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Compulsive Hoarding

Hoarding Disorder is a separate diagnosis in the OCD and Related Disorders section of DSM-5. Compulsive hoarding refers to acquiring and not being able to discard items of little value, or to a point of excess that the number of items hoarded make the living space in which the items are stored too small or crowded and unusable. Hoarders may or may not experience distress or depression, in fact, often it is anyone who lives with them or observes how they are living that experiences the most upset! People with compulsive hoarding are sometimes referred to as “pack rats.” Syllogomania and disposophobia are other names used throughout the years to describe compulsive hoarding.

Hoarding is estimated to affect between 700,000 to 1.4 million people in the United States. This may be an underestimate, as many hoarders often do not seek help on their own. It is most common for hoarders to be brought to treatment by a loved one, or for the loved one to come in on their own seeking guidance. Anywhere from 25 to 30 % of people with OCD report at least some hoarding symptoms.

Compulsive hoarding does not discriminate. It can affect anyone regardless of age, gender, or socio-economic status. Although hoarding is commonly thought of to occur in the elderly, the first signs actually often begin between age 11 or 12 on average. As with many other OCD Related conditions, hoarding, if left untreated, will become more severe over time. It is also important to consider that all hoarders are not the same. Hoarding symptoms vary in severity from mild to severe. Treating hoarding behavior early, if possible, can derail initial symptoms from becoming more severe.

Any physical item, from newspapers and clothing and toys, and in the computer age, files and apps, can be the focus of hoarding. There can be many unusual items that people with hoarding keep such as used tissues and rocks, empty containers, even body waste products. There are also “animal” hoarders.

The following categories cover many of the broad areas of items kept by hoarders.

  • Buying excessive quantities of goods (e.g. cans of tuna) beyond the amount needed for reasonable usage
  • Saving broken, irreparable, or useless things
  • Purchasing large amounts of useful items and storing them away for future usage, but never using them
  • Retrieving numerous materials from the trash on a regular basis
  • Having difficulty discarding anything due to a fear of accidentally throwing out something important
  • Saving excessive quantities of printed matter (newspapers, magazines, junk mail, etc.)
  • Making and keeping extensive lists or records of certain things, even after they are no longer needed
  • Saving large amounts of certain items for possible use by others or for future recycling

Hoarding becomes a problem when it begins to interfere with a person’s day-to-day life, or threatens safety or health of self and others (e.g. creating a fire hazard). Many individuals who hoard begin to isolate themselves from friends and family due to feelings of guilt and shame regarding their hoarded items. They also may have difficulty finding items they need as time goes on, especially if they have run out of money. In addition to these difficulties, many compulsive hoarders begin to have health problems due to dust and mold that build up on the piles of hoarded items.

Overall, there are many heartbreaking statistics related to individuals who hoard: 6% have been fired because of hoarding, 77% report 1 or more severe health conditions, up to 1 in 55 have had a child removed from their home, 13% have been evicted or threatened with eviction from their home.

Distinguishing hoarders from collectors can be hard in certain cases, such as when the hoarded item actually has monetary value, such as quality art. This may help clarify the issue: Collectors seek and maintain items that a majority of others would think of as having true value. Collectors generally organize their items and display them in an aesthetically pleasing manner, while hoarders, on the other hand, have all their stuff in boxes and the items are not organized. Hoarders, as opposed to collectors, find it difficult to determine when enough is enough.

As exemplified in DSM-5, Hoarding Disorder has features that are similar to Obsessive-Compulsive Disorder (OCD). However, there are also overlaps with ADHD (e.g. poor executive function, difficulty staying organized) and impulse control disorders as well. This profile complicates the treatment picture, e.g. hoarding is not as responsive to exposure and response prevention therapy (ERP) as is OCD. This does not mean, however, that hoarding is not treatable. With comprehensive, multimodal programs, many suffering from Hoarding Disorder can be expected to make at least mild to moderate improvements. Most treatment will need to address motivation as it is often very low for people who hoard at the outset of care and motivation can vary throughout the intervention. An intervention called Motivational Interviewing can be useful. Medication is often part of the treatment plan as well. Again, since many hoarders have cognitive and information processing deficits, as well as a proneness to minimize and justify their symptoms, treatment is complicated!

CBT treatment that targets the following areas is therefore essential: disputing erroneous thoughts about needing items or inability to tolerate discarding them, increasing organizational and decision-making skills, increasing discarding skills, increasing ability to de-clutter, and understanding what “makes sense” to keep. Effective treatment of hoarding requires sufficient intensity, duration in order to achieve desired results. Home visits are often essential to the intervention process.

People who hoard often have limited awareness of how much of a problem their hoarding behavior is causing. Forcing the person who hoard to change is not the best approach, nor is throwing all their hoarded items away. If your loved one is unwilling to attend treatment, then it would be most helpful for you to work with an experienced practitioner on how to build your loved one’s motivation. It would also be helpful to find a local support group for people who hoard or for people with OCD. Such groups can provide emotional support as well as the opportunity to learn what and what not has worked from other people who understand the challenges of Hoarding Disorder first-hand.

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