The Pathology of Compulsive Hoarding
Hoarding used to be seen simply as a negative character trait – perhaps an action of a lazy person. Today, however, the medical community has accepted hoarding as a real disorder, and we know a lot more about the causes behind such erratic and sometimes harmful behavior.
Compulsive hoarding is defined by the World Health Organization as “the inability to resist the urge to acquire possessions and to discard possessions.” It is a chronic disorder that can develop early in life and is often seen in conjunction with other similar mental illnesses. Still, it is important not to confuse hoarding with other diseases such as obsessive-compulsive disorder or ADHD. While they often exist together, they are distinct disorders caused by different things.
Compulsive hoarding can manifest itself as a symptom of OCD. However, its presence is not limited to OCD and it can be a standalone disorder in a number of patients. While much research has been done on the subject, there is still much more to do before we have all the answers about the causes of hoarding and before we have treatment that is suitable for all sufferers of the disorder.
What we do know is that hoarding has been recognized as a public health issue and that it often appears alongside other mental disorders. Hoarding, whether alone or in combination with these conditions, can cause great emotional and physical distress to the patient, and can lead to problems with neuropsychological functioning.
Compulsive Hoarding as a symptom of OCD
Compulsive hoarding is quite common among sufferers of OCD, with up to 20% of OCD patients showing it as a primary diagnosis and 42% as a secondary symptom. Primary characteristics of compulsive hoarding include:
- Repeated acquisition of items and possessions that provide little to no functional use or value
- Inability to discard these possessions
- Items and possessions render living space unlivable or prevent it from being used in its intended way
- Impaired everyday function of the hoarder himself or herself
These symptoms can appear as early as childhood and adolescence. In general, hoarders will show the inability to part with items before they exhibit the repeated acquisition of items.
Many compulsive hoarders have relatives who hoard. Chromosome 14 in families with OCD has been strongly linked in families that have 2 or more hoarders amongst them. This suggests that there are genetic factors at play when it comes to the hoarding disorder.
The phenomena of hoarding
Hoarders in general don’t just acquire singular items. They will often have a collection of duplicates or multiple items that serve the same purpose. They acquire these items in many different ways, including purchasing, inheriting, searching for free things, or even stealing. There is not specific site that a hoarder prefers – they can get these items from retail stores, garage sales, yard sales, flea markets, or even garbage dumps. In modern times, the internet has made it easier to acquire items while avoiding the embarrassment that often goes along with entering certain places multiple times in a short period of time.
This addictive like behavior to acquiring things can lead to a variety of financial and personal problems. These include debt, bankruptcy, loss of savings, legal problems, and strained family relationships.
Objects that are commonly seen in a hoarder’s household include:
- Newspapers and newspaper clippings
- Old Clothes
- Junk Mail
- Machine parts
Hoarders can become functionally handicapped by their inability to discard of such items that others may perceive to be useless. They place a higher value on these types of items than those who don’t have the disorder due to chemical imbalances in the brain. Because they assign such high value, they see it as wasteful to get rid of these items and might experience great stress and anxiety when such a decision might be made.
The initial phase of hoarding doesn’t necessarily result in clutter. It is often well organized and may not seem to show exhibits of hoarding at all. However, as time goes by, the accumulation of possessions continues, and the hoarder runs out of space for the items. An entire home can become consumed by the hoard, rendering many of the rooms and living spaces unlivable or barely usable.
As compulsive hoarding advances, the patient can become increasingly isolated from friends, family, and society. Those with both OCD and hoarding disorder often lose their friends, become estranged from their family, and never end up getting married.
Hoarding vs Collecting
Hoarding can be difficult to diagnose, as it shares many traits with other disorders and even with perfectly normal activities. Collecting is something that often gets conflated with hoarding, but these two are not the same.
Collecting has a specific, directed intent. Someone might collect baseball cards, coins, or jewelry, but they have a certain object that they search for and that they display in their collection. Their collection brings them great joy, and they are often proud of it. They will often take care of the possessions in their collection, cleaning them, maintaining them, and sometimes even trading them for more valuable versions. A collection is usually relegated to a certain part of the home and does not interfere negatively with aesthetics or with the collector’s ability to live.
Hoarding, on the other hand, is not a source of joy or pride. There is no directed intention or particular item the hoarder wishes to accumulate. A hoard can be made up of a variety of random, seemingly worthless items that have no value and offer no function. It isn’t well maintained or taken care of, and it isn’t confined to a particular place in the house. A hoard begins to spill into other rooms and makes living in the house more and more difficult as time goes by.
Compulsive Hoarding with other disorders
Compulsive hoarding is commonly seen side by side with other disorders. In fact, about 92% of patients have a diagnosis of one or more other psychiatric disorders. Some of these disorders include:
- Bipolar disorder
- Unexplained phobias
- Social problems
- Substance abuse
- Panic attacks
- Compulsive gambling
- Pathological lying
For those with OCD and hoarding, it is far more likely to suffer from even more disorders than it is for those with non-hoarding OCD. Many also exhibit behavior reminiscent of a variety of personality disorders. It is common for multiple conditions to coexist with hoarding behavior.
Hoarding in patients without OCD
Hoarding is not exclusive to people who suffer from obsessive-compulsive disorder. It is seen in many patients who do not suffer from OCD. It can be a side effect of another disorder or can come as a result of dementia. Some studies show that 23% of people who suffer from dementia are also compulsive hoarders.
Other illnesses that are often associated with hoarding include:
- Tourette syndrome
- Prader Willis Syndrom
One of the more serious forms of hoarding, animal hoarding has been designated a public health issue by the World Health Organization. This happens when instead of hoarding objects, a patient acquires a large number of animals, all of which malnourished, dirty, and neglected. Despite worsening health conditions among the animals, the owner refuses to provide clean shelter, food, or veterinary care. They will deny that there is anything wrong with the animals and will become paranoid of anyone that suggests otherwise. Often, the animal hoarder will suggest that they are saving the animals from a horrible fate. Interestingly, women living alone who are over 60 years of age make up 76% of animal hoarders.
Hoarding and Cognitive Deficits
Some studies have shown that hoarding can be linked to certain cognitive deficits, and that cognitive behavioral therapy can be effective in treating the disorder and minimizing symptoms. Some of the aforementioned cognitive deficits include:
- Inability or lowered ability to process new information
- Heightened or delusional beliefs about the objects that are owned
- Inability to make decisions, whether important or trivial
- Heightened emotional attachment to items
Diagnosing the condition of hoarding can be a challenge, as many patients are embarrassed about their condition and keep it a secret for as long as possible. However, it is common for hoarders to open up about their condition when asked about it, even if they are not interested in treating the disorder.
If you are interested in determining whether or not someone is a compulsive hoarder, consider the following questions:
- Do you find that you must acquire new possessions even if you do not plan on using them?
- Do you experience anxiety when you have to throw items away? How often does this happen?
- Do you continually obtain duplicate items that have no value or function?
- Do you find it difficult to discard items because there is not enough room for them?
- Is it difficult to move about your home due to the accumulation of your possessions?
- Are you embarrassed to invite visitors into your home because of the clutter?
- How important are your possessions to you?