Compulsive hoarding

Compulsive hoarding in an apartment, early 1970s

Compulsive hoarding (or pathological hoarding or disposophobia)^[1] is the acquisition of possessions (and failure to use or discard them) in excess of socially normative amounts, even if the items are worthless, hazardous, or unsanitary. Compulsive hoarding may impair mobility and interfere with basic activities, including cooking, cleaning, hygiene, sanitation, bathroom use and sleeping.

It is not clear whether compulsive hoarding is an isolated disorder, or rather a symptom of another condition, such as obsessive-compulsive disorder.^[2]

Characteristics

Living room in Germany

While there is no clear definition of compulsive hoarding in accepted diagnostic criteria (such as the current DSM), Frost and Hartl (1996) provide the following defining features:^[3]

• The acquisition of, and failure to discard, a large number of possessions that appear to be useless or of limited value
• Living spaces sufficiently cluttered so as to preclude activities for which those spaces were designed
• Significant distress or impairment in functioning caused by the hoarding
• Reluctance or inability to return borrowed items; as boundaries blur, impulsive acquisitiveness could sometimes lead to stealing or kleptomania

According to Sanjaya Saxena, MD, director of the Obsessive-Compulsive Disorders Program at the University of California, San Diego, compulsive hoarding in its worst forms can cause fires, unclean conditions (e.g. rat and roach infestations),^[4] injuries from tripping on clutter, and other health and safety hazards.^[5]

The hoarder may believe that the hoarded items are very valuable, or know that the accumulated items are useless but keep them anyway, or attach a strong personal value to items which other people claim would have little or no value. A hoarder of the first kind may show off a cutlery set claiming it to be made of silver and mother-of-pearl, disregarding the fact that the packaging clearly states the cutlery is made of steel and plastic.

A hoarder of the second type may have a refrigerator filled with uneaten food items months past their expiration dates, but in some cases vehemently resists any attempts by relatives to dispose of the unusable food. In other cases, the hoarder will recognize the need to clean the refrigerator but due (in part) to feelings that doing so would be an exercise in futility, and overwhelmed by the similar condition of the rest of their living space, fails to do so.

Hoarders of the third type often keep "collections" as a hobby. Dolls, toy soldiers, obsolete road maps, clothes, rusty tools, non-functional sewing machines.

Case studies

The following (edited) case study is taken from a published account of compulsive hoarding:^[6]

The client, D, lived with her two children, aged 11 and 14, and described her current hoarding behavior as a 'small problem that mushroomed' many years ago, along with corresponding marital difficulties. D reported that her father was a hoarder, and that she started saving when she was a child ... The volume of cluttered possessions took up approximately 70 percent of the living space in her house. With the exception of the bathroom, none of the rooms in the house could easily be used for their intended purpose. Both of the doors to the outside were blocked, so entry to the house was through the garage and the kitchen, where the table and chairs were covered with papers, newspapers, bills, books, half-consumed bags of chips, and her children's school papers dating back ten years.

The following case study is taken from a published account of compulsive hoarding:^[5]

A 79-year-old woman recently died in a fire at her Washington, D.C., row house when 'pack rat conditions' held back firefighters from reaching her in time. A couple of days later, 47 firefighters from four cities spent two hours fighting a fire in a Southern California home before they were able to bring it under control. There was floor-to-ceiling clutter that had made it almost impossible for them to come in the house.

Subtypes and related conditions

Living room in 2001

Obsessive–compulsive disorder

It is not clear whether compulsive hoarding is a condition in itself, or rather, a symptom of other related conditions.^[2] Several studies^[specify] have reported a correlation between hoarding and the presence and/or severity of obsessive–compulsive disorder (OCD). Compulsive hoarding does not seem to involve the same neurological mechanisms as more familiar forms of obsessive–compulsive disorder and does not respond to the same drugs, which target serotonin.^[2][7][8]

Hoarding behavior is also related to obsessive–compulsive personality disorder (OCPD). There may be an overlap with a condition known as impulse control disorder (ICD), particularly when compulsive hoarding is linked to compulsive buying or acquisition behavior. However, some people displaying compulsive hoarding behavior show no other signs of what is usually considered to be OCD, OCPD, or ICD. Those diagnosed with attention-deficit hyperactivity disorder (ADHD) often have hoarding tendencies.^[9]

Book hoarding

Bibliomania is a disorder involving the collecting or hoarding of books to the point where social relations or health are damaged. One of several^[which?] psychological disorders associated with books, bibliomania is characterized by the collecting of books which have no use to the collector nor any great intrinsic value to a more conventional book collector. The purchase of multiple copies of the same book and edition and the accumulation of books beyond possible capacity of use or enjoyment are frequent symptoms of bibliomania.

