Hoarding and What Home Healthcare Providers Should Know About Hoarding Disorder

Although research into the cause, emergence of, and behaviors of compulsive hoarding has increased within the last decade, there is still much to be learned about the disorder. In regards to age-specific prevalence, there is very little known about the symptoms of hoarding and obsessive-compulsive disorder, particularly in individuals of older age.

At Hoarding Help Central, we believe that advancements in the research of compulsive hoarding disorder and its comorbid disorders are essential to providing a greater degree of treatment for affected individuals. Age-specific prevalence, in particular, can tell us a lot about the cause of these behaviors as well as assist in identifying the link between compulsive hoarding and obsessive-compulsive disorder.

Today, Hoarding Help Central will be looking at some of the most recent studies completed surrounding the age-specific prevalence of hoarding and obsessive-compulsive disorder. These studies include findings regarding the age-specific prevalence, relationship, and severity between compulsive hoarding disorder and obsessive-compulsive disorder. Let’s get started!

What is Hoarding?

Before we discuss the age-specific prevalence of hoarding and obsessive-compulsive disorder, it is crucial that you have an understanding of each disorder. So what is hoarding? Pathological hoarding is described as both the acquisition of and difficulty getting rid of items that most people would perceive to be of little to no value. These behaviors result in excessive clutter which leads to significant impairment in the individual’s day to day life and function.

Hoarding has been found to occur both independently and in addition to a number of psychiatric disorders. A few examples of these comorbid disorders include dementia, autism, schizophrenia, and, most notably, obsessive-compulsive disorder. Until very recently, hoarding was actually classified as a symptom of obsessive-compulsive disorder rather than a unique disorder in itself. This all changed with the updated version of the Diagnostic and Statistical Manual of Mental Health Disorders, 5th Edition published in 2013. At this point, hoarding is classified as a distinct condition within the obsessive-compulsive disorder and other disorders category. Greater research into hoarding behaviors is credited with being the main reason for this change in classification.

What is Obsessive-Compulsive Disorder?

Obsessive-compulsive disorder is characterized as an anxiety disorder. This disorder is further characterized by the presence of certain symptoms including recurring, unwanted thoughts, ideas, or sensations which result in a compulsion to complete certain actions of a repetitive nature. These repetitive behaviors include, most commonly, hand washing, cleaning, checking on things, and counting. These repetitive behaviors tend to have a significant impact on an individual’s ability to function in everyday life.

While many people experience focused behaviors and recurring thoughts, most people are not functionally impaired by these occurrences. This is not the case in those with obsessive-compulsive disorder. In fact, individuals with obsessive-compulsive disorder only participate in repetitive behaviors in an attempt to save themselves from the distress caused by ignoring their compulsions.

The Prevalence of Hoarding

In regards to the prevalence of hoarding, little is known about the disorder’s prevalence and course across an affected individual’s lifespan. Though compulsive hoarding is considered to be a chronic progressive disorder, there is still a great need for increased research into the causes, emergence, and severity of the disorder. Of the research currently ongoing and those completed into compulsive hoarding, hoarding has an established general population prevalence of between 2 and 6 percent.

That being said, the need for greater research into the prevalence of hoarding as a unique disorder is observable in the fact that a wide range of prevalence (between 1.5 and 14 percent) is presented in various other research studies. Additionally, lower reported hoarding prevalence studies completed with a focus on children and adolescents highlight the need for increased research on the age-specific prevalence of compulsive hoarding disorder.

The Prevalence of Obsessive-Compulsive Disorder

As far as the prevalence of obsessive-compulsive disorder goes in an age-specific sense, there is a much greater amount of established research. Most age-specific prevalence studies completed with a focus on obsessive-compulsive disorder suggest that the disorder runs a fairly stable and chronic course across the lifespan of affected individuals.

At the same time, other reports suggest that there are more favorable outcomes as those with obsessive-compulsive disorder age. It should be noted, however, that most of these studies did not include a follow-up exceeding the age of 60 years old so little is known about obsessive-compulsive disorder in individuals in that age range.

