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Hoarding disorder

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Compulsive hoarding in an apartment, circa early 1970s.

Compulsive hoarding (or pathological hoarding or disposophobia[1] or the Messie mindset) is a mental disorder marked by an obsessive need to acquire (and failure to use or discard) a significant amount of possessions, even if the items are worthless, hazardous, or unsanitary. Compulsive hoarding causes significant clutter and impairment to basic living activities, including mobility, cooking, cleaning, showering, and sleeping. A person who engages in compulsive hoarding is commonly said to be a "pack rat," in reference to that animal's apparent fondness for material objects.

It is not clear whether compulsive hoarding is an isolated disorder, or rather a symptom of another condition, such as obsessive-compulsive disorder.[2] Hoarding unnecessary possessions may be referred to as syllogomania.

Characteristics

There is no clear definition of compulsive hoarding in accepted diagnostic criteria (such as the current DSM), Yet, Frost and Hartl (1996) provide the following defining features:[3]

  • the acquisition of and failure to discard a large number of possessions that appear to be useless or of limited value
  • living spaces sufficiently cluttered so as to preclude activities for which those spaces were designed
  • significant distress or impairment in functioning caused by the hoarding
  • reluctance or inability to return borrowed items; as boundaries blur, impulsive acquisitiveness could sometimes lead to kleptomania or stealing

In its worst forms, compulsive hoarding can cause fires, unclean conditions (e.g. rat and roach infestations[4]), injuries from tripping on clutter and other health and safety hazards, according to Sanjaya Saxena, MD, director of the Obsessive-Compulsive Disorders Program at the University of California, San Diego.[5] The hoarder may mistakenly believe that the hoarded items are very valuable, or the hoarder may know that the accumulated items are useless, or may attach a strong personal value to items which they recognize would have little or no value to others. A hoarder of the first kind may show off a cutlery set claiming it to be made of silver and mother-of-pearl, disregarding the fact that the packaging clearly states the cutlery is made of steel and plastic. A hoarder of the second type may have a refrigerator filled with uneaten food items months past their expiration dates, but in some cases would vehemently resist any attempts from relatives to dispose of the unusable food. In other cases the hoarder will recognize the need to clean the refrigerator, but due (in part) to feelings that doing so would be an exercise in futility, and overwhelmed by the similar condition of the rest of their living space, fails to do so.

  • Living room of a person with compulsive hoarding.
    Living room of a person with compulsive hoarding.
  • Living room and fireplace of a person with compulsive hoarding.
    Living room and fireplace of a person with compulsive hoarding.
  • Apartment of a person with compulsive hoarding.
    Apartment of a person with compulsive hoarding.
  • Entrance of private home of a person with compulsive hoarding.
    Entrance of private home of a person with compulsive hoarding.

Levels of Hoarding

Although not commonly used by clinical psychologists, criteria for five levels of hoarding have been set forth by the National Study Group on Chronic Disorganization (NSGCD) entitled the NGSCD Clutter Hoarding Scale.[6] Using the perspective of a professional organizer, this scale distinguishes five levels of hoarding with Level I (Roman numeral one) being the least severe and Level V (Roman numeral 5) being the worst. Within each level there are four specific categories which define the severity of clutter and hoarding potential:

  • Structure and zoning;
  • Pets and rodents;
  • Household functions; and
  • Sanitation and cleanliness.

Level I Hoarder

Household is considered standard. No special knowledge in working with the Chronically Disorganized is necessary.

Level II Hoarder

Household requires professional organizers or related professionals to have additional knowledge and understanding of Chronic Disorganization.

Level III Hoarder

Household may require services in addition to those a professional organizer and related professional can provide. Professional organizers and related professionals working with Level III households should have significant training in Chronic Disorganization and have developed a helpful community network of resources, especially mental health providers.

Level IV Hoarder

Household needs the help of a professional organizer and a coordinated team of service providers. Psychological, medical issues or financial hardships are generally involved. Resources will be necessary to bring a household to a functional level. These services may include pest control services, "crime scene cleaners," financial counseling and licensed contractors and handy persons.

Level V Hoarder

Household will require intervention from a wide range of agencies. Professional organizers should not venture directly into working solo with this type of household. The Level V household may be under the care of a conservator or be an inherited estate of a mentally ill individual. Assistance is needed from many sources. A team needs to be assembled. Members of the team should be identified before beginning additional work. These members may include social services and psychological/mental health representative (not applicable if inherited estate), conservator/trustee, building and zoning, fire and safety, landlord, legal aid and/or legal representatives. A written strategy needs to be outlined and contractual agreements made before proceeding.

Case studies

The following (edited) case study is taken from a published account of compulsive hoarding:[7]

The client, #1 lived with her two children, aged 11 and 14 and described her current hoarding behaviour as a 'small problem that mushroomed' many years ago, along with corresponding marital difficulties. D reported that her father was a hoarder and that she started saving when she was a child ... The volume of cluttered possessions took up approximately 70 percent of the living space in her house. With the exception of the bathroom, none of the rooms in the house could easily be used for their intended purpose. Both of the doors to the outside were blocked, so entry to the house was through the garage and the kitchen, where the table and chairs were covered with papers, newspapers, bills, books, half-consumed bags of chips and her children's school papers dating back ten years.