Animal hoarding

Main article: Animal hoarding

Animal hoarding involves keeping larger than usual numbers of animals as pets without having the ability to properly house or care for them, while at the same time denying this inability. Compulsive animal hoarding can be characterized as a symptom of a disorder rather than deliberate cruelty towards animals. Hoarders are deeply attached to their pets and find it extremely difficult to let them go. They typically cannot comprehend that they are harming their pets by failing to provide them with proper care. Hoarders tend to believe that they provide the right amount of care for their pets. The American Society for the Prevention of Cruelty to Animals provides a "Hoarding Prevention Team," which works with hoarders to help them attain a manageable and healthy number of pets.^[10] Along with other compulsive hoarding behaviors, it is linked in the DSM-IV to obsessive–compulsive disorder and obsessive–compulsive personality disorder.^[11] Alternatively, animal hoarding could be related to addiction, dementia, or even focal delusion.^[12]

Animal hoarders display symptoms of delusional disorder in that they have a "belief system out of touch with reality".^[13] Virtually all hoarders lack insight into the extent of deterioration in their habitation and the health of their animals, refusing to acknowledge that anything is wrong.^[14] Delusional disorder is an effective model in that it offers an explanation of hoarders' apparent blindness to the realities of their situations. Another model that has been suggested to explain animal hoarding is attachment disorder, which is primarily caused by poor parent-child relationships during childhood.^[15]

As a result, those suffering from attachment disorder may turn to possessions, such as animals, to fill their need for a loving relationship. Interviews with animal hoarders have revealed that often, hoarders experienced domestic trauma in childhood, providing evidence for this model.^[15] Perhaps the strongest psychological model put forward to explain animal hoarding is obsessive–compulsive disorder (OCD).

Neurophysiology

Brain imaging studies using positron emission tomography (PET) scans that detect the effectiveness of long-term treatment have shown that the cerebral glucose metabolism patterns seen in OCD hoarders were distinct from the patterns in non-hoarding OCD. The most notable difference in these patterns was the decreased activity of the dorsal anterior cingulated gyrus, a part of the brain that is responsible for focus, attention and decision making.^[8] A 2004 University of Iowa study found that damage to the frontal lobes of the brain can lead to poor judgment and emotional disturbances, while damage to the right medial prefrontal cortex of the brain tends to cause compulsive hoarding.^[16]

Treatment

Psychopharmacological Interventions

Obsessive-compulsive disorders are treated with various antidepressants: from the Tricyclic antidepressant family clomipramine (brand name Anafranil); and from the SSRI families paroxetine (Paxil), fluoxetine (Prozac), fluvoxamine (Luvox), sertraline (Zoloft) and citalopram (Celexa). With existing drug therapy, OCD symptoms can be controlled but not cured. Several of these compounds (including paroxetine, which has an FDA indication^[17]) have been tested successfully in conjunction with OCD hoarding.

Therapeutic Interventions

Compulsive hoarding is also treated with psychotherapy that allows patients to deal with their emotions and behaviors. Most symptoms of OCD, such as contamination fears, checking, and morbid/ritualistic thinking are effectively treated with "Exposure and Response Prevention" (ERP). ERP consists of two parts: Behavior therapy and cognitive behavioral therapy^{[citation needed]}.

In media and popular culture

Books

• Plyushkin is a fictional Russian hoarder in Nikolai Gogol's novel Dead Souls.
• Unknown Subject 522 (hoarder) in The Broken Window by Jeffery Deaver.
• Homer & Langley by E.L. Doctorow.

Film

• Seven Dumpsters and a Corpse is a 2007 film by Thomas Haemmerli.

Television

Hoarding has frequently featured in reality television programming. Notable examples include Clean House on the Style Network, Hoarders on A&E, Life Laundry on the BBC, and Hoarding: Buried Alive on TLC, which had also previously aired one-time programs on the subject (Help! I'm a Hoarder and Truth be Told: I'm a Hoarder).

Hoarding has also occurred as a theme for characters in fictional television shows. These have included Oscar the Grouch from children's show Sesame Street, whose outrageous hoarding behavior is a common theme; Ambrose Monk from comedy-drama Monk, and Eli Goldsworthy from teen drama Degrassi: The Next Generation. Hoarding has additionally served as the story basis for episodes of CSI: Crime Scene Investigation, South Park, Necessary Roughness, The Simpsons, 2 Broke Girls and House.

