People with hoarding disorder have persistent difficulty getting rid of or parting with possessions due to a perceived need to save the items. Attempts to part with possessions create considerable distress and lead to decisions to save them. The resulting clutter disrupts the ability to use living spaces (American Psychiatric Association, 2013).
Hoarding is not the same as collecting. Collectors typically acquire possessions in an organized, intentional, and targeted fashion. Once acquired, the items are removed from normal usage, but are subject to being organized, admired, and displayed to others. Acquisition of objects in people who hoard is largely impulsive, with little active planning, and triggered by the sight of an object that could be owned. Objects acquired by people with hoarding lack a consistent theme, whereas those of collectors are narrowly focused on a particular topic. In contrast to the organization and display of possessions seen in collecting, disorganized clutter is a hallmark of hoarding disorder.
The overall prevalence of hoarding disorder is approximately 2.6%, with higher rates for people over 60 years old and people with other psychiatric diagnoses, especially anxiety and depression. The prevalence and features of hoarding appear to be similar across countries and cultures. The bulk of evidence suggests that hoarding occurs with equal frequency in men and women. Hoarding behavior begins relatively early in life and increases in severity with each decade.
Hoarding disorder can cause problems in relationships, social and work activities, and other important areas of functioning. Potential consequences of serious hoarding include health and safety concerns, such as fire hazards, tripping hazards, and health code violations. It can also lead to family strain and conflicts, isolation and loneliness, unwillingness to have anyone else enter the home, and an inability to perform daily tasks, such as cooking and bathing in the home.
Diagnosing Hoarding Disorder
Specific symptoms for a hoarding diagnosis include (American Psychiatric Association, 2013):
- Persistent difficulty discarding or parting with possessions, regardless of their actual value.
- This difficulty is due to a perceived need to save the items and to the distress associated with discarding them.
- The difficulty of discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially compromise their intended use. If living areas are uncluttered, it is only because of the interventions of third parties (e.g., family members, cleaners, or the authorities).”
The hoarding causes major distress or problems in social, work, or other important areas of functions (including maintaining a safe environment for self and others).
An assessment for hoarding may include questions such as:
- Do you have trouble parting with possessions (such as discarding, recycling, selling, or giving away)?
- Because of the clutter or number of possessions, how difficult is it to use the rooms and surfaces in your home?
- To what extent does your hoarding, saving, acquisition, and clutter affect your daily functioning?
- How much do these symptoms interfere with school, work, or your social or family life?
- How much distress do these symptoms cause you?
Mental health professionals may also ask permission to speak with friends and family to help make a diagnosis or use questionnaires (rating scales) to help assess the level of functioning.
Some individuals with hoarding disorder may recognize and acknowledge that they have a problem with accumulating possessions; others may not see a problem.
Excessive acquisition occurs in the vast majority of cases and—although not a core diagnostic feature—should be carefully monitored. In addition to the core features of difficulty discarding and clutter, many people with hoarding disorder also have associated problems such as indecisiveness, perfectionism, procrastination, disorganization, and distractibility. These associated features can contribute greatly to their problems with functioning and the overall severity.
Animal hoarding may form a special type of hoarding disorder 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.
Many people with hoarding disorder also experience other mental disorders, including depression, anxiety disorders, attention-deficit/hyperactivity disorder, or alcohol use disorder.
source – psychiatry.org