 16 statements (e.g. “Whenever I enter a shopping mall, I am overcome by an irresistible urge to buy something”) that fall within two factors: 1) buying as a result of compulsion and loss of control, and 2) buying to reduce tension and negative emotions. A score below 35 points indicates a low-level risk, 35-44 a medium risk and above 44 a high level of risk of shopping addiction. The internal consistency of the questionnaire was assessed using Cronbach’s α coefficient, which is 0.92.
The Life Events Checklist for DSM-V (LEC-5) is used to assess exposure to potentially traumatic events experienced by the subject [24]. The LEC-5 contains 17 items, referring to the traumatic events that the person has experienced themselves, or was a direct witness to (e.g., natural disaster, such as flood, hurricane, tornado, earthquake, as well as events experienced indirectly that the person heard about and which concerned people close to them). The tool has satisfactory psychometric properties and is suitable for the screening and measurement of exposure to trauma.
PTSD Checklist for DSM-V (PCL-5) was developed to assess PTSD symptoms [25]. The tool consists of 20 statements (e.g. “How much have you been bothered by repeated, unpleasant, and unwanted memories of a stressful event during the last month”) describing PTSD symptoms according to the DSM-5 classification, and allows for the determination of the overall score and symptoms falling within the scope of four criteria, including intrusion, avoidance, negative changes in cognition and mood, and changes in arousal and reactivity. The cut-off point was 33; a score of 33 or higher indicates a high probability of PTSD. The tool obtained very good psychometric properties; Cronbach’s α coefficient is 0.96 [26].
Statistical analyses
The statistical analyses were performed using IBM SPSS Statistics 22. As the variables included in the study demonstrated a normal or close to normal distribution, parametric tests were used for the analyses. Student’s t-test was used to show differences between the two studied subgroups (taking into account marital status), and the relationships between variables were established based on Pearson’s correlation coefficient. In order to select the predictors of eating and shopping addiction, regression analysis (stepwise forward version) was used.
RESULTS
The means and standard deviations of the variables included in the study are presented in Table 1.
Table 1
Means and standard deviations of variables included in the study
The mean values of the eating behaviors obtained in the studied group (44.79; SD = 10.87) was similar to that obtained in the studies aimed at checking the psychometric properties of the EPS [3]. Based on the adopted criteria for the EPS, it was shown that 27 women (30.0%) presented a low intensity of the eating behaviors analyzed, while 24 (26.7%) presented moderate, and
39 (43.3%) high intensity, suggesting a high risk of deve-loping an eating addiction.
In turn, the mean intensity of shopping behaviors of the women surveyed (39.46; SD = 10.89) was slightly lower than that noted in studies examining the psychometric properties of the SBS [3]. Based on the adopted criteria, it should be noted that 49 women (54.4%) presented a low intensity of the shopping behaviors analyzed, 24 (26.7%) a moderate intensity and 17 (18.9%) high intensity, indicating a possible risk of developing a buying addiction.
Age was associated with eating behaviors (r = –0.29, p < 0.01), but not with shopping behaviors (r = –0.04). Marital status did not have an impact on eating beha-viors (1. single: M = 47.33, SD = 14.37; 2. in a relationship: M = 46.71, SD = 10.67, t = 0.23) or shopping beha-viors (1. M = 33.52, SD = 12.66, 2. M = 35.83, SD = 10.02, t = –0.95). The mean number of traumatic events expe-rienced both directly and indirectly was greater than four. The obtained mean score in the PCL-5 indicates a relatively high intensity of PTSD symptoms.
The correlation coefficients between trauma indicators and the intensity of the analyzed eating and shopping behaviors are presented in Table 2.
Table 2
Correlation coefficients between trauma and eating and shopping behaviors
It can be seen that eating behaviors are positively associated with PTSD symptoms, but not with the number of traumatic events, experienced both directly and indirectly. In turn, the studied shopping behaviors are posi-tively associated with the number of traumatic events experienced indirectly; however, they do not correlate with the number of events experienced directly or with PTSD symptoms. However, number of events experienc-ed directly negatively correlate with factor 1 of shopping behaviors, i.e., buying as a result of compulsion and loss of control. It indicates that the greater the number of traumatic events experienced directly, the less likely one is to engage in shopping as a result of compulsion and loss of control.
The two types of analyzed behavior are related. The obtained correlation coefficient (r = 0.27, p < 0.01) indicates positive relationships between eating and shopping behaviors, which is consistent with other studies.
Next, the predictors of eating and shopping addiction were established using regression analysis (stepwise forward version). The explanatory variables included both the number of traumatic events experienced directly, indirectly, and PTSD symptoms. The results are presented in Table 3.
Table 3
Predictors of eating and shopping addiction (1)
Only PTSD symptoms were found to predict eating addiction in the studied group; however, their contribution appears very weak, amounting to only 7%. In turn, the only predictor of shopping addiction is the number of traumatic events experienced indirectly, whose contribution was found to be 13%. Additio-nal analyses were also conducted; in addition to trauma indicators, these included shopping behaviors as an explanatory variable for eating addiction and eating behaviors as the explanatory variable for shopping addiction. The results of the regression analysis are presented in Table 4.
Table 4
Predictors of eating and shopping addiction (2)
In this case, two variables, viz. shopping behaviors and PTSD symptoms, proved to be predictors of eating addiction, together explaining 13% of its variance; their individual contributions were 7% (shopping behavior) and 6% (PTSD symptoms). In the case of shopping addiction, indirectly experienced traumatic events (13%) and eating behavior (8%) variables were found to play a predictive role, together explaining 21% of the variance.
