Why compulsive hoarding

The therapist will support and encourage this. Antidepressant medicines called selective serotonin reuptake inhibitors SSRIs have also been shown to help some people with hoarding disorders. CBT is a type of therapy that aims to help you manage your problems by changing how you think cognitive and act behaviour. It encourages you to talk about how you think about yourself, the world and other people, and how what you do affects your thoughts and feelings.

Regular sessions of CBT over a long period of time are usually necessary and will almost always need to include some home-based sessions, working directly on the clutter.

This requires motivation, commitment and patience, as it can take many months to achieve the treatment goal. The goal is to improve the person's decision-making and organisational skills, help them overcome urges to save and, ultimately, clear the clutter, room by room.

The therapist won't throw anything away but will help guide and encourage the person to do so. The therapist can also help the person develop decision-making strategies, while identifying and challenging underlying beliefs that contribute to the hoarding problem. The person gradually becomes better at throwing things away, learning that nothing terrible happens when they do and becomes better at organising items they insist on keeping.

At the end of treatment, the person may not have cleared all their clutter, but they will have gained a better understanding of their problem. They will have a plan to help them continue to build on their successes and avoid slipping back into their old ways. Page last reviewed: 12 June Next review due: 12 June Home Mental health Mental health conditions Back to Mental health conditions.

Hoarding disorder. Hoarding is considered a significant problem if: the amount of clutter interferes with everyday living — for example, the person is unable to use their kitchen or bathroom and cannot access rooms the clutter is causing significant distress or negatively affecting the quality of life of the person or their family — for example, they become upset if someone tries to clear the clutter and their relationship suffers Hoarding disorders are challenging to treat because many people who hoard frequently do not see it as a problem, or have little awareness of how it's affecting their life or the lives of others.

If not tackled, it's a problem that will probably never go away. Why someone may hoard The reasons why someone begins hoarding are not fully understood. Mental health problems associated with hoarding include: severe depression psychotic disorders, such as schizophrenia obsessive compulsive disorder OCD In some cases, hoarding is a condition in itself and often associated with self-neglect.

Second, we describe advances in our understanding of the epidemiology, course, and demographic features of compulsive hoarding. Third, we review the latest findings regarding possible neuropsychological correlates of the disorder. Finally, we discuss ongoing progress and future directions related to the clinical management of compulsive hoarding. Compulsive hoarding is a syndrome characterized by excessive collecting and saving behavior that results in a cluttered living space and significant distress or impairment.

This surge in interest has been coupled with contention regarding key aspects of the disorder. These controversies have led to exciting new research that has deepened our understanding of this complex syndrome. The aim of this article is to describe some of these debated issues, as well as to highlight recent advances in compulsive hoarding research.

An obvious example of a current debate within hoarding research is the question of where hoarding belongs within our diagnostic nosology.

The uncertainty regarding the most appropriate classification of compulsive hoarding syndrome has had important consequences for our understanding of hoarding, and in some ways has constituted an obstacle to hoarding research. The lack of clear placement within DSM has led to an underestimation of the significance of the burden of disease associated with compulsive hoarding, inconsistencies with respect to an appropriate clinical comparison group in hoarding research, difficulties comparing findings across hoarding studies, and misconceptions regarding which assessment and treatment models are most relevant to hoarding.

Accumulating evidence, however, suggests that it is misleading and invalid to classify hoarding as part of OCPD.

When studies examining the prevalence of OCPD in hoarding samples exclude the criterion describing difficulty discarding, most studies suggest that hoarding is no more associated with OCPD than it is with other Axis II disorders. Nevertheless, there is some evidence to suggest a link between hoarding and OCPD. A recent study of hoarding within a collaborative OCPD genetics study found that hoarders had a greater prevalence of certain OCPD traits, particularly miserliness and preoccupation with details.

For example, the Y-BOCS checklist 11 lists hoarding obsessions and compulsions, and many investigations into hoarding have involved comparing OCD individuals with and without hoarding.