The Overlap Between Hoarding and Obsessive-Compulsive Disorder

Despite the recent separation of hoarding disorder from obsessive-compulsive disorder as its own distinct disorder, an etiologic overlap between the two disorders has been observed in a variety of research studies. Most notably, there seems to be an overlap in genetic correlations between hoarding disorder and obsessive-compulsive disorder symptoms in twin-family studies varying between 0.1 and 0.4. Although the severity of hoarding symptoms that are self-reported is similar among those with and without obsessive-compulsive disorder, the presence of hoarding behavior seems to increase the severity of obsessive-compulsive symptoms in patients with obsessive-compulsive disorder.

Additionally, patients that have both hoarding disorder and obsessive-compulsive disorder have also been observed to possess much higher rates of comorbid anxiety, but not necessarily greater hoarding symptom severity. There are also several small studies to suggest that the outcome of individuals that possess both hoarding disorder and obsessive-compulsive disorder may be generally more negative than those that possess only hoarding disorder related symptoms alone. Research that targets a better understanding of age-specific prevalence of both of these disorders is essential to providing better treatment methods and intervention approaches for at-risk individuals.

Age-Specific Prevalence of Hoarding and OCD

So what are some of the recent studies that have focused on age-specific prevalence in hoarding disorder and obsessive-compulsive disorder? One study aimed to extend the work done in previous studies based on prevalence by focusing on factors including severity, by age and sex, of those with hoarding disorder and obsessive-compulsive disorder symptoms. This study was completed on a large population-based sample found in the Netherlands Twin Register. The hypothesis of this particular study included the following:

1. Hoarding disorder prevalence and the severity of symptoms would increase with age in both males and females
2. The prevalence and severity of obsessive-compulsive disorder symptoms would remain stable or lower with age
3. A younger age of onset of obsessive-compulsive disorder symptoms would result in stabilization while hoarding symptoms would worsen
4. Obsessive-compulsive disorder symptoms would be much more severe in patients with comorbid obsessive-compulsive disorder and hoarding disorder

Each of the participants observed in this study were adults found in the Netherlands Twin Register and included twin pairs and their extended family who had data available for obsessive-compulsive disorder and hoarding disorder. This sample size was representative of the greater population of the Netherlands and data was drawn from surveys collected between the years of 2009 and 2012. These surveys were mailed to families where all of the twin pairs were over the age of 18. Of the 37,934 participants who received an invitation to participate in the research study, an estimated 45 percent returned the survey.

Results of the Study

Once the returned data was analyzed by researchers, it was found that the overall provisional prevalence of hoarding disorder was found to be 2.12 percent with a rise of 3.7 percent with each year of age. These results were similar between both male and female participants. The overall provisional prevalence of obsessive-compulsive disorder was 5.7 percent but the relationship between the disorder and age was found to be nonlinear. Interestingly, both young and old individuals had higher prevalence rates than participants of middle age. Again, in the case of obsessive-compulsive disorder, there was no major difference in prevalence between male and female participants. 

Similar trends were observed in global symptom severity across ages. Hoarding severity was found to increase with age, particularly after participants reached the age of 35. In terms of the difference of hoarding severity amongst male and female participants, a significant difference in severity was observed once participants reached older ages. In this case, males tended to exhibit much greater levels of hoarding severity than females of the same age. In terms of obsessive-compulsive disorder symptom severity between the sexes, there was no measurable difference according to self-reports.

Finally, the study also measured data relating to age-specific patterns found in individual types of both hoarding disorder and obsessive-compulsive disorder. In regards to different forms of obsessive-compulsive disorder, the mean severity of the disorder remaining constant across the lifespan until it increased primarily in participants over the age of 60. In measuring different forms of hoarding behavior, researchers found an increase in severity across all age groups and types with the exception of the difficulty discarding factor which increased the most with age.

Considering the fact that this study is the first to focus on the age-specific prevalence and severity of those affected with compulsive hoarding disorder and obsessive-compulsive disorder with a large sample size, there is much that can be learned from this data. At Hoarding Help Central, we hope that this data will be used to more effectively identify new treatment methods and determining factors that increase the chances of the emergence of hoarding behavior.