Hoarding Disorder

Question 1

Hoarding disorder

Answer 1

New disorder in DSM-5 (used to be under OCD)
•different patterns of behaviour and distress

Hoarders: have distress around what they’re not able to hoard
•Will not discard large amount of possessions, resulting in accumulation (intentional - person believes the items are needed)
*accumulation is validated in a way that makes sense to them

What they hoard
•Can be valuable, but often of little value and kept because the person believes it will come in handy
*valuable things are buried among non valuable things
•Excessive acquisition in most patients (buying free stuff/distress if not allowed to)
•Animal hoarding is possible: often inhumane to animals - lower insight, more unsanitary conditions

Result
•Clutter in active living areas (taking up huge parts of the home - can result in unsafe environment)
•Is possible for hoarders to have clean home
•Throwing things out isn’t always helpful - causes significant distress (betrayal, loss of control, shame)
•Insight varies: low insight - no distress/thinks its reasonable but distress to throw things out

Hoarding disorder is NOT
•being disorganized, messy in certain rooms, normative collecting (stamps), and living in destitution
•OCD (OCD hoarding will see no desire for items, and accumulation of bizarre (magical) items)
•a neurocognitive disorder (Alzheimers)

Question 2

Psychological factors

Answer 2

1. Indecisiveness, difficulty with planning, and organizing
   •ex: when trying to clear out, getting distracted by other objects
2. Avoidance, perfectionism, procrastination
3. Unrealistic beliefs about hoarding
   •objects will be used later/cost benefit of hoarding
4. Higher attachment to objects than people
   •greater likelihood to anthropomorphize inanimate objects (give emotions to their objects)
   •ex: projecting their loneliness, therefore less likely to throw it out

Question 3

Biological factors

Answer 3

Moderate genetic heritability (50% report a relative who hoards)
Different patterns of brain activation than in OCD
•not effectively treated by SSRIs (like OCD)
•venlafacine/effexor (SNRIs) may be effective

Question 4

Prevalence

Answer 4

Not well collected
•Point prevalence: 2-6%
•Epidemiological studies found more common in men
•Clinical studies found more common in women (probably because women are more likely to get treatment)
•excessive acquisition more common in women
•3x more common in older adults (clinical research studies usually age 50s+) because
1. child hoarding: parents will throw it out
2. older: kids and parents take care of their problems
•Usually early teens onset, chronic course - more debilitating overtime, especially when lonely (ability to acquire more things, more years to accumulate stuff in home)

Comorbidities
•Depression: 50% (most common)
•Anxiety (social, GAD)
•OCD: 20% (less than what you’d think)

Question 5

Treatment

Answer 5

Often don’t seek treatment (ego-syntric - usually relatives pushing into treatment)
•ERP less effective than in OCD
•Long term in depth CBT and social support under investigation
•Home visits: gradual and collaborative removals’
•making sure they have access to areas, and removing clutter by going through whats important and what isn’t
•Simply throwing out doesn’t help