This view of hoarding as part of OCD derived from early findings that approximately one third of individuals with OCD have hoarding symptoms. For example, Wu and Watson 4 found that hoarding correlated more weakly with other symptoms of OCD than these other symptoms correlated with each other. Moreover, Saxena et al 6 found that patients who hoard, compared with other OCD patients, had different functional neuroimaging findings, response to treatment, and clinical profiles. In a large study of hoarding among OCD patients, 7 individuals with hoarding were more likely to have symmetry obsessions and counting, ordering, and repeating compulsions.

They also were more likely to have greater illness severity, more difficulty initiating and completing tasks, and problems with indecision. A recent study by Abramowitz and colleagues 15 provided further evidence that although some individuals with OCD may show hoarding behavior, hoarding is most likely distinct from OCD.

Abramowitz and colleagues compared OCD patients, patients with other anxiety disorders, and unscreened undergraduate students.

OCD patients scored higher on all OCD symptoms except hoarding, in which the student group scored slightly, but significantly higher than both clinical groups. Similarly to Wu and Watson, 4 Abramowitz and colleagues found that the magnitude of the correlations between hoarding and other OCD symptoms was significantly weaker than the magnitude of the correlations amongst all other OCD symptoms.

In addition, the hoarding items loaded weakly on a unitary OCI-R factor. In a second study, Abramowitz et al 15 found that hoarding was correlated weakly with depression, but not with anxiety. Other OCD symptoms showed at least a moderate association with anxiety.

Due to these recent findings, there is a growing consensus that hoarding should not be considered as a symptom of OCPD or OCD, but as a separate clinical syndrome. Several researchers have also examined whether there are important differences between hoarding behavior seen in the context of OCD and hoarding that occurs without any other OCD symptoms.

Individuals in the OCD plus hoarding group differed from the monosymptomatic hoarding group in several important ways. For example, OCD plus hoarding participants were more likely to hoard bizarre items and more likely to report other obsessions and compulsions related to their hoarding than those in the monosymptomatic hoarding group.

In addition, the OCD plus hoarding group endorsed more cluster C personality traits than the monsymptomatic hoarding group. Given that hoarding can occur in the absence of OCD and that it shares some similarity to impulse control disorders ICDs such as pathological gambling, pyromania, and kleptomania, it may have a place within behavioral addiction.

Although hoarding behavior is sometimes motivated by a desire to reduce anxiety, it also sometimes appears to be driven by anticipation of pleasure and impaired self-regulation.

Samuels et al 14 reported a greater frequency of trichotillomania and skin picking among hoarding compared with nonhoarding individuals with OCD. In addition, Frost et al 17 found that pathological gamblers reported significantly more hoarding symptoms than light gamblers. Although Grant et al 18 found a low prevalence of ICDs overall among individuals with obsessive-compulsive disorder, obsessive-compulsive disorder participants with a lifetime and current impulse control disorder were more likely to report hoarding symptoms.

In a recent study, Hayward and Coles 19 examined the relation of hoarding to OCD and ICDs in an undergraduate sample, and found that hoarding behaviors were related moderately to symptoms of compulsive buying, and more weakly related to pathological gambling, trichotillomania, and kleptomania.

The possible association between hoarding and ICDs is consistent with McElroy and colleagues' conceptualization of a compulsive-impulsive spectrum, 20 but requires further exploration. The nosological issues surrounding hoarding will influence its placement in the next edition of the DSM. One position is that compulsive hoarding should be included in our diagnostic system as an independent syndrome, which is sometimes comorbid with OCD. Including hoarding as a separate syndrome has a number of important practical advantages, well-summarized by Rachman and colleagues.

It would also encourage clinicians and researchers to use hoarding-specific assessment tools rather than measures designed for OCD, and facilitate the development of new treatment methods for hoarding. Hoarding researchers also have made substantial progress in understanding the prevalence and manifestation of compulsive hoarding in the population. Until very recently, researchers estimated the prevalence of hoarding as a subportion of individuals with OCD in the.

Recent epidemiological studies, however, suggest that compulsive hoarding may be far more prevalent and burdensome in the community than previously thought. Importantly, a large proportion of individuals who hoard report having at least one first-degree relative who experiences hoarding problems.

Genetic factors and unshared environmental factors may explain this familial connection. Recent data suggests that the prevalence of hoarding increases with age. Samuels and colleagues 24 reported that hoarding was almost three times more prevalent in individuals over the age of 54 than it was in individuals aged 34 to This finding most likely is due to compulsive hoarding being a chronic and progressive disorder.

