Compulsive hoarding

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Compulsive hoarding in an apartment
Living room of a person with compulsive hoarding
Living room and fireplace of a person with compulsive hoarding

Compulsive hoarding (or pathological hoarding) is the acquisition of, and failure to use or discard, such a large number of seemingly useless possessions that it causes significant clutter and impairment to basic living activities such as mobility, cooking, cleaning, showering or sleeping. A person who engages in compulsive hoarding is commonly said to be a "pack rat", in reference to that animal's apparent fondness for material objects.

It is not clear whether compulsive hoarding is a condition in itself, or simply a symptom of other related conditions.[1] Several studies have reported a correlation between hoarding and the presence and/or severity of obsessive-compulsive disorder (OCD). Hoarding behaviour is also related to obsessive-compulsive personality disorder (OCPD). Hoarding unnecessary possessions may be referred to as syllogomania or disposophobia.

Contents

[edit] Characteristics

While there is no definition of compulsive hoarding in accepted diagnostic criteria (such as the current DSM), Frost and Hartl (1996) provide the following defining features:[2]

  • the acquisition of, and failure to discard, a large number of possessions that appear to be useless or of limited value.
  • living spaces sufficiently cluttered so as to preclude activities for which those spaces were designed
  • significant distress or impairment in functioning caused by the hoarding
  • Reluctance or inability to return borrowed items. As boundaries blur, impulsive acquisitiveness could sometimes lead to kleptomania or stealing.

The hoarder may mistakenly believe that the hoarded items are very valuable, or the hoarder may know that they are useless. A hoarder of the first kind may show off a cutlery set claiming it to be made of silver and mother-of-pearl, disregarding the fact that the packaging clearly states the cutlery is made of steel and plastic. A hoarder of the second type may have a refrigerator filled with food items that expired months ago without ever eating them, but would vehemently resist any attempts from relatives to dispose of the unusable food items.

[edit] Case study

The following (edited) case study is taken from a published account of compulsive hoarding:[3]

The client, #1 lived with her two children, aged 11 and 14, and described her current hoarding behaviour as a "small problem that mushroomed" many years ago, along with corresponding marital difficulties. D reported that her father was a hoarder and that she started saving when she was a child ... The volume of cluttered possessions took up approximately 70 percent of the living space in her house. With the exception of the bathroom, none of the rooms in the house could easily be used for their intended purpose. Both of the doors to the outside were blocked, so entry to the house was through the garage and the kitchen, where the table and chairs were covered with papers, newspapers, bills, books, half-consumed bags of chips and her children's school papers dating back ten years.

[edit] Subtypes and related conditions

[edit] OCD

It is not clear whether compulsive hoarding is a condition in itself, or simply a symptom of other related conditions.[4] Several studies have reported a correlation between hoarding and the presence and / or severity of obsessive-compulsive disorder (OCD). Hoarding behaviour is also related to obsessive-compulsive personality disorder (OCPD). There may be an overlap with a condition known as impulse control disorder (ICD), particularly when compulsive hoarding is linked to compulsive buying or acquisition behaviour. However, some people displaying compulsive hoarding behaviour show no other signs of what is usually considered to be OCD, OCPD or ICD. Those diagnosed with attention-deficit hyperactivity disorder (ADHD) often have hoarding tendencies.[5]

[edit] Book hoarding

Bibliomania is an obsessive-compulsive disorder involving the collecting or hoarding of books to the point where social relations or health are damaged. One of several psychological disorders associated with books, bibliomania is characterized by the collecting of books which have no use to the collector nor any great intrinsic value to a genuine book collector. The purchase of multiple copies of the same book and edition and the accumulation of books beyond possible capacity of use or enjoyment are frequent symptoms of bibliomania.

[edit] Digital hoarding

Digital hoarding involves collecting files on ones computer beyond the point of usefulness. Often, files can be acquired through Internet piracy at no monetary cost, leading to extraordinarily large collections. Examples include music collections, often beyond what ones enjoys or can listen to, and television shows, movies, and computer games. Hoarders, or "digital pack rats",[6] often resort to buying optical media or new hard drives[7] to store their collections, rather than deleting what they may never use. Digital hoarders find it just as difficult to press delete as traditional hoarders find throwing items in the trash can, have the same feeling of clutter and chaos, feel that they might find the item useful "someday," and similarly spend large amounts of time acquiring and organizing their collections.[8] Scientific American remarked that humanity's propensity for data collection is growing at a rate faster than their ability to store it.[9]

[edit] Animal hoarding

Animal hoarding involves keeping higher than usual numbers of animals as pets without having the ability to properly house or care for them, while at the same time denying this inability. Compulsive animal hoarding can be characterized as a symptom of obsessive-compulsive disorder rather than deliberate cruelty towards animals. Hoarders are deeply attached to their pets, and find it extremely difficult to let the pets go. They typically cannot comprehend that they are harming their pets by failing to provide them with proper care. Hoarders tend to believe that they provide the right amount of care for their pets. The American Society for the Prevention of Cruelty to Animals provides a "Hoarding Prevention Team", which works with hoarders to help them attain a manageable and healthy number of pets.[10] Along with other compulsive hoarding behaviours, it is linked in the DSM-IV to obsessive-compulsive disorder and obsessive-compulsive personality disorder.[11] Alternatively, animal hoarding could be related to addiction, dementia, or even focal delusion.[12]