The following case study is taken from a published account of compulsive hoarding:[5]

A 79-year-old woman recently died in a fire at her Washington, D.C., row house when 'pack rat conditions' held back firefighters from reaching her in time. A couple of days later, 47 firefighters from 4 cities spent 2 hours fighting a fire in a Southern California home before they were able to bring it under control. There was floor-to-ceiling clutter that had made it almost impossible for them to come in the house.

Obsessive–Compulsive Disorder

It is not clear whether compulsive hoarding is a condition in itself, or rather a symptom of other related conditions.[2] Several studies[specify] have reported a correlation between hoarding and the presence and / or severity of obsessive–compulsive disorder (OCD). Compulsive hoarding does not seem to involve the same neurological mechanisms as more familiar forms of obsessive–compulsive disorder and does not respond to the same drugs (which target serotonin).[8][9][2] Hoarding behavior is also related to obsessive–compulsive personality disorder (OCPD). There may be an overlap with a condition known as impulse control disorder (ICD), particularly when compulsive hoarding is linked to compulsive buying or acquisition behavior. However, some people displaying compulsive hoarding behaviour show no other signs of what is usually considered to be OCD, OCPD or ICD. Those diagnosed with attention-deficit hyperactivity disorder (ADHD) often have hoarding tendencies.[10]

Book hoarding

Bibliomania is an obsessive–compulsive disorder involving the collecting or hoarding of books to the point where social relations or health are damaged. One of several psychological disorders associated with books, bibliomania is characterized by the collecting of books which have no use to the collector nor any great intrinsic value to a more conventional book collector. The purchase of multiple copies of the same book and edition and the accumulation of books beyond possible capacity of use or enjoyment are frequent symptoms of bibliomania.

Digital hoarding

Digital hoarding involves collecting files on one's computer beyond the point of usefulness. Often, files can be acquired through the Internet at no monetary cost, leading to extraordinarily large collections. Examples are music collections, often beyond what one enjoys or can listen to and television shows, movies and computer games. Hoarders, or "digital pack rats",[11] often resort to buying optical media or new hard drives[12] to store their collections, rather than deleting what they may never use.

Digital hoarders find it just as difficult to press delete as traditional hoarders find throwing items in the trash can. They have the same feeling of clutter and chaos, and feel that they might find the item useful "someday," and similarly spend large amounts of time acquiring and organizing their collections.[13] However, unlike physical clutter, automated systems exist to organize digital clutter. Scientific American remarked that humanity's propensity[14] for data collection is growing at a rate faster than their ability to store it.[15]

Digital hoarding is not a currently recognized subtype of compulsive hoarding by the DSM.

Animal hoarding

Main article: Animal hoarding

Animal hoarding involves keeping larger than usual numbers of animals as pets without having the ability to properly house or care for them, while at the same time denying this inability. Compulsive animal hoarding can be characterized as a symptom of obsessive–compulsive disorder rather than deliberate cruelty towards animals. Hoarders are deeply attached to their pets and find it extremely difficult to let the pets go. They typically cannot comprehend that they are harming their pets by failing to provide them with proper care. Hoarders tend to believe that they provide the right amount of care for their pets. The American Society for the Prevention of Cruelty to Animals provides a "Hoarding Prevention Team," which works with hoarders to help them attain a manageable and healthy number of pets.[16] Along with other compulsive hoarding behaviours, it is linked in the DSM-IV to obsessive–compulsive disorder and obsessive–compulsive personality disorder.[17] Alternatively, animal hoarding could be related to addiction, dementia, or even focal delusion.[18]

Animal hoarders display symptoms of delusional disorder in that they have a "belief system out of touch with reality".[19] Virtually all hoarders lack insight into the extent of deterioration in their habitations and the health of their animals, refusing to acknowledge that anything is wrong.[20] Delusional disorder is an effective model in that it offers an explanation of hoarder’s apparent blindness to the realities of their situations. Another model that has been suggested to explain animal hoarding is attachment disorder, which is primarily caused by poor parent-child relationships during childhood.[21] As a result, those suffering from attachment disorder may turn to possessions, such as animals, to fill their need for a loving relationship. Interviews with animal hoarders have revealed that often hoarders experienced domestic trauma in childhood, providing evidence for this model.[21] Perhaps the strongest psychological model put forward to explain animal hoarding is obsessive–compulsive disorder (OCD).

