Overview
Hoarding disorder was once thought to be a symptom of OCD, and there are some similarities between the two, however, hoarding is now recognized as a separate condition. Hoarding disorder (HD) is the excessive acquisition of and inability to discard objects, resulting in debilitating clutter; identify various deficits in cognitive processes, as well as maladaptive beliefs and behavioral patterns, as relevant underlying mechanisms. Specific cognitive impairments noted in patients with HD include impaired attention, impaired verbal and nonverbal recall, and impaired categorization and decision-making ability. Maladaptive beliefs include perfectionism and fears of making wrong decisions, fears of wasting or losing important information, and emotional or anthropomorphic attachment to possessions. Hoarding disorder is characterized by marked avoidance of decision making about possessions. Patients with HD are frequently characterized by poor insight about the severity of their condition, leading to resistance of attempts by others to intervene.
Hoarding can begin in adolescence and not only continue but worsen as the person gets older. Unlike someone who is a collector of objects generally recognized as collectible with some known value, a person with hoarding disorder collects random items and is overly attached to personal possessions that may or may not have any value. Although they may be convinced to give up or throw away some of the items, doing so causes the person great distress. Ultimately, almost every surface in the home of a hoarder, including floors, furniture, counters and other fixtures, is covered in growing piles of clutter.
Causes
Impairments might suggest abnormalities in frontal cortical regions and the anterior cingulate cortex (ACC), which are involved with executive functions, such as decision making and categorization, and temporal regions that are associated with memory, categorization, and attachment of affective or motivational significance to stimuli.
Positron emission tomography research reveals that patients with obsessive-compulsive disorder (OCD) with hoarding symptoms have lower resting state glucose metabolism in the posterior cingulate and cuneus than do healthy control subjects (HCs) and lower glucose metabolism in the dorsal ACC than do patients with OCD without hoarding symptoms.
Functional magnetic resonance imaging (fMRI) reveals that patients with OCD (mostly patients with OCD without hoarding symptoms) asked to imagine discarding an item experience greater activity in the left precentral gyrus and right medial orbitofrontal cortex (OFC) than do HCs,and patients with OCD with hoarding symptoms experience greater activation in the ventromedial prefrontal cortex than do patients with OCD without hoarding symptoms and HCs using the same task.
During actual decision making about real possessions, patients with HD experience greater activity in the left lateral OFC and parahippocampal gyrus than do HCs.
If you parents were hoarders, you may also be prone to hoarding. The environment in which we grew up influences your adulthood. If you were never taught to organize and sort through material objects, you are likely to have clutter.
If the house you grew up in was chaotic and unhealthy, you may tend to hoard. This is because the act of hoarding can give you a sense of calm in a frantic environment.
A collection of items may offer you a sense of security that you will not be abandoned. It may also make you feel as if your pain eases with each item collected.
Reports suggest anxiety disorder can trigger the need to hoard. One study found that those who hoard have difficulty coping with negative emotions. Anxiety can operate in two ways when you hoard. One, the feeling of anxiety is sometimes eased when you find an item you want to keep. Two, if you are faced with discarding that item, you become extremely anxious and uncomfortable.
Symptoms
Getting and saving an excessive number of items, gradual buildup of clutter in living spaces and difficulty discarding things are usually the first signs and symptoms of hoarding disorder, which often surfaces during the teenage to early adult years.
As the person grows older, he or she typically starts acquiring things for which there is no immediate need or space. By middle age, symptoms are often severe and may be harder to treat.
Problems with hoarding gradually develop over time and tend to be a private behavior. Often, significant clutter has developed by the time it reaches the attention of others.
Signs and symptoms may include:
- Excessively acquiring items that are not needed or for which there’s no space
- Persistent difficulty throwing out or parting with your things, regardless of actual value
- Feeling a need to save these items, and being upset by the thought of discarding them
- Building up of clutter to the point where rooms become unusable
- Having a tendency toward indecisiveness, perfectionism, avoidance, procrastination, and problems with planning and organizing
Excessive acquiring and refusing to discard items results in:
- Disorganized piles or stacks of items, such as newspapers, clothes, paperwork, books or sentimental items
- Possessions that crowd and clutter your walking spaces and living areas and make the space unusable for the intended purpose, such as not being able to cook in the kitchen or use the bathroom to bathe
- Buildup of food or trash to unusually excessive, unsanitary levels
- Significant distress or problems functioning or keeping yourself and others safe in your home
- Conflict with others who try to reduce or remove clutter from your home
- Difficulty organizing items, sometimes losing important items in the clutter
People with hoarding disorder typically save items because:
- They believe these items are unique or will be needed at some point in the future
- The items have important emotional significance — serving as a reminder of happier times or representing beloved people or pets
- They feel safer when surrounded by the things they save
- They don’t want to waste anything
Complications and Assessment
The hoarding causes major distress or problems in social, work or other important areas of functions (including maintaining a safe environment for self and others).
Hoarding disorder can cause a variety of complications, including:
- Increased risk of falls
- Injury or being trapped by shifting or falling items
- Family conflicts
- Loneliness and social isolation
- Unsanitary conditions that pose a risk to health
- A fire hazard
- Poor work performance
- Legal issues, such as eviction
An assessment for hoarding may include questions such as:
- Do you have trouble discarding (or recycling, selling or giving away) things that most other people would get rid of?
- Because of the clutter or number of possessions, how difficult is it to use the rooms and surfaces in your home?
- To what extent do you buy items or acquire free things that you do not need or have enough space for?
- To what extent do your hoarding, saving, acquisition and clutter affect your daily functioning?
- How much do these symptoms interfere with school, work or your social or family life?
- How much distress do these symptoms cause you?
Treatment
Although hoarding may persist for a lifetime, treatment can help reduce the need to hold on to unnecessary items and improve decision-making, stress reducing, and organizational skills. Cognitive-behavioral therapy and antidepressant medication (selective serotonin reuptake inhibitors or SSRIs Paroxetine such as Paxil, Paxil CR, Pexeva, Brisdelle) are the primary treatments used to relieve symptoms of hoarding disorder. One or the other, or both, may be employed. Venlafaxine extended-release such as Effexor XR may be effective for treatment of Hoarding Disorder.
Co-morbidity
Many people with hoarding disorder also experience other mental health disorders, such as:
- Depression
- Anxiety disorders
- Obsessive-compulsive disorder (OCD)
- Attention-deficit/hyperactivity disorder (ADHD)
Hoarding is linked to indecisiveness, disorganization and procrastination, and many diseases such as anorexia, schizophrenia, Alzheimer’s disease and dementia. It is estimated to affect up to 2 million people in the U.S.
Don’t become subject to Hoarding Disorder.
