Attention Shoppers:
How Money and Recovery Are Related

Money has more to do with recovery than you might realize. With the average monthly cost of inpatient eating disorders treatment estimated at $30,000 and the total cost of outpatient care over the life of the illness reaching upwards of $100,000 (Source: Department of Mental Health Study conducted in 2006 by South Carolina), finances are definitely part of the equation. Families are taking second and third mortgages out on their homes to pay for care. Clients are reaching into their retirement savings to go into programs that insurance companies do not see as "coverable," but are highly effective. And healthcare providers are continuing to accept low rates from insurance carriers at their own personal cost.

In addition to the cost of treatment, compulsive spending and mismanagement of money is often part of the picture for individuals with eating disorders. Some people compulsively shop, while others restrict spending and refuse to buy necessary items such as food and clothing. Commonly referred to as "compulsive shopping," a person uses buying as a way to manage difficult feelings and as a result, experiences negative financial consequences. These include excessive credit card debt, bounced checks, strained relationships, and in some instances, bankruptcy. While there is as yet no clinical DSM diagnosis for spending disorder, there is a high correlation between compulsive shopping and eating disorders, especially bulimia and/or binge eating.

So how do you know if you have a problem? The biggest telltale sign is if you are using shopping to manage difficult feelings or distract yourself from the reality of life. In a society that encourages excessive consumer consumption and promotes "retail therapy," it is sometimes hard to distinguish between a true spending disorder and typical American buying behavior. (See box for a listing of signs and symptoms.) However, when clients are asked directly about finances and spending habits, it is my experience that they are quick to self-identify. They want help and often are not aware of the overlap between food behaviors and money. Once this parallel is made, change can happen.

Karen's Story

Karen, a 25-year-old sales executive, is a great example. She came into my office one day with a brand new outfit. This was not unusual as she was always dressed impeccably and typically did not wear the same thing twice. What was different is she started to talk about her shopping in her therapy session.

"I feel like I shop to avoid life," she said. "When I am not binge eating, I find myself going to department stores and trying on clothes and shoes. Most of the time I buy over $500 worth of stuff and feel great for about 30 minutes. Then I get home and have buyer's remorse. I usually call my dad and tell him I need more money and he sends it. While I don't have a big bill anymore, I feel awful. Today I shopped before our session and I am miserable."

This was the first step in Karen identifying that her eating, shopping, and mood were all interconnected. I recommended she look at all three in our work. Eventually, Karen recognized that her spending habits were a way to stay in touch with her father, who was a distant workaholic executive. She described feeling close to him and special when she needed him to bail her out financially. When asked why she did not bail herself out, she started to cry and told me she desperately feared she would fail at the task.

In time, Karen and I looked at her issues of dependency and the complications of separating from her parents, especially her father, as she felt she did not get "enough of him" growing up. I was very proud of her when she decided to take the risk of paying for her own sessions and supporting herself. She later went on to set a budget, shop responsibly, and develop an adult relationship with her dad.

What Karen and other clients have taught me is that there is common ground between the goals of eating disorders recovery and financial recovery. At the core are self-care, emotional regulation, and taking adult responsibility in the world. A few of the common goals are as follows:

Self-Awareness: This is the first step in changing a relationship with food and money. When Karen was able to identify her thoughts, beliefs, and automatic actions in these areas, she then could decide which behaviors to keep and which to change.

Failure is okay: By giving herself permission to fail, Karen truly learned she could be self-reliant. She, like many men and women with food issues, was a perfectionist, afraid of messing up. By giving herself permission to fail, she learned that she could not only take care of her nutritional needs but her financial ones as well.

Resilience: The ability to bounce back from tough times is a necessary life skill. Karen had not been given a chance to develop her resilience, as her dad would consistently rescue her when things got difficult. Over time, she learned through trial and error that she could handle life's curve balls.

Support: Karen did ask for support, but not the healthy type of support she needed. Over time she could identify her needs, verbalize them, and then ask for appropriate help regarding her food and her finances.

Self-Care Skills/Financial Skills: These are two different skill sets, but both are important in living a healthy, satisfying adult life. Karen's treatment involved not only learning nutritional self-care but also learning basic financial skills like balancing a checkbook, paying off her credit cards each month, and paying her rent on time.

Health Motive/Profit Motive: To do the hard work of recovery, motivation is key. Karen made a conscious decision to recover, as she wanted to have healthy relationships with her friends and family. Later, she decided to work on her spending habits as an extension of this work. She is now motivated to make, spend, and invest her money wisely as she feels worthy of financial independence.

As you can see, money is worth exploring in therapy. Whether it is indicative of an underlying emotional issue or a symptom of another problem, chaotic spending needs to be addressed. So the next time someone asks you what money has to do with eating disorders recovery, tell that person, "more than you would think."