See also

• Bibliomania
• Collecting
• Diogenes syndrome
• Hoarding
• Impulse control disorder
• Collyer brothers, notable hoarders
• Edmund Trebus, notable hoarder
• Alexander Kennedy Miller, hoarded about 30 Stutz automobiles
• Simple living

References

1. ^ Iyna Bort Caruso (2006). The Everything Home Storage Solutions Book. ISBN 1593376626. "At the extreme end are folks who suffer from what some call disposophobia—fear of disposing. In other words, they hoard. According to one report, ..." 
2. ^ ^{a b c} Steketee G, Frost R (December 2003). "Compulsive hoarding: current status of the research". Clin Psychol Rev 23 (7): 905–27. doi:10.1016/j.cpr.2003.08.002. PMID 14624821. http://linkinghub.elsevier.com/retrieve/pii/S0272735803000916. 
3. ^ Frost RO, Hartl TL (April 1996). "A cognitive-behavioral model of compulsive hoarding". Behav Res Ther 34 (4): 341–50. doi:10.1016/0005-7967(95)00071-2. PMID 8871366. http://linkinghub.elsevier.com/retrieve/pii/0005-7967(95)00071-2. 
4. ^ being taken invaded in large numbers^{[clarification needed]}
5. ^ ^{a b} Kaplan, A. (2007). "Hoarding: Studies Characterize Phenotype, Demonstrate Efficacy". Psychiatric Times. http://www.psychiatrictimes.com/print/article/10168/55256?pageNumber=1. 
6. ^ Hartl TL, Frost RO (May 1999). "Cognitive-behavioral treatment of compulsive hoarding: a multiple baseline experimental case study". Behav Res Ther 37 (5): 451–61. doi:10.1016/S0005-7967(98)00130-2. PMID 10228316. http://linkinghub.elsevier.com/retrieve/pii/S0005-7967(98)00130-2. 
7. ^ Mary Duenwald (October 2004). "The Psychology of . . . Hoarding: What lies beneath the pathological desire to stockpile tons of stuff?". Discover. http://discovermagazine.com/2004/oct/psychology-of-hoarding. 
8. ^ ^{a b} Saxena, S.; Brody, AL; Maidment, KM; Smith, EC; Zohrabi, N; Katz, E; Baker, SK; Baxter Jr, LR (2004). "Cerebral Glucose Metabolism in Obsessive-Compulsive Hoarding". American Journal of Psychiatry 161 (6): 1038. doi:10.1176/appi.ajp.161.6.1038. PMID 15169692. http://ajp.psychiatryonline.org/cgi/content/full/161/6/1038. 
9. ^ Hartl TL, Duffany SR, Allen GJ, Steketee G, Frost RO (2005). "Relationships among compulsive hoarding, trauma and attention-deficit/hyperactivity disorder". Behaviour research and therapy 43 (2): 269–76. doi:10.1016/j.brat.2004.02.002. PMID 15629755. 
10. ^ Hoarding of Animals Research Consortium (HARC) (2004). "Commonly asked questions about hoarding". http://www.tufts.edu/vet/cfa/hoarding/abthoard.htm. 
11. ^ "Mental health issues and animal hoarding". http://www.tufts.edu/vet/cfa/hoarding/mental.htm. 
12. ^ Berry, Colin, M.S., Gary Patronek, V.M.D., Ph.D. and Randall Lockwood, Ph.D.. "Long-Term Outcomes in Animal Hoarding Cases" (PDF). http://www.tufts.edu/vet/cfa/hoarding/pubs/berry.pdf. 
13. ^ Patronek, Gary (May/June 2001). "The Problem of Animal Hoarding". Animal Law 19: 6–9. 
14. ^ Arluke, Arnie; et al. (2002-05). "Health Implications of Animal Hoarding". Health & Social Work 27 (2): 125. 
15. ^ ^{a b} Frost, Randy (2000). "People Who Hoard Animals". Psychiatric Times 17 (4). 
16. ^ Univ. of Iowa on brain's cortex and compulsive hoarding.
17. ^ Paxil treats Compulsive Hoarding

External links

• A guide to understanding the traits and compulsions of compulsive hoarding including what to do if your family member is a compulsive hoarder
• 7 Signs that Lead to Hoarding, Charles & Hudson
• MSNBC article discussing the disorder and its relationship to OCD
• How Compulsive Hoarding Can Threaten Your Health and Take Over Your Life, an interview with a professional organizer on compulsive hoarding
• International OCD Foundation – About Hoarding
• Animal Hoarding: Alone in a Crowded Room
• On "If I Were A Hoarder" , the daughter of a compulsive hoarder writes about hoarding.
• Television show "Hoarders" on A&E network
• Jessie Sholl, author of the first memoir by the child of a hoarder