Buried treasures: understanding compulsive hoarding – Got Anxiety?

On May 26, 2010, Fox News reported the following: “Fire crews investigating a mysterious smell uncovered a severe case of hoarding when they found an elderly couple in their late ‘70s buried alive under mounds of garbage and piles of food waste in their Chicago home.”

Two days later, both individuals died of malnutrition — the result of compulsive hoarding, which had been occurring for more than 20 years, in their small 2-bedroom home.

For several years, compulsive hoarding was considered a form of Obsessive-Compulsive Disorder (OCD). However, in 2014 the American Psychiatric Association published the Diagnostic & Statistical Manual, 5th Ed., concluding that hoarding existed independently from OCD, due to several unique symptoms which, although similar to OCD, also included other characteristics not associated with those who evidence a diagnosis of OCD.

Thus, a new diagnosis — “Hoarding Disorder” — was established. In a nutshell, the primary criteria consistent with this condition include the following:

Intentional over acquisition of various items such as papers, clothing, food, animals, etc.

Persistent difficulty discarding (throwing/giving away, donating, selling, etc.) over acquired possessions, regardless of their actual value.

Attempts to discard possessions trigger severe emotional distress (anxiety, shame, and/or disgust).

The significant amount of items over acquired results in excessive clutter; defined as large groups of unrelated objects piled together throughout one’s home in an unorganized manner.

Clutter results in active living spaces (bedrooms, kitchens, bathrooms, living rooms, etc.) becoming virtually unusable, as well as dangerous to one’s health and welfare.

Seen below, is a brief summary regarding the prevalence, course of development, causes, and co-occurring disorders associated with Hoarding Disorder.

PREVALENCE & COURSE OF DEVELOPMENT

4-6% of the general population.

Greater occurrence in males, although excessive acquisition seen more in females.

Average age of onset is 11-15 years.

Three times more prevalent in ages 55-95 years, vs. 34-54 years.

Severity increases across each decade of life.

Course is chronic, with very little waxing/waning.

Treatment, though rarely sought, occurs 12-15 years following symptom onset.

Cause of serious marital problems and/or legal proceedings from public health officials.

CO-OCCURRING DISORDERS

Depression.

Attention Deficit Disorder (ADD).

Obsessive-Compulsive Disorder (OCD).

Obsessive-Compulsive Personality Disorder (OCPD).

Another anxiety disorder; typically Social Anxiety or Panic Disorder.

CAUSES

Genetic predisposition.

Neurochemical (insufficient serotonin and dopamine levels).

Temperamental vulnerability (indecisiveness, perfectionism, fear of making mistakes).

Environmental vulnerabilities (traumatic life experiences, major life transitions, etc.).

Most people reading this article have, from time to time, over-acquired items from sources such as yard sales, stores, friends, etc., that they simply does not need.

In addition, we have all experienced great difficulty discarding various possessions when moving into another residence, or simply “spring cleaning.”

Many individuals love to collect items such as rare coins, vintage cars and wines, antiques, etc. Collecting may serve as a hobby, or even be one’s primary source of employment.

However, collecting is not the same as hoarding. Below, is a brief outline regarding key differences between collecting vs. compulsive hoarding.

THOSE WHO COLLECT

Feel proud of their possessions.

Keep their possessions well organized, and void of clutter.

Willingly display their possessions to others.

Feel tremendous satisfaction when adding to their collections.

Attend meetings with others who share their collection interests.

THOSE WHO HOARD

Feel embarrassed of their possessions.

Possessions are scattered, with no organizational structure.

Refuse to allow others to view or even touch their possessions.

Experience guilt, sadness, confusion, or shame when acquiring additional items.

Attend mandated support groups for helping to treat over acquisition and the lack of discarding possessions, which often result in dangerous clutter.

OK, so we all like our stuff and have a hard time tossing it out, even if we haven’t used it in years, which is different from those who collect meaningful items.

Thus, a major issue deserving attention concerns understanding the personality profile which contains the defining characteristics of those who engage in compulsive hoarding. This topic will be specifically addressed in our next article.

Barry C. Barmann, Ph.D., is a Licensed Clinical Psychologist in Nevada and California. His wife, Mary B. Barmann, MFT, is a licensed Marriage and Family Therapist in California. Visit anxietytreatmentinclinevillage.com to learn more.