Examining Hoarding Symptoms in Young People

Many of us have been made aware of compulsive hoarding disorder thanks to popular television shows like Hoarders and Hoarding: Buried Alive. While these shows portray individuals with heavily cluttered homes that undergo a cleanout with both the support and pressure from relatives, a TV-team, and (sometimes) a therapist, critical viewers of these programs are often left with lingering questions. For example, what happened to those on the television show after the cameras were turned off? Did they ever get better or did they return to their old ways? These shows also cause many people to wonder about how the problem began in the first place. Did the hoarding problems appear suddenly or could signs that a hoarding problem was developing be observed in early childhood?

Today, Hoarding Help Central seeks to answer these questions concerning how compulsive hoarding disorder starts. By examining the clinical features, etiology, and prevalence of compulsive hoarding disorder in young people, we hope to answer these questions. Let’s get started!

What is Compulsive Hoarding Disorder?

Compulsive hoarding disorder has, historically, been mentioned as a symptom of obsessive-compulsive disorder. In 2013, however, hoarding was finally included in the DSM-V as its own unique disorder. The most distinguishing feature of compulsive hoarding disorder is the persistent difficulty letting go of items. Individuals with compulsive hoarding disorder experience a very real need to keep their possessions and become significantly distressed when attempting to discard or, by other means, let go of their possessions. Strong emotional attachment to their possessions is incredibly common and certain areas of cognitive function, such as decision-making, can be impaired. This, in many cases, makes letting go of their possessions even more challenging.

According to the American Psychiatric Association, compulsive hoarding disorder is defined as a person’s “persistent difficulty getting rid of or parting with possessions, leading to clutter that disrupts their ability to use their living or work spaces”. It should be noted that hoarding is not the same as collecting because, while collectors look for specific items in order to organize or display them, people with hoarding disorder often save random items of little perceived value and store them haphazardly.

In order to be diagnosed with compulsive hoarding disorder, an individual must meet the following criteria as outlined by the DSM-V:

1. Persistent difficulty discarding or parting with possessions, regardless of their actual value.
2. This difficulty is due to a perceived need to save the items and to distress associated with discarding them.
3. The difficulty discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use. If living areas are uncluttered, it is only because of the interventions of third parties (e.g., family members, cleaners, authorities).
4. The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others).
5. The hoarding is not attributable to another medical condition (e.g., brain injury, cerebrovascular disease, Prader-Willi syndrome).

The hoarding is not better explained by the symptoms of another mental disorder (e.g., obsessions in obsessive-compulsive disorder, decreased energy in major depressive disorder, delusions in schizophrenia or another psychotic disorder, cognitive deficits in major neurocognitive disorder, restricted interests in autism spectrum disorder).

What are the Consequences of Compulsive Hoarding Disorder?

As you might imagine, the symptoms associated with compulsive hoarding disorder come with their fair share of consequences. Compulsive hoarding disorder is, for one, commonly associated with distress and this can have a very negative impact on both occupational and psychosocial areas in an individual’s life. As an example, according to one study, individuals with hoarding reported 7 psychiatric work impairment days during the past month of their lives at the time that they were surveyed.

Individuals with compulsive hoarding disorder are also much more likely to be either widowed or unmarried, as well as having more financial difficulties than non hoarders. More extreme consequences of compulsive hoarding disorder also include an increased risk of eviction, homelessness, fire hazards, and in some cases, even death caused by the fire hazards sometimes referred to as “clutter avalanches”.

The symptoms of compulsive hoarding disorder also present serious strain on the likes of caretakers and family. The relatives of individuals with compulsive hoarding disorder tend to experience a burden that is very similar to the caretakers of people suffering from dementia. The burden placed on the family members of someone with compulsive hoarding disorder is also similar to children who grow up with someone who hoarded and, as a result, report a childhood filled with distress.

Unfortunately, compulsive hoarding disorder can also have hugely negative impacts on animals. In some cases of compulsive hoarding, a large number of animals are accumulated and kept by an individual who fails to provide adequate care to the animals they have collected. This behavior, in particular, can contribute to highly unsanitary environments and even the eventual death of the animals in their possession.

What is the Prevalence of Compulsive Hoarding Disorder?

So how prevalent is compulsive hoarding disorder in young people? Overall, estimates of the occurrence of hoarding problems in the community suggest that compulsive hoarding disorder may be surprisingly common. One early estimate of the prevalence of hoarding in adults, for example, indicated that as many as 14.4% of US adults had hoarding symptoms. It should be noted, however, that these results were based on two questions surrounding compulsions and obsessions related to hoarding and doesn’t correspond to the current conceptualization of hoarding disorder but rather hoarding symptoms typical for obsessive-compulsive disorder.

While there are several epidemiological reports that examine the prevalence of compulsive hoarding disorder in the general population, there are very few studies that have examined its prevalence in young adults. Two studies reported about a 1 percent prevalence of hoarding disorder in young adults. In a third study, there was a 3.4 percent prevalence rate for hoarding behavior among university students, suggesting that the third study’s result was three times greater than the rates reported in the two previous studies.