Animal hoarders display symptoms of delusional disorder in that they have a “belief system out of touch with reality”.[13] Virtually all hoarders lack insight into the extent of deterioration in their habitations and on the health of their animals, refusing to acknowledge that anything is wrong.[14] Delusional disorder is an effective model in that it offers an explanation of hoarder’s apparent blindness to the realities of their situations. Another model that has been suggested to explain animal hoarding is attachment disorder, which is primarily caused by poor parent-child relationships during childhood.[15] As a result, those suffering from attachment disorder may turn to possessions, such as animals, to fill their need for a loving relationship. Interviews with animal hoarders have revealed that often hoarders experienced domestic trauma in childhood, providing evidence for this model.[15] Perhaps the strongest psychological model put forward to explain animal hoarding is obsessive-compulsive disorder (OCD).

[edit] Physiology and treatment

Brain imaging studies (PET) have shown that the cerebral glucose metabolism patterns seen in OCD hoarders were distinct from the patterns in non-hoarding OCD. The most notable difference in these patterns was the decreased activity of the dorsal anterior cingulated gyrus, a part of the brain that is responsible for focus, attention, and decision making.[16] A 2004 University of Iowa study found that damage to the frontal lobes of the brain can lead to poor judgment and emotional disturbances, while damage to the right medial prefrontal cortex of the brain tends to cause compulsive hoarding. [17]

OCD disorders are treated with various antidepressants: from the Tricyclic antidepressant family clomipramine (brand name Anafranil); and from the SSRI families paroxetine (Paxil), fluoxetine (Prozac), fluvoxamine (Luvox), sertraline (Zoloft), and citalopram (Celexa). With existing drug therapy OCD symptoms can be controlled, but not cured. Several of these compounds have been tested successfully in conjunction with OCD hoarding, but paroxetine in particular is indicated for treatment of compulsive hoarding.[18] A 2006 study of this usage of the drug to treat compulsive hoarding was conducted by the University of California, San Diego. OCD disorders are also treated with psychotherapy.

[edit] See also

[edit] References

  1. ^ Steketee, G,; Frost, R. (2003). Compulsive hoarding: Current status of the research. Clinical Psychology Review, 23 (7), 905-27.
  2. ^ Frost, R.O.; Hartl, T.L. (1996). A cognitive-behavioral model of compulsive hoarding. Behavior Research and Therapy, 34 (4), 341-50.
  3. ^ Hartl, T.L.; Frost, R.O. (1999). Cognitive-behavioral treatment of compulsive hoarding: a multiple baseline experimental case study. Behavior Research and Therapy, 37 (5), 451-61.
  4. ^ Steketee, G,; Frost, R. (2003). Compulsive hoarding: Current status of the research. Clinical Psychology Review, 23 (7), 905-27.
  5. ^ Hartl TL, Duffany SR, Allen GJ, Steketee G, Frost RO (2005). "Relationships among compulsive hoarding, trauma, and attention-deficit/hyperactivity disorder". Behaviour research and therapy 43 (2): 269–76. doi:10.1016/j.brat.2004.02.002. PMID 15629755. 
  6. ^ http://pqasb.pqarchiver.com/chicagotribune/access/687143721.html?dids=687143721:687143721&FMT=ABS Chicago Tribune (September 1, 2004) — Information overload ; Digital pack rats get bogged down by clutter
  7. ^ http://query.nytimes.com/gst/fullpage.html?res=9505EFDA1E38F937A15752C0A9639C8B63
  8. ^ http://www.npr.org/templates/story/story.php?storyId=10238217
  9. ^ http://www.computerworld.com/action/article.do?command=viewArticleBasic&articleId=9000409
  10. ^ Hoarding of Animals Research Consortium (HARC) (2004). "Commonly asked questions about hoarding". http://www.tufts.edu/vet/cfa/hoarding/abthoard.htm. 
  11. ^ "Mental health issues and animal hoarding". http://www.tufts.edu/vet/cfa/hoarding/mental.htm. 
  12. ^ Berry, Colin, M.S., Gary Patronek, V.M.D., Ph.D., and Randall Lockwood, Ph.D.. "Long-Term Outcomes in Animal Hoarding Cases" (PDF). http://www.tufts.edu/vet/cfa/hoarding/pubs/berry.pdf. 
  13. ^ Patronek, Gary. “The Problem of Animal Hoarding.” Animal Law May/June 2001: 6-9, 19.
  14. ^ Arluke, Arnie; et al. (2002-05). "Health Implications of Animal Hoarding". Health & Social Work 27 (2): 125. 
  15. ^ a b Frost, Randy (2000). "People Who Hoard Animals". Psychiatric Times 17 (4). 
  16. ^ Cerebra Glucose Metabolism in Compulsive Hoarding.
  17. ^ Univ. of Iowa on brain's cortex and compulsive hoarding.
  18. ^ Paxil treats Compulsive Hoarding

[edit] External links

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