Understanding Hoarding as a Mental Health Disorder

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“Hoarding is distinct from many other mental health disorders because intervention often requires the engagement of the community” ~ Kate Kysow

The definition of hoarding was coined in 1996 as, “a behavioral phenomenon of acquisition of objects and failure to discard objects“.

Until 2013, hoarding was primarily considered a sub-type of OCD. However, research in recent years has demonstrated that hoarding is a phenomenon distinct from OCD.[2]  This has led to the inclusion of Hoarding Disorder in both the DSM-5 and ICD-11.

It is estimated that approximately 2.6% of the population suffers from this mental health condition.[3] Research shows that the disorder occurs equally among men and women, with hoarding behaviors first emerging in adolescence or early adulthood. The condition increases in gravity with the passing of each decade and reaches peak severity in those over 60. For this reason, hoarding disorder is most commonly clinically diagnosed in those of middle age.[4]

Studies evidence that 50% of those diagnosed additionally suffer from co­morbid depression. Co-occurring disorders such as Attention-Deficit Hyperactivity Disorder, anxiety disorder, and chronic stress are also prevalent. The onset of hoarding disorder is also connected to past trauma and situations of intense pressure.[5]

Physical health is a significant concern in hoarding cases, with studies demonstrating that these individuals are more likely to suffer from physical health conditions, including obesity and diabetes.

What is Hoarding Disorder?

Three prominent characteristics classically mark hoarding disorder:

  1. Difficulty letting go of possessions.
  2. Excessive and compulsive acquisition of new items.
  3. Disorganized clutter.

Individuals who hoard tend to have strong beliefs related to acquiring and discarding items. They see value and beauty in everyday things where the general population would not.  The articles are often of little monetary value and invoke a strong emotional attachment.

Attempts to discard items can trigger painful and stressful responses, making it difficult for the person to discard items or get control of the situation.

Some individuals may hoard a wide range of items, while others may hoard specific types of objects. Common examples include:

  • Bills, receipts, and coupons
  • Newspapers and magazines
  • Books
  • Flyers, leaflets, and letters
  • Clothes
  • Tupperware, bottles, plastic bags, bottle tops, and cardboard boxes
  • Household supplies
  • Food products
  • Animals and pets

Complications and Risk Factors

The hoarded items can block walkways and entrances, posing a fire hazard and health and safety risks. The items can also pose a significant health threat and result in health code violations due to poor ventilation and an inability to clean, prepare food, or wash.Hoarders frequently live without heat or hot water or endure broken appliances rather than allow a repairperson into their home to fix a problem.

Hoarding disorder can cause a variety of wideranging complications, such as:

  • Risk of falls
  • Injury or becoming trapped by falling or shifting items
  • Family conflicts, separation, divorce, or loss of child custody
  • Social isolation and loneliness
  • Unsanitary, unhealthy living conditions
  • Fire hazard
  • Loss of employment
  • Legal issues, such as eviction


Hoarding additionally affects family members and loved ones, as the situation can cause resentment, conflict, anger, and depression and have a detrimental impact on the social development of children who may live at home.

The disorder is usually only diagnosed once someone intervenes, which usually provokes emotional distress.[6]

The person intervening could be a loved one or a neighbor who recognizes the problem, or it may be a medical professional, pest control or waste management worker, fire officer, or local government official who steps in.

Hoarding vs. Collecting

The difference between what constitutes a “hoard” and a “collection” is how these items are organized.

Collectors tend to take pride in the items they have acquired and take care to organize them and display them effectively. They plan their acquisitions with consideration for space, time, and budget and gain satisfaction from their decision-making.

