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Hoarding Disorder (Compulsive Hoarding): Symptoms, Causes & Treatment

Hoarding disorder, also called compulsive hoarding is a behavioural pattern characterised by the inability or unwillingness in parting with objects and possessions. An individual with hoarding disorder finds it extremely difficult to get rid of the things he or she has collected and experienced immense distress, even at the thought of giving or throwing away the objects. The object will not necessarily have any monetary value and can result in overrunning the place of hoarding [1]

Hoarding can affect the individual's health as collecting too many unwanted items create cramped living conditions - severely hampering a normal lifestyle. The mental condition is linked with economic burden, health risks, workplace impairment, impaired functioning, and adverse effects on friends and family members as well[2] . It can vary from mild to severe, where the mild situation will not have any major impact on your life, however, serious cases can adversely affect the individual and the ones around them.

Individuals suffering from hoarding disorder usually do not view it as a problem, making it difficult for others to help them. According to some studies, it has been estimated that 2% to 5% of adults exhibit hoarding behaviours [3] . Hoarding disorder can affect men and women equally, however, adults aged 55 and older are three times more likely to develop HD than younger adults. It was recently classified as a disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders [4] .

Symptoms Of Hoarding Disorder

The first and foremost sign of compulsive hoarding is collecting an excessive number of items, gradual buildup of clutter in living spaces and difficulty in discarding the mostly unwanted items. The signs of hoarding disorder usually develop during the teenage to early adult years. And with age, the need to collect things for which there are no requirement or space increases. As the individual reaches middle age, the symptoms will turn severe and difficult to treat [5] [6] .

  • Excessively acquiring items that are not needed or for which there's no space.
  • Feeling the need to save the collected items, and being upset by the thought of discarding them.
  • Persistent difficulty throwing out or parting with things, regardless of their value.
  • An increased tendency to be indecisive and perfect, along with avoidance, procrastination and a lack of planning and organising skills.
  • Having a conflict with loved ones because of excessive clutter
  • Being unable to find important items amid excessive clutter.
  • Being unable to let items go for fear that they'll be needed 'someday'.
  • Feeling distressed but helpless about the amount of stuff in their space.
  • Losing rooms to clutter, making them unable to function for their intended purposes.
  • Putting off home repairs because of clutter and refusing to let people into their home to fix stuff.

Causes Of Hoarding Disorder

The behavioural pattern can develop due to various reasons. A person who is exposed to the following factors can be prone towards developing hoarding disorder[7] .

  • Living alone
  • Growing up in a disorganised space
  • Having a difficult and deprived childhood

Likewise, the condition is linked with some mental health conditions such as [8] :

  • Schizophrenia
  • Attention deficit hyperactivity disorder (ADHD)
  • Depression
  • Obsessive-compulsive personality disorder
  • Dementia
  • Anxiety
  • Obsessive-compulsive disorder

Some health practitioners link hoarding disorder with a lack of executive functioning ability. Such as having difficulty paying attention, making decisions and categorising things.

Risk Factors Of Hoarding Disorder

The adverse factors associated with the condition are as follows[8] :

  • Family history: If one of the family members has hoarding disorder, the chances of developing the disorder is high.
  • Stressful life events: It can also develop as a result of experiencing a stressful life event that is difficult to cope with such as losing a loved one, eviction etc.
  • Personality: A large number of people with hoarding disorder have a temperament that includes indecisiveness.

Complications Of Hoarding Disorder

  • Legal issues, such as eviction[9]
  • Family conflicts
  • Injury or being trapped by shifting or falling items
  • Increased risk of falls
  • Fire hazard
  • Loneliness and social isolation
  • Unsanitary conditions that pose a risk to health
  • Poor work performance

Diagnosis Of Hoarding Disorder

A doctor will be able to examine and understand compulsive hoarding through interviews with the person as well as their loved ones. They may also visit the person's home to understand the severity and risk of the situation.

Treatments For Hoarding Disorder

Some of the ways through which medical practitioners help the individual overcome the behavioural pattern is by carrying out the following measures [10] .

  • Cognitive behavioural therapy (CBT)
  • Peer-led groups
  • Medications for symptoms

You can help the person get over this behavioural issue by lending helpful support. That is, you can stop helping the person with hoarding tendencies, encourage them to get professional help, support without criticising, and suggest about treatments that could help make a positive impact on their life.

View Article References
  1. [1] Mataix‐Cols, D., Frost, R. O., Pertusa, A., Clark, L. A., Saxena, S., Leckman, J. F., ... & Wilhelm, S. (2010). Hoarding disorder: a new diagnosis for DSM‐V?.Depression and anxiety,27(6), 556-572.
  2. [2] Frost, R. O., Steketee, G., & Tolin, D. F. (2011). Comorbidity in hoarding disorder.Depression and anxiety,28(10), 876-884.
  3. [3] Steketee, G., Frost, R. O., Tolin, D. F., Rasmussen, J., & Brown, T. A. (2010). Waitlist‐controlled trial of cognitive behavior therapy for hoarding disorder.Depression and anxiety,27(5), 476-484.
  4. [4] Levy, H. C., Worden, B. L., Gilliam, C. M., D’Urso, C., Steketee, G., Frost, R. O., & Tolin, D. F. (2017). Changes in saving cognitions mediate hoarding symptom change in cognitive-behavioral therapy for hoarding disorder.Journal of obsessive-compulsive and related disorders,14, 112-118.
  5. [5] Stewart, N. A., Brewin, C. R., & Gregory, J. D. (2019). The Role of Intrusive Imagery in Hoarding Disorder.Behavior Therapy.
  6. [6] Samson, G. (2015). Book Review: Treatment for Hoarding Disorder: therapist guide ; Treatment for Hoarding Disorder: workbook.Behavioural and Cognitive Psychotherapy,43(5), 635.
  7. [7] Mackin, R. S., Vigil, O., Insel, P., Kivowitz, A., Kupferman, E., Hough, C. M., ... & Mathews, C. A. (2016). Patterns of clinically significant cognitive impairment in hoarding disorder.Depression and anxiety,33(3), 211-218.
  8. [8] Rhead, J., & Clark, M. (2019). Wealth Acquisition and Hoarding Addictive Disorder: A Proposed Diagnostic Classification.The Journal of Science and Healing,15(1), 65-68.
  9. [9] Kress, V. E., Stargell, N. A., Zoldan, C. A., & Paylo, M. J. (2016). Hoarding disorder: Diagnosis, assessment, and treatment.Journal of Counseling & Development,94(1), 83-90.
  10. [10] Tolin, D. F., Frost, R. O., Steketee, G., & Muroff, J. (2015). Cognitive behavioral therapy for hoarding disorder: A meta‐analysis.Depression and anxiety,32(3), 158-166.
Story first published: Tuesday, May 7, 2019, 19:45 [IST]