Hoarding Flashcards
Differentials
In general, hoarding appears to emerge during two broad life periods—youth and late adulthood. During youth, hoarding is commonly present in conjunction with OCD. In the aged, hoarding is usually not associated with OCD. In addition to these differences in onset, there appear to be a number of psychological divergences between these two presentations of hoarding as well.
Hoarding onset in youth
Hoarding has long been an associated symptom of OCD and is encountered in 18 to 33% of such patients. In a large sample of hoarders with comorbid OCD (N= 235), Samuels et al determined a mean age-of-onset of 14.4 years as well as high rates of mood disorders (e.g., 68% with major depression) and anxiety disorders (e.g., 45% with social phobia, 42% with generalized anxiety disorder, 38% with specific phobia). In this sample, the most frequent comorbid Axis II disorder was obsessive-compulsive personality disorder (22%).
Winsberg et al also described a cohort of hoarders with comorbid OCD (N=20). In this sample, the mean age-of-onset for hoarding behaviour was 20 years. Among these participants, 84 percent reported a family history of hoarding, 80 percent grew up in a household with a hoarder, and a number of participants disclosed comorbid psychiatric syndromes such as major depression (40%), obsessive-compulsive personality disorder (the only Axis II disorder reported, 15%), and impulsive behaviours (e.g., compulsive shopping, 35%; pathological gambling, 10%). terms of adjunctive psychological features, in comparison to hoarders without OCD, research indicates that hoarders with OCD tend to acquire bizarre items, demonstrate comorbid obsessions and compulsions related to hoarding, and experience checking rituals. In addition, hoarders with OCD symptoms commonly demonstrate a negative affect.
Hoarding in old age
A second general group of hoarders appears to develop symptoms in late adulthood. First reported in a 1975 Lancet article, Clark et al described a pattern of “serious self-neglect in the elderly,” which they labelled with the moniker Diogenes Syndrome. In their original description, Clark et al emphasised the behaviour of “syllogomania”—the hoarding of rubbish—as well as “dirty untidy” homes and a “shameless filthy” appearance. In their case review, affected individuals frequently presented for medical care because of falls or physical collapse. While most were well known to social services, few accepted intervention. The authors suggested that this syndrome may be a reaction in late life to stress within the context of a certain type of personality.
While empirical data for this older subgroup of hoarders are limited, in a community study (N=27), the only one of its kind, Samuels et al found that no participant exhibited comorbid OCD. As expected, researchers found an increasing prevalence of hoarding with increasing age, with hoarding being three times more likely in the oldest compared to the youngest age group. Associated psychiatric characteristics in this sample included high rates of lifetime alcohol dependence (52%), several personality disorder traits (e.g., in order of frequency—obsessive-compulsive, avoidant, paranoid, schizotypal, antisocial personalities), and a history of childhood adversity (e.g., a parent with psychiatric symptoms, a lack of physical security, excessive physical discipline in childhood). Some of these characteristics appear to echo the findings originally described in Diogenes Syndrome, including the presence of personality factors as well as psychosocial stressors. Indeed, old age has been a repeated epidemiological theme in this subtype of hoarding, with Saxena stressing the importance of an early versus late-onset dichotomy. Research also suggests that this subgroup may have lower levels of anxiety, worry, stress, and negative affect.
