Hoarding disorder is a condition where an individual finds it difficult to discard possessions regardless of their value. This may lead to clutters affecting their ability to use their work or living spaces.
What Is Hoarding Disorder?
Hoarding disorder, also known as compulsive hoarding, refers to a persistent difficulty in getting rid of things that are not useful. Hoarders engage in excessive accumulation of unnecessary items and believe they need to save their possessions irrespective of their value. They may feel intense stress and anxiety when they are asked or compelled to think about disposing of their possessions. Hoarding disorder can “make someone accumulate and acquire an unnecessary amount of items & then store them, mostly in their living spaces, in a haphazard and chaotic way leading to unmanageable clutter.” – Mind Journal
According to the American Psychiatric Association, around 2-6% of the population are affected by this disorder. Men are more likely to become compulsive hoarders than women. Moreover, it is observed thrice as many times in older adults (55 to 94 years of age) than in adults (34 to 44 years of age). People with this condition often tend to hoard things like:
- Advertisement magazines
- Old newspapers
- Piles of clothes
- Old kitchen items
- Things that are used for craft
- Broken things or trash
- Bills and receipts
A 2011 study 1 identifies this disorder as a “separate diagnostic entity”. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) 2 lists it as “both a mental disability and a possible symptom of OCD”.
Understanding Compulsive Hoarding
According to the American Journal of Psychotherapy 3, researchers recognized the onset of hoarding as a phenomenon since the 1980s. It is extremely stressful for an individual suffering from this disorder to throw away things that other people think are useless. Hoarding usually varies from mild to severe. Although mild hoarding may not significantly affect the quality of life of the sufferer, severe hoarding can have adverse effects leading to negative financial, emotional and social problems. Moreover, it may also affect their ability to function in daily life. According to the American Psychological Association (APA), compulsive hoarding is characterized by 3 major factors:
- Difficulty in letting go of material possessions
- Excessive or compulsive acquisition of new or unnecessary items
- Inability to prevent clutter leading to disorganization
Prolonged hoarding can lead to crowded and cramped living conditions. Most hoarders find their houses or workplaces filled to capacity consisting only of narrow winding pathways through the clutter. Items may be piled up on the floor, furnitures, storage units, garage or vehicles and even in the bed. The hoarder usually fails to realize this as a major problem which can prevent them from seeking or accepting treatment or help. However, through effective and persistent treatment hoarding disorder can be effectively treated so that the sufferer can live a safer, healthier and more fulfilling life.
According to the Anxiety and Depression Association of America (ADAA), “Hoarding can be related to compulsive buying (such as never passing up a bargain), the compulsive acquisition of free items (such as collecting flyers), or the compulsive search for perfect or unique items (such as an old container).”
Compulsive hoarding becomes a problem when the clutter:
- Interferes with day to day life. For example, when someone is unable to use a particular room due to an excessive amount of things scattered around the place.
- Negatively affects the quality of life of a person or family.
Hoarding vs Collecting
Hoarding and collecting is not the same thing. People with this condition tend to collect various types of items, unlike collectors who collect only one specific type of item, like coins or stamps. Hoarders like collecting various items such as piles of clothes, old magazines, food wrappers, and childhood trinkets.
Collectors are usually organized and proudly display their collections. Hoarders, on the other hand, often feel guilty and shame when others learn about their behaviour. The American Psychiatric Association explains that hoarders “often save random items and store them haphazardly. In most cases, they save items that they feel they may need in the future, are valuable or have sentimental value. Some may also feel safer surrounded by the things they save.”
Why Hoarders Save Items They Don’t Need?
An individual suffering from this disorder feels the need to save because:
- They believe that the items are unique and they may need them in the future.
- The items they save have emotional significance i.e. a reminder of good times and hence find it hard to part from it.
- It makes them feel safe when they are surrounded by the things they saved.
- They don’t want anything to go to waste.
According to the International OCD Foundation (IOCDF), the following factors make it difficult for hoarders to get rid of unnecessary items:
- Trouble organizing items
- Feeling positive emotions, like joy and happiness, when acquiring new items
- Intense negative emotions, like anger or fear, when thinking of discarding items
- Strongly believing that their possessions are useful and valuable, even when they are useless to others
- Feeling responsible for their possessions and may even believe items have feelings
- Denial of a mental health issue even when hoarding affects their daily functioning
What Are The Symptoms Of Hoarding Disorder?
Usually, the symptoms of this disorder begin in the early teenage years with an average age being 13 years old, according to the American Psychiatry Association. Some of the most common symptoms they may experience are:
- Storing a large number of items that people would consider useless
- Clutter making their rooms inaccessible to themselves as well as their family members
- The clutter can cause illness, distress, or impairment
- Inability to get rid of possessions
- Being indecisive
- Feeling anxious about needing the items in the future
- Distrusting of others touching their possessions
- Constantly procrastinating about putting everything in order
There are also some typical behaviors that hoarders may relate to, such as:
- They don’t allow visitors or maintenance professionals since the clutter embarrasses them.
- They are unable to return borrowed items.
- They keep the shades drawn so no one can look inside their house.
- There are frequent arguments occurring with family members due to the clutter.
- They are at risk for fire, falling, infestation, and eviction
- They often feel depressed or anxious for not being able to organize things.
What Are The Causes Of Hoarding Disorder?
The cause of this disorder is still unknown. However, there are several risk factors associated with this condition, including:
- A family member or relative suffering from this disorder.
- Brain injury
- Traumatic life event
- Mental health disorders like OCD or depression
- Inability to manage buying habits
- Inability to let go of free items like flyers or coupons.
- Personality issues that makes them indecisive
- Stressful or traumatic life events, like divorce, loss of loved on or eviction
Are There Any Complications?