In contrast, hoarders often experience embarrassment about their possessions and their impact on their living space.  They may feel ashamed by their compulsive acquisition and struggle with debt or financial difficulty.[7]

 Symptoms of Hoarding Disorder

Excessive acquisition and disorganization are the critical features of a hoarding disorder. However, additional may symptoms include:[8]

  • Persistent inability to discard or part with possessions, regardless of their value.
  • Severe anxiety and distress when attempting to discard items.
  • Extreme difficulty in organizing, categorizing, or storing items.
  • Embarrassment, shame, or feeling overwhelmed about their possessions or living space.
  • Suspicion and distrust of others entering their home or touching their possessions.
  • Obsessive and compulsive acquisition of unneeded items.
  • Functional impairments, such as social isolation, loss of living space, relationship discord, financial difficulties, health hazards, and diminished mental and physical health.

While some individuals with hoarding disorder acknowledge and recognize the negative impact their acquisition of possessions have on their lives, others will remain disillusioned until an intervention occurs.

 Possible Causes

The reasons for the onset of a hoarding disorder are not yet fully understood. Possible causes include genetics, traumatic life events, brain functioning, and pre-existing mental health disorders.

The key risk factors include:

  • Personality – Many people who have hoarding disorder have a temperament that includes indecisiveness, procrastination, doubt, low self-esteem, and low sense of self-worth.
  • Family history – If a family member has a hoarding disorder, the child is far more likely to suffer from the condition. Similarly, if they lived in a cluttered home as a child, experienced neglect or abuse, or lacked material possessions, the condition is more likely to develop.
  • Trauma – Stressful life events such as an accident, the death of a loved one, divorce, losing possessions in a fire, natural disaster, physical injury, or loss of home are all factors in developing a hoarding disorder.

 Conclusion

Hoarding disorder is a particularly challenging condition because the sufferer is unlikely to be diagnosed without an intervention. The individuals frequently do not, or will not, acknowledge their hoarding as a problem and have little awareness of its detrimental impact on themselves and others. Even if they accept that help is needed, the shame of seeking it out is often too great to bear.

Cognitive Behavioral Therapy is one of the most prominent forms of treatment and takes a twofold approach. CBT first uncovers the root cause of the disorder and the underlying reasons for the compulsive acquisition of items. Secondly, it will encourage the individual to build autonomy through practical steps and an action plan to de-clutter their home and lead a healthier and more fulfilling life.

We must encourage anyone we know who is hoarding to ask for therapeutic support. This condition will only escalate unless professional treatment is sought.

If you are concerned about any issues discussed in this blog, please contact Heather R. Hayes & Associates.  Call 800-335-0316 or email info@heatherhayes.com today.


Sources:

[2] “Treating People with Hoarding Disorder”. Https://Www.Apa.Org, 2021, https://www.apa.org/monitor/2020/04/ce-corner-hoarding.

[3] Postlethwaite, Adam et al. “Prevalence of Hoarding Disorder: A Systematic Review and Meta-Analysis”. Journal Of Affective Disorders, vol 256, 2019, pp. 309-316. Elsevier BV, doi:10.1016/j.jad.2019.06.004. Accessed 2 Nov 2021.

[4] Vilaverde, Daniela et al. “Hoarding Disorder: A Case Report”. Frontiers In Psychiatry, vol 8, 2017. Frontiers Media SA, doi:10.3389/fpsyt.2017.00112. Accessed 2 Nov 2021.

[5] Vilaverde, Daniela et al. “Hoarding Disorder: A Case Report”. Frontiers In Psychiatry, vol 8, 2017. Frontiers Media SA, doi:10.3389/fpsyt.2017.00112. Accessed 2 Nov 2021.

[6] Mataix-Cols, David et al. “Hoarding Disorder: A New Diagnosis for DSM-V?”. Depression and Anxiety, vol 27, no. 6, 2010, pp. 556-572. Wiley, doi:10.1002/da.20693. Accessed 2 Nov 2021.

[7] . “Hoarding: The Basics | Anxiety and Depression Association of America, ADAA”. Adaa.Org, 2021, https://adaa.org/understanding-anxiety/obsessive-compulsive-disorder-ocd/hoarding-basics.

[8] “What is Hoarding Disorder?”. Psychiatry.Org, 2021, https://www.psychiatry.org/patients-families/hoarding-disorder/what-is-hoarding-disorder.

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