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There has always been an observed social stigma for people with mental illness. These people afflicted with psychological disorders are usually perceived as dangerous and could inflict gross injury or harm upon other people. According to Rosenberg (2013), “the odds will probably be greater than 50 percent, according to the new (Diagnostic and Statistical Manual (DSM)), that (people) have a mental disorder in one’s lifetime” (p. 1). In fact, the DSM-5 was noted to include fifteen (15) new mental disorders (Wieczner, 2013). As such, the subject of the current discourse would be a discussion of one of the new disorders, hoarding disorder. The presentation of information would be adhering the following structure: provision of an overview of the hoarding disorder, its background or history, signs and symptoms, complications, recommended treatment, contributions to the study of psychology, relevant case studies, and personal experience.
Definition and Understanding Hoarding Disorder
By virtue of the definition of the term, hoarding disorder is “the name of a psychiatric condition that produces symptoms such as the compulsive urge to acquire unusually large amounts of possessions and an inability to voluntarily get rid of those possessions, even when they have no practical usefulness or monetary value” (Elements Behavioral Health, 2013, p. 1).
As learned, hoarding is “is the persistent difficulty discarding or parting with possessions, regardless of their actual value. The behavior usually has deleterious effects—emotional, physical, social, financial, and even legal—for a hoarder and family members. For those who hoard, the quantity of their collected items sets them apart from other people. Commonly hoarded items may be newspapers, magazines, paper and plastic bags, cardboard boxes, photographs, household supplies, food, and clothing” (Anxiety and Depression Association of America, 2016). Moreover, for people who hoard, the causes for hoarding excessive number of items and objects were noted to range from considering items as having sentimental value; that these would be useful in the near future; that they feel safer when surrounded with these items; or that seeing them offered as a bargain was too good to refuse (Anxiety and Depression Association of America, 2016).
As emphasized, the hoarding disorder was previously thought of as inclusive of the obsessive-compulsive disorder (OCD). Accordingly, “people affected by OCD have symptoms that typically center on the presence of persistent mental fixations (i.e., obsessions), as well as the presence of compulsive behaviors or rituals that temporarily ease the strain caused by those fixations. According to this perspective, people who engage in hoarding, collecting and/or saving behaviors constitute one of the four potential sub-categories of OCD” (Elements Behavioral Health: Reasons for Creating Hoarding Disorder, 2013, par. 1). However, further evaluation of the symptoms and behavior of hoarders proved that there are disparities in manifestations of people diagnosed with OCD and with the hoarding disorder.
- Comparative Difference with OCD
A previous 2004 study that was published in the American Journal of Psychiatry revealed that the differences between people afflicted and diagnosed with OCD, especially in terms of awareness level, genetic characteristics and mode of treatment. As emphasized,
“From the hoarding perspective, examples of these differences include a relative lack of awareness regarding the condition’s real-world impact, a relative decline in overall mental function, and an increased likelihood of having co-occurring mental health conditions such as personality disorders, anxiety or depression. Compulsive hoarders also typically have certain genetic characteristics that clearly differentiate them from people with OCD. In addition, two of the treatments most commonly used to address the symptoms of OCD (a form of psychotherapy called cognitive behavioral therapy and antidepressant medications called SSRIs) don’t work very well in addressing the symptoms of compulsive hoarding” (Elements Behavioral Health: Reasons for Creating Hoarding Disorder, 2013, par. 2).
Moreover, it was explained that people diagnosed with OCD who might have exhibited tendencies to hoard manifested differences in terms of recognizing that the hoarding behavior was unpleasant or troublesome; that they do not show any genuine interest for the items that were accumulated; and that no further quests to acquire or accumulate items of excessive quantities have been allegedly exhibited (Elements Behavioral Health, 2013).
In sum, it was recognized that a separate classification of the hoarding disorder should be integrated in the DSM-5 and was officially incorporated as part of the DSM-5 on May 2013 (Wieczner, 2013).
Signs and Symptoms
The Mayo Clinic presented the signs and symptoms of hoarding to include the following:
- “Excessively acquiring items that are not needed or for which there’s no space
- Persistent difficulty throwing out or parting with your things, regardless of actual value
- Feeling a need to save these items, and being upset by the thought of discarding them
- Building up of clutter to the point where rooms become unusable
- Having a tendency toward indecisiveness, perfectionism, avoidance, procrastination, and problems with planning and organizing” (Mayo Clinic, 2017, p. 1).
