Hoarding, a type of obsessive-compulsive disorder?

Collyer’s syndrome aka hoarding was named in honour of Homer and Langley Collyer, brothers who buried themselves in their family mansion in Harlem, fill­ing it with rubbish between WW1 until they both died in 1947, buried under junk. By mid century, as the post-WW2 econ­om­ic boom enabled people of modest means to acquire heaps of objects, Collyer’s syndrome became more wide­spread.

If the compulsive hoarding of useless things seemed to be noticed only since WW1, and primarily the last few de­cades, something must have changed in history and cul­t­ure. For those who hoarded them, ob­jects took on individual person­alities with oversized emotional signif­ic­ance. The objects couldn’t be cas­ually discarded; if they were discarded by others, the hoarder suffered terrible distress.

 

The lounge room has disappeared under the rubbish
Vancouver

Preparing food, washing dishes and eating at the kitchen table

are impossible under the rubbish. 
Searcy, Arkansas

Acquisition was the first half of the disorder. People loved the rubbish they didn’t immediately need becausea.it was free,
b.it re­minded them of a particular experience,
c.they might need it some­day,
d.it might become valuable in the future or
e.the hoarder didn’t want to be cont­rolled by others.

Even if they would have liked to downsize, hoarders faced the over­whelming diff­iculty of sorting their mess. They tended to be easily distracted and couldn’t concentrate. And they put off making decisions, rather than risk making wrong decisions. Yet they had a deep aversion to others helping or sifting through the piles.

Was the hoarding disorder really increasing or was an inc­rease in media coverage simply boosting public awareness? The first task force that formed in 1989 estimated 19 mil­lion Americans hoarded. And now there are 100+ such organisations in the USA. 

The disorder occasionally showed up in adolescence, but it usually intensified in older age, made worse by divorce, bereavement, poor thinking or financial crisis. 65+ was the prime age for hoard­ing, the very point where people were losing their indep­endence, work, status, connect­ions, sensory acuity, physical strength and mental sharp­ness. Hoarding was one way an older person shored himself up. 

A hoarding industry has sprung up: psychologists, social workers, public health workers, professional org­anisers, fire marshals, bio-hazard cleaners and haulers. The workers found that the hoarders might have been intelligent, well-educated and creative, but they did NOT want to be sorted out. Even where city offic­ials had for­c­ed a cleanup, the house had filled up again soon after it had been emptied.

Clearly most hoarders didn’t see their own behaviour as disordered, and or­iginally psychology didn’t either. Only in 2013 was the key Diag­nostic and Statistical Manual of Mental Disorders/DSM revised to list sev­ere hoarding as a disorder in its own right. According to this Manual, hoarding was diagnosed when the criteria below were met (American Psychiatric Association, 2013):

1.Hoarder had ongoing difficulty throwing out or giving away poss­essions, even if the objects were largely useless.

2.The sufferers had difficulty discarding possessions as they believed they needed to save them. They became very distressed when faced with the prospect of discarding them.

3.Hoarders ended up with too many possessions which caused con­gestion in the living areas of their home, office, car or garden. They built a wall of shame that blocked the entry of family, friends and trade­s­men.

4.The behaviour impaired hoarders’ ability to function at work, or to maintain a safe environment to live in. Crawling with rodents and cockroaches, covered in mould and bact­eria, these mounds were a health hazard and a fire hazard.

5.The hoarding was not attributable to another medical condition e.g. head injury, stroke.

6. The hoarding was not attributable to other psychiatric disorders.

Psych­ologists believed hoarding was a type of obsessive-compulsive disorder/OCD: repeated, ritualised action intended to ward off anxiety. That theory lasted for decades, even though clinical hoard­ing affected 6% of the world population, twice as many as OCD affected. Once the DSM listed severe hoarding as a disorder apart from obsessive-compulsive disorder, psychologists were asking what explained its prevalence.

Most people who engaged in extreme hoarding didn’t meet the crit­eria for OCD. They were more prone to depress­ion than those with OCD, and they had more difficulty making decis­ions. Worst of all they had little awareness of their own destructive behaviour. Genetic link­age studies showed a different pattern of inheritance from OCD, and brain scans showed a different pattern of activation. Drugs successful in treating OCD were ineffective for hoarding!

In 2013 hoarding disorder was freed from the OCD categ­ory, but could have been connected to an array of causes. In families with two or more members who hoarded, researchers identified an allele on chromosome 14. 80%+ of the subjects reported a first-degree rel­at­ive with similar prob­l­ems. See Randy Frost and Gail Stek­etee’s book Stuff: Compul­sive Hoarding and the Meaning of Things.

Sleeping by the hoarder and his family takes place wherever space is available
Singapore

In countries with large yards, the hoarding can spread out to the verandas and gardens
Bondi, Sydney

Other studies suggested non-genetic causes. Hoarding could acc­omp­any certain traumatic brain injuries, Tourette’s syndrome, ADHD, neuro-degenerative disorders, generalised anxiety disorder, clinic­al depression and dementia. Note that childhood poverty did not seem to be connected with hoarding. But resear­ch­ers found a possible link between hoarding and PTSD among Holocaust surviv­ors; late-onset hoarding was often linked to loss or trauma. The psych­ol­ogical thesis was that objects were gath­ered in a fut­ile attempt to fill emotional emptiness, piled up like a protective bar­r­icade.

Cognitive behavioural therapy was a commonly employed treatment for hoarding disorder. Anxiety Treatment Australia stated the aims of therapy thus: to
Decrease clutter
Improve the client’s decision-making re their belongings
Improve the hoarder’s organisational skills re their belongings
Increase the client’s resistance to the urge to save objects.

Suggested treatments that did not require professional intervention included:

Hoarders must cease subscribing to magazines and to put a “no junk mail”‘ notice on their letter box.

Hoarders must develop a schedule in activities previously avoided eg washing, emptying rubbish.
Sufferers will use relaxation skills, since discarding belongings can trigger anxiety.

Hoarders will keep a daily log of every time they acquire or purchase something so they can identify their triggers.

For properly assessed, professional treatment programmes, read the Treatments for Hoarding Behaviours in ResearchGate.

I encourage readers to see Hoarders, the successful American reality tv programme that debuted on A&E in Aug 2009.