The Rise of Compulsive Hoarding
Wednesday, January 13th, 2016 at 5:55 pm
For most, this hard-to-explain pattern of behavior is even harder to stop
Written by: Andy Heger | Updated: September 12, 2012
Originally published: https://www.uthealthleader.org/story/the-rise-of-compulsive-hoarding
It’s hard for most of us to imagine what goes through the mind of a compulsive hoarder. Sure, we see instances of this behavior through television programs like A&E’s “Hoarders,” which takes viewers weekly into people’s horrifically cluttered homes. Yet, even as television tries to encapsulate this phenomenon, it continues to baffle us.
Hoarding, which affects up to 5 percent of adults, is characterized by the inability to get rid of excess or unused items to the point that they take over living space. Even though it is becoming more prevalent, hoarding isn’t yet considered an official, distinct disorder. In fact, the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders), published by the American Psychiatric Association, lists hoarding as a symptom of OCD (obsessive compulsive disorder) and refers to it as “compulsive hoarding.” However, in recent years, researchers have found compulsive hoarders unresponsive to OCD treatments. As a result, compulsive hoarding could be redefined in the DSM-V (to be published May 2013) as a separate “hoarding disorder.”
Contrary to popular belief, most hoarders don’t even demonstrate OCD-related symptoms. Instead, hoarding appears to be more common in people with a wide range of psychiatric disorders, such as alcohol dependence, depression, anxiety and attention-deficit hyperactivity disorder (ADHD).
“Like a lot of behaviors, there is a spectrum [with compulsive hoarding],” says Oscar Bukstein, MD. “It is really scattered due to its co-morbidity with other disorders and cognitive impairment such as dementia.”
Causes, symptoms and complications
There are different motivations for compulsive hoarding. For instance, researchers have linked development of this behavior to family history as well as traumatic events, such as death of a loved one or divorce. In addition, compulsive hoarders are more likely to form sentimental attachments to items or receive comfort from hoarding items due to loneliness.
Compulsive hoarding takes many different forms, from stacking newspapers and trash to keeping dozens of pets. However, it’s not always easily detectable, says Bukstein.
“In mild cases, one might consider compulsive hoarding as a kind of sloppiness resulting from an inability to keep up with cleaning,” he says. “In the case of animals, people form connections and feel good about helping them out. Eventually, though, it becomes a health issue.”
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September 12, 2012
Erica Bruce, LCSW, a senior clinical social worker in the Department of Psychiatry & Behavioral Services at UTHealth Medical School, says the key to recognizing compulsive hoarding is determining whether or not the behavior is impeding the person’s daily functioning. “People can be quirky and eclectic, but is [their behavior] restricting them to the point that they can’t use their kitchen or walk through their house? Are they spending all of their money buying things and are unable to pay their bills?”
Common signs and symptoms of compulsive hoarding may include:
- Cluttered living environment with obstructed walkways
- Keeping stacks of newspapers, magazines or other papers
- Moving items from one pile to another, without discarding anything
- Acquiring useless items, such as trash, gum wrappers or restaurant napkins
- Difficulty managing daily activities and making decisions
- Excessive attachment to possessions, including uneasiness with letting others touch or borrow them
- Limited or no social interaction with family, friends or the outside world
Compulsive hoarding may cause a variety of serious health, environmental and social problems. One complication that may arise from compulsive hoarding is the effect it has on the hoarder’s family, especially children. “Others don’t like the hoarding behavior. When you get into a family system there are space demands,” says Bukstein. “Kids learn to live with it, but they usually become too embarrassed to invite friends over.”
Other complications from compulsive hoarding include:
- Unsanitary conditions that pose a health risk
- Increased risk of falls and other physical hazards
- An inability to perform daily tasks, such as bathing or cooking
- Poor work performance
- Social isolation due to embarrassment
- Fire hazards
Is treatment successful?
Treating a compulsive hoarder is challenging and often meets with mixed results. Sometimes, the difficulty lies in the fact that many hoarders don’t recognize the negative impact compulsive hoarding has on their lives, especially if their items or pets offer comfort. Also, when hoarders are asked to make a decision about whether to keep or discard possessions, they may become agitated. Their attention may wander, they may have difficulty organizing or the process starts to feel punishing rather than rewarding. It becomes such an overwhelming and unpleasant experience that they may avoid help altogether.
“Most people realize they have a problem, but some heavily defend their actions. Sometimes it takes family members, protective services or some other agency’s involvement to prompt the intervention,” says Bruce. “It may even require confronting the person who hoards, since their behavior is similar to someone with an addiction issue who remains in denial.”
Bukstein says some people use motivational interviewing to push the hoarder along and make him or her better understand their behavior in order to motivate them to take medications or receive therapy. He adds that older people or people who are cognitively impaired may not be able to handle their messy living space, so a professional service may be required to clean and organize (or provide assistance if animals are involved).
To begin treatment, both Bukstein and Bruce suggest a general mental health evaluation, preferably with a psychiatrist, psychotherapist or other mental health provider who has experience in treating compulsive hoarding.
“People affected need a general mental health evaluation because of other problems associated with hoarding,” says Bukstein. “It’s not good enough to get rid of stuff because if you haven’t taken care of these co-existing and contributing problems, it will come back.”
Cognitive behavior therapy is the most common form of psychotherapy used to treat hoarding. As part of cognitive behavior therapy, hoarders attend family or group therapy, learn why they are compelled to hoard and how to improve their decision-making skills, and declutter their living space during in-home visits by a therapist or professional organizer.
“Mental health experts realize there are biological, psychological and social pieces to all disorders that need to be identified and worked on,” says Bruce. “The biology piece pushes behavior from an anxiety perspective or cognitive disorder, and a psychiatrist could possibly prescribe medications to help with that. At the same time, psychotherapy is important for helping the person realize the psychological and social impact of their behavior.”
No matter what type of treatment is used, moral support from loved ones is crucial to its success. “Friends and family members should let the hoarder know, in a supportive way, that they have noticed a problem and are concerned,” says Bruce. “They should ask questions and be careful not to state them in a judgmental fashion. Let them know ‘I am here for you, and I want to help you get better.’”
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