DISCUSSION
The surveyed group of women generally presented unfavorable eating behaviors, with 43% demonstrating a possible risk of developing an eating addiction. In contrast, 19% of the respondents demonstrated a high intensity of shopping behaviors, associated with a high probability of developing a buying addiction.
Age was associated with the intensity of eating but not shopping behaviors. Neither form of addictive beha-vior was differentiated by marital status. The participants reported experiencing various traumatic situations, and many of them more than one; the mean number of traumatic events experienced both directly and indirectly was higher than four. The respondents were characterized by a relatively high intensity of PTSD symptoms; this would not be entirely surprising as the percentage of people with PTSD in Poland is increasing, which may be an effect of the COVID-19 pandemic or the ongoing war in Ukraine [27].
A positive correlation was found between the two types of behaviors analyzed, which indicates that compulsive eating can co-occur with compulsive buying. This is consistent with data presented by other researchers [5, 28]; however it is difficult to determine the direction of this relationship.
The relationship between trauma and the addictive behaviors analyzed appear to be complex: the eating behaviors were found to be positively associated with PTSD symptoms but were not associated with the number of traumatic events experienced, either directly or indirectly. PTSD symptoms also served as a predictor of eating addiction, albeit a weak one. It should also be noted that including shopping behaviors among the explana-tory variables resulted in them becoming a predictor of eating addiction, in addition to PTSD symptoms. This suggests that the development of eating addiction can be predicted both by the occurrence of excessive shopping and PTSD symptoms.
The obtained results are consistent with the results obtained by other researchers, indicating a positive association between trauma and compulsive eating [17-21], and buying [22, 23]. They also seem to be consistent with the “self-medication” model which, although it refers to the use of psychoactive substances, and especially alcohol consumption [15, 16], may also apply to behavioral addictions [29].
It is worth noting that the trauma indicators included have different influences on the types of behavior analyzed. The presence of severe PTSD symptoms is asso-ciated with an increased risk of eating addiction but not shopping addiction; however, the latter can be predicted by a large number of indirectly experienced traumatic events. It is difficult to clearly explain why this happens. Persistent symptoms of PTSD in women who have experienced traumatic events may indicate their difficulties in cognitive processing of trauma and problems in emotion regulation; this may be reflected in a tendency to overeat and, consequently, a risk of developing an eating addiction. It cannot be ruled out that, for women, engaging in excessive eating is an easier, more accessible and less costly way of coping with the consequences of the trauma experienced than engaging in intensive shopping. Excessive eating is also a behavior that is often under-taken as a result of daily stress, which can exacerbate feelings of trauma. Furthermore, it is a behavior that provides immediate gratification.
It should be emphasized, however, that the experience of trauma and the resulting symptoms of PTSD predict only slightly the development of eating and shopping addictions. It is possible that other factors, not included in the study, may have a more significant role here than the traumatic events experienced and their consequences, i.e. symptoms of PTSD. It is also possible that trauma plays a greater role in the development of addictions to psychoactive substances, including alcohol or drugs, than in the development of behavioral addictions [15].
The research is not without certain limitations. The study group was small and limited only to women, and the analyses did not take into account the age of the respondents or the type of traumatic events they had experienced. In addition, it did not check education level, financial status, personality traits or competences in coping with traumatic stress.
The design of the study was cross-sectional, which does not allow for conclusions about cause-effect relationships to be drawn. It indicates that the temporal sequence between trauma, PTSD symptoms, and the examined behaviors remains uncertain. It is therefore impossible to clearly determine whether these behaviors emerge as a response to trauma/PTSD, whether they predate and coexist independently, or whether trauma amplifies existing vulnerabilities and thus indirectly contributes to dysfunctional behaviors. However, taking into account the self-medication model, it can be assumed that excessive engagement in eating and shopping may be a consequence of the trauma, not its cause.
Despite these limitations the study contributes new content on the relationships between trauma and the risk of developing eating and shopping addictions: a new research area in Poland. The study considered various trauma indicators, i.e., the number of traumatic events experienced (both directly and indirectly) and symptoms of PTSD symptoms. It also examined the relationship between trauma and the risk of developing the two types of addiction in the same group. It is worth noting that the study used relatively new measurement tools to assess traumatic events and PTSD symptoms, such as the LEC-5 and PCL-5, developed in accordance with the DSM-5 classification.
The results obtained may be important for practice, especially since the population of Poland appears to be characterized by a higher percentage of people with symptoms PTSD than other countries [27]. Most importantly, they may be used to increase awareness of the links between trauma and behavioral addiction among therapists and thus improve the effectiveness of the treatment they offer. In such cases, the therapist should aim at reducing both the risk of addiction and the severity of PTSD symptoms experienced by clients. Particular attention should be paid to the cognitive processing of trauma and the modification of the dysfunctional beliefs that underlie the development of both addiction and PTSD. Our findings may also be useful in developing preventive programs for people who have experienced trauma but do not yet show symptoms of addiction. They also indicate that people exposed to trauma should be equipped with the skills to cope with the consequences of their experiences.
CONCLUSIONS
PTSD symptoms may increase the risk of developing eating addiction, while the number of traumatic events experienced indirectly seems to increase that of shopping addiction.
In order to reduce the risk of behavioral addiction, preventive programs should aim to equip people with the skills necessary to cope with the experience of traumatic events and their negative consequences, in the form of PTSD.
