Hoarding disorder

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at June 17, 2016
StartDiseasesHoarding disorder

Compulsive hoarding or hoarding disorder is persistent difficulty in parting with or discarding objects due to a perceived need to retain them, regardless of their actual value. Hoarding is not the same as collecting. While collectors experience a sense of pride about their possessions and enjoy displaying and talking about them, hoarders experience embarrassment about their possessions and feel uneasy when people see them. Additionally, while collectors budget the time and money they spend on acquiring items, hoarders do not and are often in debt. 

Contents

Definition & Facts

Approximately 2-6% of the general American population suffers from compulsive hoarding. Hoarders often have mood disorders, such as depression as well as generalized anxiety disorder or social anxiety disorder. Hoarding does not seem to be more common in one gender over the other, and its onset typically occurs before the age of 20, with symptoms typically beginning to appear in early adolescence. A hoarder's functional impairment and the amount of clutter acquired generally gets worse with age.

Symptoms & Complaints

Compulsive hoarding is comprised of several symptoms. Hoarders are unable to throw objects away despite their actual value because they feel a need to save things. Additionally, they feel extreme anxiety when they attempt to get rid of possessions. Hoarders also experience distress when others touch or borrow their things.

They have a lot of difficulty organizing or categorizing their possessions and cannot decide where to keep or put things they acquire. A hoarder's home will be full of clutter. The continuous accumulation of items clutters active living spaces, making them unusable. For instance, the kitchen will have so much clutter that it is impossible to cook in it. 

Compulsive hoarding either causes the sufferer significant distress or functional impairment. For example, a hoarder may begin to isolate himself or avoid socializing with family and friends. Hoarding can also interfere with marital relationships, leading to divorce. The condition may also interfere with a person's ability to function in school or at one's job. 

People who hoard have different reasons for doing so. Some hoarders believe that the items they keep will be useful or valuable in the future. Other hoarders have difficulty parting with items because they have sentimental value – the items they keep remind them of a lost loved one or pet, happier times, or special events. Furthermore, hoarders may keep things as a way of jogging their memories, and they believe that if they get rid of the items, they won't be able to remember a significant person or event. 

Causes

It isn't clear what causes hoarding. However, there seem to be several risk factors for developing the disorder. Genetic factors seem to play a role; hoarders often have family members who also suffer with the condition. Some individuals develop the disorder following a traumatic or stressful life event, such as the death of a loved one, losing things in a fire or natural disaster, divorce, or eviction. Additionally, while it's true that hoarding tends to lead to social isolation, some individuals may develop the condition in response to being lonely. 

Diagnosis & Tests

An individual is diagnosed with hoarding disorder when he or she meets the diagnostic criteria specified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. The DSM-5 specifies that an individual with the condition possesses a persistent difficulty in discarding or parting with items, regardless of their actual value, which is due to a perceived need to keep the items or extreme anxiety associated with parting with them.

The accumulation of things leads to cluttered active living spaces and compromises their intended use. The DSM-5 specifies that if living spaces are clean, it is only because of the intervention of a third party, such as a family member, friend, or professional cleaner. Additionally, hoarding must either cause significant distress or functional impairment for the sufferer. 

Before compulsive hoarding disorder is diagnosed, a mental health professional must rule out medical causes for the condition, such as a brain injury or Prader-Willi syndrome. Finally, hoarding must not be better explained by a symptom of another mental illness, such as a lack of energy in depression, obsessions in obsessive-compulsive disorder, or delusions associated with schizophrenia

Treatment & Therapy

Once a person is diagnosed with the condition, treatment for hoarding can begin. However, hoarders don't typically recognize their behavior as a problem. Therefore, many hoarders only seek treatment when they are pressured to do so by a family member or friend. Other times, individuals will seek help only when they are pressured to clean up by a landlord or the authorities. 

Because many hoarders don't realize that their behavior is a problem, treatment can be challenging. This can be especially true when a hoarder finds comfort in his possessions. If a hoarder's possessions are taken away, he will simply begin to accumulate more things in order to fill his emotional needs. 

Cognitive behavioral therapy (CBT) is the most common form of psychotherapy utilized in the treatment of this condition. In CBT, a hoarder will explore why she feels compelled to accumulate things, learn and practice relaxation techniques, and learn how to organize items. CBT also focuses on helping hoarders develop decision-making and problem solving skills, identify and challenge cognitive distortions, and identify values.

A therapist or professional organizer may also aid in cleaning the home, helping hoarders determine what to keep and what to discard. When seeking help, hoarders should seek a therapist who specializes in treating the disease. CBT for hoarding must be continued for six months to one year or longer, depending on the severity of the condition, in order for treatment to be effective. 

While CBT is the primary treatment for this condition, medication is sometimes utilized to help manage symptoms as well. Specifically, selective serotonin reuptake inhibitors (SSRIs) are most often used in the treatment of compulsive hoarding. Other medications, such as tricyclic antidepressants and benzodiazepines may also be used to treat any co-occurring mental illnesses, such as depression, obsessive-compulsive disorder, or generalized anxiety disorder. 

Prevention & Prophylaxis

Unfortunately, because so little is understood about what actually causes compulsive hoarding, there are no known ways to prevent the condition. However, as with many conditions, getting help at the first sign of an issue may help keep hoarding from becoming severe.