When Does Compulsive Hoarding Disorder Start?

Although individuals with compulsive hoarding disorder who come to the attention of clinical services and research tend to be older (above the age of 50), in most people with compulsive hoarding disorder, the origins of the disorder can be observed decades earlier. A number of studies have made attempts at testing the trajectory of compulsive hoarding disorder by asking those suffering from the disorder to report the course of their difficulties throughout their lives.

In one particular study completed by Grisham, Kim, Hood, Steketee, and Frost, a total of 51 participants (between the ages of 26 and 71) with hoarding problems were asked to recall the age of onset as well as the severity of their difficulty discarding. In this particular study, the age of onset was found to be an average of 13 years of age with the age of 18 showing the highest debut of hoarding difficulties in the sample at 80 percent. The study also showed that the severity of the symptoms became moderate at age 24 before becoming much more severe at age 34. This study suggests that hoarding debuts during childhood, adolescence, or young adulthood. As the individual ages, the severity of their compulsive hoarding symptoms increases.

Etiology of Compulsive Hoarding Disorder

A number of family studies show that between 40 and 80 percent of people with hoarding problems report a first-grade relative that also experiences issues with hoarding. Although there is a large variability in these estimates, when compared to prevalence estimates within the general population, these studies clearly suggest that there is a genetic link found in compulsive hoarding disorder. Studies of twins have also confirmed that hoarding is transmitted in families and extended this finding by showing that familial similarity is due largely to the influence of genes. Heritability estimates from twin studies have ranged between 0.33-0.49 percent.

While these studies show that there is some genetic link to be found in compulsive hoarding disorder, more work needs to be done. Knowledge about the developmental structure of both genetic and developmental risk factors for compulsive hoarding disorder in young people could potentially further our understanding of a possible etiological link found in a specific crucial phase of the development of compulsive hoarding disorder symptoms. This would be helpful in helping us to better understand how compulsive hoarding disorder is passed down in families as well as inform better approaches to treatment in young people.

Hoarding in Children and Adolescents

Although symptoms of compulsive hoarding disorder tend to debut early in an individual’s life, very little is understood about the emergence of these symptoms in children and adolescents. Although there is a lack of conclusive evidence, however, it is probable that hoarding symptoms present very differently in young people than they do in the older adult population. Generally, young people do not have the same means of which to acquire items in comparison to the older adult population. Further, it is likely that the degree of clutter that young people collect is milder and restricted to the young person’s room rather than the entire house as is the case with most older hoarders. Evidence from case reports surrounding compulsive hoarding disorder in children also indicate that difficulties discarding occur long before excessive acquisition and clutter.

There is also some evidence to suggest the emergence of compulsive hoarding symptoms and the presence of ADHD. In a study which included youth and adult patients with childhood-onset OCD, hoarding symptoms occurred in 21 percent of their sample and were strongly associated with ADHD. The association between ADHD and hoarding symptoms was further explored in a sample of 99 youth with ADHD (between the ages of 8 and 17) of which 29 percent had clinically significant hoarding symptoms and compared to non-hoarding participants, exhibited greater ADHD symptom severity.

As is established by the studies that exist surrounding compulsive hoarding disorder in children and adolescents, there are many basic questions about compulsive hoarding disorder in young people that are still unanswered. For example, the prevalence and clinical presentation of hoarding symptoms are still largely unknown. Another question that we still don’t have the answer to is whether or not young people with compulsive hoarding symptoms would meet the DSM-V’s criteria for compulsive hoarding disorder or whether or not the criteria should be updated.

Treating Compulsive Hoarding Disorder in Young People

Despite the consequences and impact on families associated with compulsive hoarding disorder, very few people with compulsive hoarding disorder receive treatment for their condition. Nevertheless, most individuals with compulsive hoarding disorder report that they actually would be interested in treatment, if such treatment was available to them. So what is the best treatment option available to young people who demonstrate compulsive hoarding symptoms?

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is thought to be the most effective form of treatment for people that are either diagnosed with compulsive hoarding disorder or that demonstrate symptoms of the disorder. While little is known about the exact effects of CBT on young people demonstrating symptoms specifically, it is widely thought that it is the best option available regardless of age. CBT for compulsive hoarding disorder builds on the cognitive behavioral model for hoarding and generally involves building skills for better decision-making and categorization of possessions. CBT also involves working on exposure to negative emotions when discarding and the cognitive restructuring of dysfunctional beliefs related to saving and acquiring.

More Needs to Be Learned About Compulsive Hoarding Disorder in Young People

Although we have certainly learned more about compulsive hoarding disorder symptoms in young people in recent years, there is still more work that needs to be done. There are still many questions regarding compulsive hoarding disorder in young people and these questions will remain unanswered until more research is done. Hoarding Help Central believes, however, that with more research, more can be learned about compulsive hoarding disorder and better treatment strategies can be put in place in regards to young people specifically.