People who manifested and exhibited tendencies for having contracted hoarding disorder could also have increased propensities to contract other complications of the illness. Due to the accumulated things that are piled up in limited spaces, there could be tendencies and risks for falls. Likewise, the pile of accumulated things could also fall and result to physical injury or even being trapped in the pile of items. Moreover, the afflicted person could actually encounter increased fights and conflicts with other members of the family; which could further lead to feelings of isolation and loneliness. In addition, there is obvious complication in terms of exposure to health hazards due to the state of unsanitary condition brought about by the accumulated items over time. Also, there is increased exposure to fire hazard stemming from disorderly pile of accumulated objects. Finally, there could be legal issues including eviction, especially when the accumulated items jeopardize the condition of a leased property or home.
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The recommended treatment for people diagnosed with the hoarding disorder are varied: psychotherapy and medications. The primary therapy, known as talk treatment should be applied; and cognitive behavior therapy was revealed as the most common form of psychotherapy to treat people with hoarding disorder (Mayo Clinic, 2017). The cognitive behavior therapy recommends patients with the disorder to adhere to the following:
- “Learn to identify and challenge thoughts and beliefs related to acquiring and saving items
- Learn to resist the urge to acquire more items
- Learn to organize and categorize possessions to help decide which ones to discard
- Improve decision-making and coping skills
- Declutter home during in-home visits by a therapist or professional organizer
- Learn to reduce isolation and increase social involvement with more meaningful activities
- Learn ways to enhance motivation for change
- Attend family or group therapy
- Have periodic visits or ongoing treatment to help keep up healthy habits” (Mayo Clinic: Diagnosis and Treatment, 2017, p. 1).
On the other hand, medications could also be administered, especially “a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs)” (Mayo Clinic: Diagnosis and Treatment, 2017, p. 1).
Contributions to the Study of Psychology
The inclusion of the hoarding disorder is a contribution to the study of psychology, especially in terms of recognizing how people afflicted with the illness could be treated with a more specialized and effective method. As indicated, “thanks to the DSM-5’s inclusion of “hoarding disorder” as a standalone diagnosis, doctors may be able to treat the condition with a pill… hoarding may have underlying neurobiological causes, which may mean that it can be treated with medication. Indeed, some DSM critics believe the creation of hoarding disorder could be driven by pharmaceutical interests” (Wieczner, 2013, p. 5).
A case study of a person afflicted with the hoarding disorder was published in the Royal College of Psychiatrists. A person, named George, in his 50s, was diagnosed with the illness. He allegedly started hoarding as a child when he was reportedly sent to boarding school at 10 years of age. His loneliness and longing for home led him to initially collect items from his home, like sweet wra.ppings (Royal College of Psychiatrists, 2017). Apparently, when his mother died, the hoarding illness progressed to appease his loneliness and missing his mother. Eventually, he accumulated too much of everything that his entire house was filled with items. He apparently could hardly move, walked in constrained spaces, slept in the living room chair, could not use his bathroom, and had to contend with rodents, insects, and pests.
It was noted that his family prodded George to seek professional help. He was given required therapy with SSSI medication (Royal College of Psychiatrists, 2017). Eventually, the report indicated that “after a year he had cleared his house. He organised repairs and hired a company to clean the whole house and get rid of the vermin. George was much happier. He was able to take up voluntary work and returned to education to re-establish his legal skills” (Royal College of Psychiatrists, 2017, p. 1).
Another case study of a famous personality who had hoarding disorder was Andy Warhol (Worrall, 2016). As reported, “the artist Andy Warhol, who likely had compulsive hoarding disorder, filled “time capsules” with decaying pizza, cheap watches, and wigs” (Worrall, 2016, p. 1). In addition, there was also a certain Lee Shuer who was also diagnosed as a compulsive hoarder (Jabr, 2013). Nevertheless, Jabr (2013) asserted that “neuroimaging studies and case reports have revealed divergent patterns of brain activity and various cognitive peculiarities common to many hoarders: The very act of deciding what to keep and what to throw away causes them great anxiety, for instance, and they form unusually strong emotional attachments to inanimate objects” (p. 1).
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There had been new treatments that were supposedly developed to address hoarding disorders. According to Jabr (2013), Buried Treasure workshops were designed specifically for hoarding patients. As explained, “in typical Buried in Treasures workshops, which are free, between eight and 12 participants complete many of the same exercises and homework assignments central to hoarding-specific CBT over a period of 20 weeks, guided by a peer ‘facilitator’” (Jabr, 2013, p. 1). The program allegedly have documented marked improvements by noted a decline in symptoms of hoarding by 22 to 27%, as well as improvement in more than 70% of the participants who joined the program (Jabr, 2013).
