What is hoarding?
Compulsive hoarding is characterized by a persistent pattern of difficulty in parting with personal possessions, leading to excessive collecting and saving behavior. Despite the items not having any clear value, the individual maintains a strong desire to save them while simultaneously acquiring more unneeded items. A consequence of this behavior is a cluttered living space with extreme distress. Hoarding behaviors may signify a hoarding disorder, or may occur as a symptom of other psychiatric disorders, including obsessive compulsive disorder (OCD), depression, anxiety, schizophrenia, and dementia.
Who experiences hoarding?
According to a survey by the National Comorbidity Survey Replication, up to 14% of the US population experiences clinically significant hoarding. While the age of onset varies across all ages, symptoms typically appear in childhood or adolescence. Although hoarding behaviors are not always immediately problematic, they can interfere with daily living and cause significant impairment as people age and acquire more possessions. Hoarding can be a chronic problem, worsening overtime if left untreated.
How is hoarding related to OCD?
The relationship between OCD and hoarding is a controversial topic, and has within the past decade undergone more extensive research. Hoarding was previously believed to be a subtype of OCD, but more recent research suggests that it exists as its own separate disorder. Hoarding can co-occur with OCD, but it can also occur on its own.
Dr. Michael Wheaton, Assistant Professor of Psychology at Barnard College, shares, “It used to be that researchers considered hoarding to be a symptom or ‘subtype’ of OCD. However, accumulating research suggested that hoarding is in many ways distinct from OCD and may require separate treatment. In the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), which was published in 2013, hoarding was for the first time recognized as an independent diagnosis (‘hoarding disorder’). This disorder was however written into the category of OCD-Related Disorders, suggesting that there may still be some underlying similarities with OCD.”
How is hoarding treated?
Most data for treatment of hoarding is based on modified treatment approaches for OCD. The focus of treatment for hoarding is centered on behavioral strategies, including cognitive behavioral therapy (CBT), motivational interviewing, and harm reduction. Dr. Wheaton explains, “[CBT] involves examining patterns of thoughts and behaviors that make it difficult to discard possessions...This treatment is often done with an individual therapist, who may come to the individual's home to help supervise discarding practices.”
There is less data examining the efficacy of medications for hoarding. The most common classes of agents utilized are the selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs), which are also commonly prescribed for OCD treatment.
Data from the Baltimore Epidemiologic Catchment Area Follow-up survey suggest that 5% of the general population experiences clinically significant hoarding, while data from the National Comorbidity Survey Replication indicate that the lifetime prevalence of compulsive hoarding may be as high as 14%.
Grisham, J. R. (2010, June). Compulsive hoarding: Current controversies and new directions. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181962/
While the age of onset for hoarding symptoms is similar to that of OCD (ages 12-15), these symptoms do not initially cause impairment or distress, but typically become problematic later in life, usually around the 4th or 5th decades.
Mathews, C. A. (2014, August). Hoarding Disorder: More than just a problem of too much stuff. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4432907/
The treatment of HD has for the most part been based on and modified from current treatment strategies for OCD, and most of the focus has been on behavioral approaches.