There may be several complications that can arise due to consistent hoarding. Complications associated with this disorder are:
- Difficulty functioning day to day activities
- Lack of hygiene
- Poor diet
- Increasing chances of living in unsafe environments, fire hazards, or piles of items collapse
- Social isolation or loneliness
- Not allowing people to visit their home
- Financial issues
- Relationships with family members getting foul.
In addition to these complications, there are several other mental health conditions associated with this disorder:
- Attention deficit hyperactivity disorder (ADHD)
- Alcohol use disorder
- Anxiety disorder
This disorder is also associated with:
- Pica disorder
- Prader Willi syndrome (a genetical condition)
- Autism spectrum disorder
How To Diagnose Hoarding Disorder
According to the APA, approximately 2.5% of people meet the diagnostic criteria for compulsive hoarding. The DSM-5 has laid down the following diagnostic criteria for this disorder:
- Consistent difficulty discarding possessions regardless of its value.
- This difficulty is due to strong urges to save the items.
- The symptoms result in the accumulation of a large number of items that create clutter in living and work spaces.
- These can cause clinically significant distress or impairment in social, occupational, or other areas of functioning.
- The disorder doesn’t happen due to any general medical condition
- The symptoms are strictly related to mental disorders
Hoarders not only can be dangerous to themselves but also to others. According to a 2009 study 4, “excessive acquiring is not a diagnostic criterion of hoarding, at least two-thirds of individuals with hoarding disorder excessively acquire possessions”
In order to diagnose this disorder, the doctor will ask the patient several questions. These questions include:
- How hard is it to get rid of unwanted things?
- Is it hard to use rooms and other surfaces at home because of the clutter?
- Is it hard to organize the clutter?
- Does the clutter interfere with your day to day function?
- Does the clutter interfere with work, school, or relationships?
- Are you fearful of people touching, using, or destroying your belongings?
When Should You See A Doctor?
It can be hard to see your loved one suffering from this disorder but it’s important to seek professional help when it comes to the health and safety of you and your family. In case of health hazards, you may need to call local authorities like the police or fire department to get the situation under control.
Treatment For Hoarding Disorder
As of now, researchers are still looking for evidence-based treatment for this disorder. However, according to the International OCD Foundation, there are some treatments that are usually used to treat compulsive hoarding.
The treatment for this disorder has no medication that has been approved by the FDA. However, there are other medications that can help to change the brain chemistry of an individual. They can allow the patient to be more focused on the treatment process. These medications help in reducing severe anxiety or depression.
Antidepressants such as venlafaxine and paroxetine are found to have improved the symptoms in patients. Some clinical trials 5 have found monoamine reuptake inhibitors to be successful in some cases.
2. Counseling and therapy
Here are some therapy techniques that are recommended to people suffering with this disorder:
A. Cognitive Behavioral Therapy (CBT)
CBT allows patients to examine how they think and behave. It involves restructuring thoughts and beliefs about the items the individual is hoarding. This helps them to change the way they think or behave which is problematic. The specific CBT treatment in the case of hoarding disorder patients includes restriction from acquiring items, practicing organizing items, and discarding unwanted items.
Regular sessions of CBT may be necessary and this will also include home-based sessions that will involve working on the clutter. It is important to be committed to therapy in order to heal and achieve your goals.
B. Motivational Interviewing
This technique helps to increase the individual’s motivation to make positive changes in their behavior. It allows the individual to connect with their values and goals related to their behavior and come up with ways that are aligned with their goals.
C. Skills Training
Skills training allows people to learn:
- How to organize their belongings
- How to solve the problems arising from the clutter
- How to decide which items to keep and which items to discard.
With the right treatment, people suffering from this disorder can recover and can greatly reduce the major symptoms and risk of complications.
Is Hoarding Preventable?
Since the cause of this disorder is unknown, there is no way to prevent it. However, if you are suffering from any of the symptoms, seeking medical help can significantly reduce the symptoms and improve the quality of life.
Can You Recover From Hoarding Disorder?
Patients suffering from this disorder are frequently indecisive, procrastinators, and lack motivation. It is of utmost importance to have the self-determination to heal this disorder. Lack of motivation often becomes the cause of not being able to recover from this disorder. With a little motivation and professional help, recovery is possible.References:
- Frost, R. O., Steketee, G., & Tolin, D. F. (2011). Comorbidity in hoarding disorder. Depression and anxiety, 28(10), 876–884. https://doi.org/10.1002/da.20861
- Mataix-Cols D, Frost RO, Pertusa A, Clark LA, Saxena S, Leckman JF, Stein DJ, Matsunaga H, Wilhelm S. Hoarding disorder: a new diagnosis for DSM-V? Depress Anxiety. 2010 Jun;27(6):556-72. doi: 10.1002/da.20693. PMID: 20336805.
- Greenberg, D. (2018, April 30). Compulsive hoarding. American Journal of Psychotherapy. https://psychotherapy.psychiatryonline.org/doi/10.1176/appi.psychotherapy.1987.41.
- Frost, R. O., Tolin, D. F., Steketee, G., Fitch, K. E., & Selbo-Bruns, A. (2009). Excessive acquisition in hoarding. Journal of anxiety disorders, 23(5), 632–639. https://doi.org/10.1016/j.janxdis.2009.01.013
- Piacentino, D., Pasquini, M., Cappelletti, S., Chetoni, C., Sani, G., & Kotzalidis, G. D. (2019). Pharmacotherapy for Hoarding Disorder: How did the Picture Change since its Excision from OCD?. Current neuropharmacology, 17(8), 808–815. https://doi.org/10.2174/1570159X17666190124153048