Physiology and treatment

Brain imaging studies (PET)[22] have shown that the cerebral glucose metabolism patterns seen in OCD hoarders were distinct from the patterns in non-hoarding OCD. The most notable difference in these patterns was the decreased activity of the dorsal anterior cingulated gyrus, a part of the brain that is responsible for focus, attention and decision making.[9] A 2004 University of Iowa study found that damage to the frontal lobes of the brain can lead to poor judgment and emotional disturbances, while damage to the right medial prefrontal cortex of the brain tends to cause compulsive hoarding.[23]

Obsessive compulsive disorders are treated with various antidepressants: from the Tricyclic antidepressant family clomipramine (brand name Anafranil); and from the SSRI families paroxetine (Paxil), fluoxetine (Prozac), fluvoxamine (Luvox), sertraline (Zoloft) and citalopram (Celexa). With existing drug therapy OCD symptoms can be controlled, but not cured. Several of these compounds have been tested successfully in conjunction with OCD hoarding, but paroxetine in particular is indicated for treatment of compulsive hoarding.[24] A 2006 study of this usage of the drug to treat compulsive hoarding was conducted by the University of California, San Diego. Compulsive hoarding is also treated with psychotherapy which allows patients to deal with their emotions and behaviors. This method is vital to the successful treatment of hoarding[25]. Most symptoms of OCD, such as contamination fears, checking and morbid/ritualistic thinking, are effectively treated with "Exposure and Response Prevention" (ERP). ERP consists of two parts: Behavior Therapy (BT) and Cognitive Behavioral Therapy (CBT).

See also

References

  1. ^ Iyna Bort Caruso (2006). The Everything Home Storage Solutions Book. ISBN 1593376626. At the extreme end are folks who suffer from what some call disposophobia — fear of disposing. In other words, they hoard. According to one report, ... {{cite book}}: Cite has empty unknown parameter: |coauthors= (help); line feed character in |quote= at position 81 (help)
  2. ^ a b c Steketee, G,; Frost, R. (2003). Compulsive hoarding: Current status of the research. Clinical Psychology Review, 23 (7), 905-27.
  3. ^ Frost, R.O.; Hartl, T.L. (1996). A cognitive-behavioral model of compulsive hoarding. Behavior Research and Therapy, 34 (4), 341-50.
  4. ^ being taken invaded in large numbers[clarification needed]
  5. ^ a b Kaplan, A.; (2007). [1]. Hoarding: Studies Characterize Phenotype, Demonstrate Efficacy. Psychiatric Times.
  6. ^ http://www.nsgcd.org/resources/clutterhoardingscale/nsgcd_clutterhoardingscale.pdf
  7. ^ Hartl, T.L.; Frost, R.O. (1999). Cognitive-behavioral treatment of compulsive hoarding: a multiple baseline experimental case study. Behavior Research and Therapy, 37 (5), 451-61.
  8. ^ Mary Duenwald (October 2004). "The Psychology of . . . Hoarding: What lies beneath the pathological desire to stockpile tons of stuff?". Discover.
  9. ^ a b Saxena, S. (2004). "Cerebral Glucose Metabolism in Obsessive-Compulsive Hoarding". American Journal of Psychiatry. 161: 1038. doi:10.1176/appi.ajp.161.6.1038. PMID 15169692.
  10. ^ Hartl TL, Duffany SR, Allen GJ, Steketee G, Frost RO (2005). "Relationships among compulsive hoarding, trauma and attention-deficit/hyperactivity disorder". Behaviour research and therapy. 43 (2): 269–76. doi:10.1016/j.brat.2004.02.002. PMID 15629755.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  11. ^ http://pqasb.pqarchiver.com/chicagotribune/access/687143721.html?dids=687143721:687143721&FMT=ABS Chicago Tribune (September 1, 2004) — Information overload ; Digital pack rats get bogged down by clutter
  12. ^ Tedeschi, Bob (January 24, 2005). "E-Commerce Report; For digital pack rats who are finding their hard drives filling up fast, one way to free up space is to deposit files in an online storage bank". The New York Times. Retrieved April 30, 2010.
  13. ^ http://www.npr.org/templates/story/story.php?storyId=10238217
  14. ^ an inclination or tendency to do something
  15. ^ http://www.computerworld.com/action/article.do?command=viewArticleBasic&articleId=9000409
  16. ^ Hoarding of Animals Research Consortium (HARC) (2004). "Commonly asked questions about hoarding".
  17. ^ "Mental health issues and animal hoarding".
  18. ^ Berry, Colin, M.S., Gary Patronek, V.M.D., Ph.D. and Randall Lockwood, Ph.D. "Long-Term Outcomes in Animal Hoarding Cases" (PDF).{{cite web}}: CS1 maint: multiple names: authors list (link)
  19. ^ Patronek, Gary. "The Problem of Animal Hoarding." Animal Law May/June 2001: 6-9, 19.
  20. ^ Arluke, Arnie (2002-05). "Health Implications of Animal Hoarding". Health & Social Work. 27 (2): 125. {{cite journal}}: Check date values in: |year= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  21. ^ a b Frost, Randy (2000). "People Who Hoard Animals". Psychiatric Times. 17 (4).
  22. ^ stands for: positron emission tomography. This information is used to detect the effectiveness of long-term treatment.
  23. ^ Univ. of Iowa on brain's cortex and compulsive hoarding.
  24. ^ Paxil treats Compulsive Hoarding
  25. ^ . This is particularly vital to the success of compulsive hoarder patients because it's a method in helping them deal with their emotions and behaviors
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