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Compulsive Hoarding

Compulsive hoarding is a disorder characterized by difficulty discarding items that appear to most people to have little or no value. This leads to such an accumulation of clutter that living and work spaces cannot be used for their intended purposes. The clutter can result in serious threats to the health and safety of the person and those who live with or nearby the person hoarding. Often people with compulsive hoarding also acquire too many items -either free or purchased. In order to meet criteria for a diagnosis of compulsive hoarding, a person must experience significant distress and/or impairment in functioning as a result of his/her hoarding behavior. Common types of functional impairment include: fire or health hazards caused by excessive clutter, infestations, inability to have guests over to the home, inability to prepare or eat food in the home, inability to find important possessions because of clutter, inability to finish tasks on time, and interpersonal conflicts caused by the clutter.

Not all hoarding is compulsive. Hoarding and saving behaviors can be seen in people with various neuropsychiatric disorders, such as psychotic disorders, dementia, eating disorders, autism, and developmental disabilities, as well as in people with no psychiatric disorder.

However, it is most frequently associated with obsessive compulsive disorder (OCD). Between 25-40% of people with OCD have compulsive hoarding symptoms. It is not clear atthis point whether compulsive hoarding is part of OCD or whether it is a separate disorder that is common in people who have OCD.

Compulsive hoarding is typically driven by excessive concerns or fears of:

  • Discarding valuable items that might be needed or useful someday
  • Losing important information
  • Making a mistake
  • Being wasteful
  • Losing something that reminds a person of a loved one
  • Not being able to do things as completely or as well as one would like

What are some other symptoms of compulsive hoarding?

Compared to people with non-hoarding OCD, those with compulsive hoarding typically

show:

  • More functional impairment
  • More social and family disability
  • More severe anxiety and depression symptoms
  • Older age when presenting for treatment
  • Poor insight into the severity of the problem

The clutter that accumulates in the homes of people who hoard is often a serious fire risk.

These homes are also frequently vulnerable to infestation from rodents, insects, and molds, which can put the inhabitants of the home at risk for various health problems, including asthma, allergies, and infections. Family members are often frustrated by the gradual worsening of symptoms and the extent of the person’s impairment. They often want very much to help but feel powerless to do so. They may become angry at the person’s inability to clean or discard clutter, not understanding that this is not possible without treatment.

Are people with compulsive hoarding just lazy?

No. Compulsive hoarding is not due to laziness or weakness of character, nor is it due simply to disorganization. Rather, compulsive hoarding may be due to distinct brain abnormalities that will not improve without treatment.  People with this problem are often acutely aware that the degree of clutter in their home is socially unacceptable and often believe that others will think them lazy. Not surprisingly, they are frequently secretive about their problems and will often isolate themselves from family and loved ones. This may also be why they are reluctant to seek treatment.

How many people suffer from compulsive hoarding in the United States?

The true prevalence is unknown, but it is estimated that up to 1.2 million people have compulsive hoarding in the U.S.A.

What causes compulsive hoarding?

Compulsive hoarding may be hereditary. Up to 85% of people with compulsive hoarding can identify another family member who has this problem. Abnormal brain develop ment and brain lesions may also play a role. Compulsive hoarding can begin after brain damage, such as strokes, surgery, injuries, or infections. Family experiences and psychological factors may also play a role in the development of hoarding and emotional stress may heighten symptoms.

Research indicates that people with compulsive hoarding have unique abnormalities of brain function that are different from those seen in people with non-hoarding OCD and those with no psychiatric disorders. However, we do not yet fully know what causes these brain abnormalities. All people with significant hoarding behaviors should receive a thorough assessment which can evaluate possible causes of hoarding behavior, determine the correct diagnosis, and develop an appropriate treatment plan.

What is the course of compulsive hoarding?

Compulsive hoarding tends to be a chronic disorder. Left untreated, it usually worsens gradually over time.

What treatments are available for compulsive hoarding?

Cognitive-behavior therapy (CBT) using the technique of exposure and response prevention appears to improve compulsive hoarding symptoms. This technique decreases excessive fears of making decisions, losing important possessions, throwing things away, and organizing saved items out of sight, by gradual exposure to tasks that provoke these fears.

People with compulsive hoarding problems are encouraged to resist their urges to engage in their usual behaviors, such as postponing decision making, saving things “just in case”, or putting things in piles rather than sorting them. This ultimately results in a decrease of anxiety, avoidance, and compulsive behaviors, and changes the way people with compulsive hoarding think about their possessions. CBT for compulsive hoarding can be effectively done either in someone’s home or in a therapists office.

Also, a combination of medication and CBT appears to be the most effective treatment regimen for most people with compulsive hoarding, but not all.

For more information about compulsive hoarding, go to www.ocfoundation.org and click on the compulsive hoarding section.

DISCLAIMER: The information contained in this publication is not intended to provide medical advice. This information is intended only to keep you informed. It is strongly advised that you check any medications or treatments with a qualified mental health provider.

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