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See Inside Scientific American Mind Volume 24, Issue 4

Hoarding Can Be a Deadly Business

If parting with possessions is a serious problem, you can now be officially diagnosed with hoarding disorder



KATY LEMAY

Stuff, stuff and more stuff. Many of us love to buy and keep things, even when the items are not useful. About 70 percent of children amass collections of favored objects, such as coins, dolls or baseball cards; many adults do the same. People often regard possessions as extensions of themselves and become attached to them accordingly.

Yet in rare cases, the habit of gathering and retaining things reaches unhealthy extremes, culminating in hoarding disorder, a condition that is poorly understood. Many laypeople believe that clinical hoarders are too lazy to discard their junk or that they enjoy living with it. Neither of those assumptions appears to be true. Moreover, most experts have long assumed that extreme hoarding is a variant of obsessive-compulsive disorder (OCD), even though most recent research suggests otherwise. Instead the ailment may stem from an exaggerated version of a basically adaptive tendency to accumulate materials that are important to us.

Distinct Pathology

Nikolai Gogol's 1842 novel, Dead Souls, featured a character named Plyushkin, a landowner who saved almost everything he found. Sigmund Freud regarded hoarding as a symptom of what he termed the “anal character,” purportedly stemming from overly harsh toilet training. (Few psychologists today share this view.) In the early and mid-1990s, however, hoarding increasingly came to be recognized as a serious clinical problem. Systematic research criteria for pathological hoarding, introduced in 1993 by psychologist Randy O. Frost of Smith College, spread awareness of the malady, as did a parade of television documentaries and reality shows, such as Hoarders, Clean House and Hoarding: Buried Alive.

Until recently, most mental health professionals regarded pathological hoarding as a subtype of OCD. Hoarding was considered a compulsion—a repeated, ritualized action intended to ward off anxiety, such as checking the stove repeatedly to make sure that it is turned off. According to a 2010 review by psychologist David Mataix-Cols of King's College London, however, 80 percent or more of people who engage in extreme hoarding do not meet criteria for OCD. For example, many do not experience the obsessions—recurrent or intrusive thoughts, images or impulses—that are widespread in OCD. Moreover, hoarders tend to be poorer, older, and more prone to mood and anxiety disorders than those with OCD; they are also less likely than OCD sufferers to be aware that they are disordered.

In recognition of these differences, the fifth edition of the American Psychiatric Association's diagnostic manual (DSM-5), published this past May, for the first time included pathological hoarding as a distinct condition. According to this volume, “hoarding disorder” is characterized by extreme and enduring difficulties parting with possessions, even if they have no tangible value. The afflicted have powerful urges to retain items or become very upset about tossing them out. Their home or workplace is filled with so much clutter that the space is unusable—and their problems seriously impair their everyday functioning or cause distress. Before diagnosing hoarding disorder, clinicians must rule out medical conditions that can lead to hoarding. For instance, in a 1998 study psychiatrist Jen-Ping Hwang of the Veterans Administration of Taipei and his colleagues found that 23 percent of patients with dementia displayed clinically significant hoarding behavior.

Hoarding disorder appears to be present in between 2 and 5 percent of the population, making it more prevalent than schizophrenia. It afflicts men and women in about equal numbers. People most often hoard books, magazines, newspapers and clothes; in some cases, they accrue scores of shirts, pants and dresses that have never been removed from their packaging. More rarely, individuals stockpile animals. In one case in 2010 authorities found more than 150 cats living in a home in Powell, Wyo. Animal hoarders tend to be more psychologically impaired than other hoarders and live in more squalid conditions, according to a 2011 article by Frost and his colleagues.

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