To: WHO ICD-11 Maintenance Platform

Dear ICD-11 Revision and Maintenance Committee Members,

I respectfully submit this proposal requesting the creation of a stand-alone ICD-11 diagnostic entity for Compulsive Buying–Shopping Disorder (CBSD).

Current ICD-11 status

In ICD-11, compulsive buying–shopping disorder appears only as an example/inclusion term under the residual category 6C7Y – Other specified impulse control disorders, rather than as a distinct diagnostic entity. This residual placement limits international surveillance, research comparability, and health-system planning.

Epidemiologic justification

Evidence demonstrates that CBSD is prevalent and persistent across cultures:

• A meta-analysis of 40 studies (≈32,000 participants) reported a pooled prevalence of ~5% (Maraz et al., Addiction, 2016).

• U.S. population prevalence is estimated at 5.8% (Koran et al., Am J Psychiatry, 2006).

• Representative European samples show prevalence near 7% (Müller et al., J Behav Addict, 2010).

These rates justify recognition beyond a residual category.

Social and health-economic burden

CBSD produces measurable harms:

• Objective association with real consumer debt (Achtziger et al., J Econ Psychol, 2015).

• Demonstrated quality-of-life impairment, with income-equivalent monetary valuation of burden in a longitudinal community cohort (Zhang et al., Psychiatry Research, 2017).

• Significant comorbidity with mood, anxiety, and substance-use disorders, implying increased health-service utilization (Black, World Psychiatry, 2007; Zhang et al., 2017).

Clinical validity

CBSD is characterized by:

• persistent/recurrent buying or shopping behavior,

• impaired control,

• continuation despite negative consequences,

• clinically significant distress or impairment,

• exclusion when behavior occurs exclusively during manic or hypomanic episodes.

Randomized and controlled trials demonstrate benefit from disorder-specific psychotherapy, particularly CBT (Mitchell et al., 2006; Müller et al., 2008), supporting its validity as a distinct treatment target.

Proposed ICD-11 placement (two acceptable options)

Option A (conservative):
Create CBSD as a leaf entity within Impulse control disorders, replacing its current “example only” status under 6C7Y.

Option B (behavioral-addiction aligned):
Create CBSD as a leaf entity under Disorders due to addictive behaviours, consistent with an emerging scholarly position and its phenomenologic overlap with gambling and gaming disorders.

Expected impact

Establishing a stand-alone ICD-11 entity would:

• improve international epidemiologic surveillance,

• enhance research comparability,

• reduce misuse of residual categories,

• support health-economic analyses and treatment evaluation.

Thank you for your consideration of this proposal.

Respectfully submitted,

David Behar, MD
United States