There was actually a long-distance aunt who could have manifested signs and symptoms of the hoarding disorder. She was living alone and had not married. As such, she does not have any companion, except for her cats. I remembered that when my mother (who was actually her second cousin) and I visited her more than ten (10) years ago, she had already started accumulating different items: from newspapers, milk cartons, old clothes of her relatives, knick knacks, and mixes of valuable and invaluable items. We can see from the living room, which was already starting to have piles of objects, that her bedroom was also filed with different sorts of items. My mother just asked why is it that she had to collect all of these stuff? To this, my auntie responded that she remembered that her mother used to save items for safekeeping; and that these saving of things actually helped them when World War II broke out. As such, she rationalized that there might be some emergency in the future, like war or natural disaster, and that she would sure be able to use all of these things for whatever purpose they could serve.
Just two (2) years ago, my mother informed me that this distant aunt already died. Her house was reportedly filled with accumulated items from ceiling to floor and in every room in the house. Just like George, my auntie apparently slept on a couch in the living room, still filled with items on areas where she does not sleep on. Allegedly, she contracted health complications, including respiratory and pulmonary illness for living in a congested house. Despite prodding to seek a professional, she allegedly refused to consult a doctor for fear that she would be recommended to give away all her stuff.
From the experience with my auntie, it was understood that she must have been exhibiting signs and symptoms of the hoarding disorder. However, her living in isolation and without any family member to support or assist her disabled access to much needed healthcare, especially to address the mental disorder.
The current discourse has successfully presented essential information about a mental illness, hoarding disorder, which was only recently included in the DSM-5. As disclosed, the hoarding disorder was initially categorized within the OCD; yet differences in awareness level, genetic characteristics and mode of treatment led to its inclusion as a separate disorder only in May of 2013. Defined as a psychiatric condition that produces symptoms such as the compulsive urge to acquire unusually large amounts of possessions and an inability to voluntarily get rid of those possessions, even when they have no practical usefulness or monetary value. The disorder exemplified a set of signs and symptoms that clearly separated it from other mental disorders; yet, manifested behavior could have contributed to challenges in diagnosing people afflicted with it. If left untreated or unattended, there could be complications in terms of increased risk of falls, potential injuries or risks of being trapped by shifting or falling items, encountering family conflicts, manifestation of loneliness and social isolation, presence of unsanitary conditions that pose a risk to health, increasing propensities to encountering fire hazards, exposure to poor work performance, and risks of encountering legal issues, such as eviction.
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Concurrently, cognitive behavior therapy (CBT) was the primary treatment method that was noted, in conjunction with administration of selective serotonin reuptake inhibitors (SSRIs). A new therapy through the Buried Treasure program was revealed to be effective. Nevertheless, case studies have been presented to affirm the experiences of people who were diagnosed with the illness. A famous personality, Andy Warhol, was also identified to have hoarding disorder.
In retrospect, the information gathered of the hoarding disorder confirmed that if and when diagnosed accurately, effective treatment methods could be recommended which would facilitate the recovery process. Just like other mental illnesses, the hoarding disorder could elicit social stigma. However, its inclusion in the DSM-5 attests that psychiatrists have exerted time and resources for evaluating the illness in order to ensure that patients diagnosed with it would have greater chances for speedy recovery. From the case studies that were presented, in conjunction with personal experiences, one affirms that people afflicted with the hoarding disorder should not be embarrassed or ashamed of what other people would say. Professionals have gained expertise to ensure that proper treatment is accorded, as needed.
- Anxiety and Depression Association of America. (2016). Hoarding: The Basics.
- Elements Behavioral Health. (2013, May 3). DSM-V: Hoarding New Mental-Disorder Diagnoses.
- Jabr, F. (2013, February 25). Compulsive Hoarders.
- Mayo Clinic. (2017, May). Hoarding disorder.
- Rosenberg, R. S. (2013, April 12). Abnormal Is the New Normal.
- Royal College of Psychiatrists. (2017). Hoarding.
- Wieczner, J. (2013, May 25). 15 new mental illnesses in the DSM-5.
- Worrall, S. (2016, April 9). The Troubled Minds of the Rich and Famous.