Dear Editor:

According to a search of the PubMed and PsycINFO databases, no study to date has examined associations among shoplifting, compulsive buying, and borderline personality disorder (BPD)—syndromes possibly related through impulsivity. Relationships have previously been reported between shoplifting and BPD in eating disorder cohorts,[1–3] in kleptomania,[4] and in internal medicine outpatients,[5] but not in a French study of adolescent males.[6] Compulsive buying, another aberrant consumer behavior like shoplifting,[7] has been associated with dissociative-like experiences (also reported in kleptomania[8]) as well as BPD.[9,10] We hypothesized that there might be relationships among shoplifting, compulsive buying, and BPD, with the two aberrant consumer behaviors related through characterological impulsivity.

Participants in this study were consecutive female outpatients, ages 18 years or older, who were seeking nonemergent care through an obstetrics/gynecology clinic that is affiliated with the local university. Individuals with severe intellectual (e.g., mental retardation), medical (e.g., pain), psychiatric (e.g., psychotic), and/or cognitive impairment (e.g., dementia) were excluded by the recruiter if symptoms were of sufficient severity to preclude the successful completion of a survey.

The average age of participants was 26.18 years (standard deviation [SD]=7.62), with a range from 15 to 61 years. In terms of racial/ethnic background, most were either Caucasian (54.9%) or African-American (38.5%), with 6.6 percent being of other or mixed ethnicities. Approximately 88 percent of participants had at least a high school diploma and 13 percent had completed college. The majority of participants were never married (73.1%), with 16.1 percent being married, 6.9 percent divorced, and the remaining 3.9 percent separated or widowed. About 80 percent of participants indicated that they had government insurance, 5.5 percent were privately insured, and 14.4 percent had no insurance or elected to self-pay.

As consecutive patients arrived at the outpatient obstetrics/gynecology clinic, one of the researchers (JC) informally assessed exclusion criteria and solicited potential candidates. Participants were then invited to complete a four–page survey, which took about 10 minutes. The cover page of the survey contained the elements of informed consent, and completion of the survey was presumed to be implied consent (this was specifically clarified on the cover page).

The survey included a demographic query as well as 1) a one-item query for shoplifting (i.e., “Have you ever shoplifted?”); 2) the Compulsive Buying Scale (CBS),[11] a seven-item self-report measure with Likert-style response options; and 3) two assessments for borderline personality symptomatology—the BPD scale of the Personality Diagnostic Questionnaire-4[12] and the Self-Harm Inventory.[13]

Participants were instructed to place completed surveys into accompanying envelopes, to seal the envelopes, and then return them to the researcher. Data were collected in October of 2010. This project was approved by the university’s institutional review board.

Results are reported in Table 1. Note that shoplifting demonstrated statistically significant point-biserial correlations with both measures of BPD as well as with compulsive buying. However, when examining the results from a hierarchical logistic regression analysis, in which the two BPD measures were entered in the first step and CBS in the second step, it was revealed that compulsive buying did not predict shoplifting above and beyond borderline personality symptomatology (chi2 [3, N=368]=58.48, p<0.001 [overall model fit]; delta chi2CBS=2.41, p=0.126). It should be noted that both the SHI (Wald=5.02, p=0.025; odds ratio [OR]=1.10) and PDQ-4 BPD scale (Wald=14.62, p<0.001; OR=1.32) scores uniquely predicted shoplifting.

To summarize, findings from the present study indicate that there are relationships between shoplifting and borderline personality symptomatology, as in our previous study of internal medicine outpatients;[6] and there are associations between shoplifting and compulsive buying, both aberrant consumer behaviors that may be related through borderline personality symptomatology. Thus, shoplifting, compulsive buying, and borderline personality symptomatology appear to be an indistinct and potential clinical triad.

This study has a number of potential limitations, including the self-report nature of all data and the tendency for self-report measures of BPD to be over-inclusive. However, in a consecutive and reasonably sized sample, we examined relationships that have not been previously explored and found that shoplifting, compulsive buying, and borderline personality symptomatology are somewhat interrelated behaviors.

References
1. Selby EA, Bulik CM, Thornton L, et al. Refining behavioral dysregulation in borderline personality using a sample of women with anorexia nervosa. Pers Disord Theory Res Treat. 2010;1:250–257.
2. Nagata T, Kawarada Y, Kiriike N, Iketani T. Multi-impulsivity of Japanese patients with eating disorders: primary and secondary impulsivity. Psychiatry Res. 2000;94:239–250.
3. Suzuki K, Higuchi S, Yamada K, et al. Bulimia nervosa with and without alcoholism: a comparative study in Japan. Int J Eat Disord. 1994;16:137–146.
4. Grant JE. Co-occurrence of personality disorders in persons with kleptomania: a preliminary investigation. J Am Acad Psychiatry Law. 2004;32:395–398.
5. Sansone RA, Lam C, Wiederman MW. The relationship between shoplifting and borderline personality symptomatology among internal medicine outpatients. Innov Clin Neurosci. 2011;8:12–13.
6. Saint-Martin C, Chabrol H. Contribution of psychopathic traits to delinquent behaviors in a sample of high-school male students. Encephale. 2010;36:155–158.
7. Budden MC, Griffin TF. Explorations and implications of aberrant consumer behavior. Psychology & Marketing. 1996;13:739–740.
8. Sarasalo E., Bergman B, Toth J. Kleptomania-like behaviour and psychosocial characteristics among shoplifters. Legal and Criminological Psychology. 1997;2:1–10.
9. Mueller A, Muhlhans B, Silbermann A, et al. Compulsive buying and psychiatric comorbidity. Psychother Psychosom Med Psychol. 2009;59:291–299.
10. Schlosser S, Black DW, Repertinger S, Freet D. Compulsive buying. Demography, phenomenology, and comorbidity in 46 subjects. Gen Hosp Psychiatry. 1994;16: 205–212.
11. Faber RJ, O’Guinn TC. A clinical screener for compulsive buying. J Consum Res. 1992;19:459–469.
12. The Personality Diagnostic Questionnaire – version 4. 1994. http://www.pdq4.com/. Accessed July 21, 2011.
13. Sansone RA, Wiederman MW, Sansone LA. The Self-Harm Inventory (SHI): development of a scale for identifying self-destructive behaviors and borderline personality disorder. J Clin Psychol. 1998;54:973–983.

With regards,
Randy A. Sansone, MD
Joy Chang, BS
Bryan Jewell, MD
Martin Sellbom, PhD
Dr. Sansone is a professor in the Departments of Psychiatry and Internal Medicine at Wright State University School of Medicine in Dayton, Ohio, and Director of Psychiatry Education at Kettering Medical Center in Kettering, Ohio. Ms. Chang is a medical student at Wright State University School of Medicine in Dayton, Ohio. Dr. Jewell is a resident in the Department of Obstetrics/Gynecology at Wright State University School of Medicine in Dayton, Ohio. Dr. Sellbom is an Assistant Professor in the Department of Psychology at The University of Alabama in Tuscaloosa, Alabama.

Funding and disclosures: There was no funding received for the development of this letter. The authors have no conflicts of interest relative to the content of this letter.