Hoarding disorder, also known as compulsive hoarding, is one of five disorders classified as Obsessive Compulsive and Related Disorders in the DSM V (Diagnostics and Statistics Manual). It is a stand alone disorder that can also be found comorbid with OCD.
The disorder features the excessive acquisition of and inability or unwillingness to discard, large quantities of objects. The objects can end up covering the living areas of a home and cause significant distress or impairment.
Hoarding disorder has been associated with health risks, impaired functioning, economic burden and adverse effects on family members and friends. Impaired functioning can result in areas of the home unusable for as intended, affecting activities like cooking, cleaning, moving around and sleeping. The result can be dangerous for the individual or others, who can be put at risk of fire, falling, poor sanitation and other health concerns.
Hoarding Disorder was first defined as a mental disorder in the fifth edition of the DSM (Diagnostics and Statistics Manual) in 2013. Prevalence rates have been estimated at two to five per cent in adults. The condition typically manifests in childhood and gets worse through adulthood.
Hoarding behavior is often severe because of poor insight of the hoarding patients in that they do not recognize it as a problem. Without this insight, it is much harder for behavioral therapy to be the key to the successful treatment of compulsive hoarders. The results found that hoarders were significantly less likely to see a problem in a hoarding situation than a friend or a relative might. This is independent of OCD symptoms as patients with OCD are often very aware of their disorder.
The DSM V diagnostic criteria for hoarding disorder are:
- Persistent difficulty discarding or parting with possessions, regardless of the value others may attribute to these possessions. (The Work Group is considering alternative wording: “Persistent difficulty discarding or parting with possessions, regardless of their actual value.”)
- This difficulty is due to strong urges to save items and/or distress associated with discarding.
- The symptoms result in the accumulation of a large number of possessions that fill up and clutter active living areas of the home or workplace to the extent that their intended use is no longer possible. If all living areas become decluttered, it is only because of the interventions of third parties (e.g., family members, cleaners, authorities).
- The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others).
- The hoarding symptoms are not due to a general medical condition (e.g., brain injury, cerebrovascular disease).
- The hoarding symptoms are not restricted to the symptoms of another mental disorder (e.g., hoarding due to obsessions in Obsessive-Compulsive Disorder, decreased energy in Major Depressive Disorder, delusions in Schizophrenia or another Psychotic Disorder, cognitive deficits in Dementia, restricted interests in Autism Spectrum Disorder, food storing in Prader-Willi syndrome).
Cognitive Behavioral Therapy is often used to treat Hoarding Disorder.