Compulsive Hoarding Disorder




People with compulsive hoarding disorder have difficulty throwing things out so they accumulate, or hoard unneeded items.





People with compulsive hoarding disorder have difficulty throwing things out so they accumulate, or hoard unneeded items.

When does saving things become hoarding? Hoarding (HOR-ding) is defined by the Anxiety and Depression Association of America (2015) as the “persistent difficulty discarding or parting with possessions, regardless of their actual value.”

What Is Hoarding?

Hoarding is extreme collecting and saving of objects of varying value and the inability to discard anything that has been saved. This can lead to the accumulation of a mass of objects to the point that all rooms of the home (including the garage and outside storage sheds) or workplace are filled. As the home is filled, there is less space for the person to live, resulting in the inability to carry out normal activities. This contributes to an unsafe environment that increases the risk for injury, disease, or fire. The hoarder often experiences severe distress and disability related to the hoarding.

Hoarding differs from collecting in that collectors generally work within a budget and take pride in displaying and discussing their collections. Hoarders are typically embarrassed by the state of their homes and do not want people to visit.

What Do People Hoard?

Usually, people hoard common items such as paper (such as newspapers, mail, and junk mail), books, clothing, and containers (such as boxes and plastic containers). Some people hoard food items, including garbage, outdated food items, or rotten food. Sometimes the items are valuable but in a far greater amount than the person can use, such as when a person purchases a large quantity of perishable food that has a short “use by” date because it is on sale.

Sometimes, people hoard animals. In this case, the person usually cannot keep up with the care of the animals, resulting in animal waste and rotting food that attracts insects and rodents. This causes an unhealthy environment for both the hoarder and the animals. When animals are hoarded, animal protection agencies can be called in to remove the animals for the welfare of both the animals and any persons in the home.

What Are the Characteristics of People Who Hoard?

According to the International Obsessive-Compulsive Disorder Foundation, an estimated 2 percent (1 in 50 people) to 5 percent (1 in 20 people) of the population has a serious hoarding disorder. The average age of a person seeking treatment for hoarding is 50, but symptoms of hoarding usually begin in early teenage years, with the average age of first signs being 13 years of age. Signs of hoarding include the following:

Why Do People Hoard?

The exact cause of hoarding is still unknown. Hoarding has historically been considered a subtype of obsessive-compulsive disorder (OCD), which is a chronic disorder in which a person suffers from uncontrollable, recurring thoughts or behaviors. It is estimated that around one in four people who have OCD are also compulsive hoarders. Recently, however, this association has been reevaluated and in the 2013 edition of the Diagnostic and Statistical Manual of Mental Disorders DSM-5 hoarding, though still grouped with OCD and other similar disorders, was recognized as a distinct disorder in its own right.

A 2012 study on hoarders revealed distinct patterns of brain activity that differ from those of people with OCD. The hoarders displayed unusual activity in the sections of the brain related to decision making and risk assessment when asked to discard their own items (but not the items of others). According to the researchers, hoarders often felt that they were at risk of making a wrong decision and that that decision could bring about greater consequences than it actually would.

Risk factors for hoarding include having another family member who is a hoarder, social anxiety or isolation, and an indecisive temperament. Some people turn to hoarding after a stressful life event, such as the death of a loved one or divorce.

What Are the Consequences of Hoarding?

Hoarding disorder can affect the ability to function in the family, social, and work environments. Hoarders may experience family stress and conflict, resulting in isolation and loneliness. They may refuse to allow others to enter their home. They may have difficulty in performing the daily tasks of living such as bathing, cooking, eating, and cleaning their environment.

Extreme hoarding can result in health and safety concerns. Saving large quantities of flammable objects such as old newspapers, magazines, junk mail, books, and clothing can increase the risk for fire. The inability to discard old food items that have greatly exceeded their “use by” date or garbage can lead to rodent infestation and disease. Large amounts of clutter can increase the risk of people falling or of towers of items collapsing onto people. Mold and dust can accumulate, causing breathing problems. In some cases the damage done to the home is so extreme it must be condemned.

How Do Doctors Diagnose and Treat Compulsive Hoarding Syndrome?

Diagnosis

Compulsive hoarding syndrome is diagnosed by a psychiatrist or psychologist. The American Psychiatric Association (DSM-5 2013) describes the criteria for diagnosis as:

Treatment

There are two types of treatment for people diagnosed with hoarding disorder: medication and cognitive-behavioral therapy (CBT). Medication is often used to treat conditions such as anxiety and depression that aggravate hoarding and typically only works on those hoarders who also suffer from OCD.

With CBT, the hoarder is educated about the nature of the disorder and the possible consequences of it. CBT generally involves regular sessions that may last as long as year, and many of these sessions take place in the hoarder's home. The CBT therapist will work with the hoarder on his or her decision making and organizational skills in order to help the hoarder learn to get rid of possessions with less anxiety and distress.

See also Anxiety and Anxiety Disorders: Overview • Obsessive-Compulsive Disorder

Resources

Books and Articles

American Psychiatric Association. “Hoarding Disorder.” Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Washington, DC: American Psychiatric Association, 2013.

Frost, Randy O., and Gail Steketee. Stuff: Compulsive Hoarding and the Meaning of Things. New York: Houghton Mifflin Harcourt, 2010.

International OCD Foundation. “Hoarding Fact Sheet.” https://iocdf.org/wp-content/uploads/2014/10/Hoarding-Fact-Sheet.pdf (accessed March 25, 2016).

Websites

Harmon, Katherine. “Brain Scans of Hoarders Reveal Why They Never De-clutter.” Scientific American. http://blogs.scientificamerican.com/observations/scans-of-hoarders-brains-reveal-why-they-never-de-clutter/ (accessed March 25, 2016).

San Francisco Bay Area Internet Guide for Extreme Hoarding Behavior. http://www.hoarders.org (accessed June 9, 2016).

Organizations

American Psychiatric Association. 1000 Wilson Blvd., Suite 1825, Arlington, VA 22209-3901. Toll-free: 800-368-5777. Website: http://www.psychiatry.org (accessed March 25, 2016).

Anxiety and Depression Association of America. 8730 Georgia Ave., Suite 600, Silver Spring, MD 20910. Telephone: 240-485-1001. Website: http://www.adaa.org (accessed March 25, 2016).

International OCD Foundation. PO Box 961029, Boston, MA 02196. Telephone: 617-973-5801. Website: https://iocdf.org (accessed March 25, 2016).

Disclaimer:   This information is not a tool for self-diagnosis or a substitute for professional care.

(MLA 8th Edition)