Hoarding symptoms often develop during childhood or adolescence, and become clinically significant during middle age. In such cases, progression of hoarding symptoms may be slow. In other cases, hoarding may have a sudden onset in adulthood, such as after a traumatic life event or brain injury 27 , 28 Fifty-five percent of Grisham and colleagues' 27 sample reported experiencing a stressful life event at the onset of hoarding symptoms, and these individuals had a significantly later age of onset than individuals who did not experience a stressful life event.

Clinical studies have demonstrated that hoarding often co-occurs with other psychological disorders. In a large clinical sample, almost all individuals with a hoarding diagnosis met criteria for another Axis I disorder, and these individuals had significantly more co-occurring disorders than nonhoarding individuals with OCD. In men, hoarding is associated with generalized anxiety disorder and tics, while among women, hoarding is associated with social phobia, post-traumatic stress disorder, body dysmorphic disorder, nail biting, and skin picking.

While clinical samples tend to be predominantly female, 3 , 30 epidemiological samples have found that hoarding is twice as prevalent in males. A growing body of research suggests that hoarding is associated with a lower quality of life. First, hoarding appears to occur more frequently in the unemployed and poor. Five percent of the Web sample reported they had been fired because of hoarding, and on average, employed individuals reported seven psychiatric work impairment days per month.

Animals may be confined inside or outside. Because of the large numbers, these animals often aren't cared for properly. The health and safety of the person and the animals are at risk because of unsanitary conditions. If you or a loved one has symptoms of hoarding disorder, talk with a doctor or mental health professional as soon as possible. Some communities have agencies that help with hoarding problems.

Check with the local or county government for resources in your area. As hard as it might be, if your loved one's hoarding disorder threatens health or safety, you may need to contact local authorities, such as police, fire, public health, child or elder protective services, or animal welfare agencies. It's not clear what causes hoarding disorder. Genetics, brain functioning and stressful life events are being studied as possible causes.

Hoarding usually starts around ages 11 to 15, and it tends to get worse with age. Hoarding is more common in older adults than in younger adults. Because little is understood about what causes hoarding disorder, there's no known way to prevent it.

However, as with many mental health conditions, getting treatment at the first sign of a problem may help prevent hoarding from getting worse. Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. This content does not have an English version. This content does not have an Arabic version. These associated features can contribute greatly to their problems with functioning and the overall severity.

Animal hoarding may form a special type of hoardindisordder and involves an individual acquiring large numbers dozens or even hundreds of animals. The animals may be kept in an inappropriate space, potentially creating unhealthy, unsafe conditions for the animals. People who hoard animals typically show limited insight regarding the problem. The cause of hoarding disorder is unknown. Due to its recent classification, the neurobiology of hoarding disorder in humans is a newly burgeoning field; making it somewhat premature to draw firm conclusions.

Hoarding is more common among individuals with a family member who also has a problem with hoarding. A stressful life event, such as the death of a loved one, can worsen symptoms of hoarding. Hoarding disorder has a symptom profile, neural correlates, and associated features that differ from OCD and other disorders. A number of information processing deficits have been associated with hoarding; including planning, problem-solving, visuospatial learning and memory, sustained attention, working memory, and organization.

Hoarding behaviors appear relatively early in life and then follow a chronic course. Most studies report onset between 15 and 19 years of age. Early recognition, diagnosis, and treatment are crucial to improving outcomes. Treatment can help people with hoarding disorder to decrease their saving, acquisition, and clutter, and live safer, more enjoyable lives. Randomized controlled trials have established cognitive behavioral therapy CBT for hoarding disorder as an effective treatment.

During CBT, individuals gradually learn to discard unnecessary items with less distress—diminishing their exaggerated perceived need or desire to save these possessions. They also learn to improve skills such as organization, decision-making, and relaxation. Despite the effectiveness of CBT for hoarding disorder, a substantial number of hoarding disorder cases remain clinically impaired by their hoarding symptoms after treatment.

Regarding medication treatment, studies of hoarding disorder psychopharmacology have been small and open-label, which limit the conclusions that can be drawn from this literature.