Hoarding disorder, also known as compulsive hoarding, is characterized by an excessive collecting or saving of items that leads - in contrast to “ordinary collecting” - to an increasing level of disarray in the living and/or work spaces of those affected, to an increasing level of dysfunction in social and/or occupational areas, and to an increasing disability.
Having to discard some or all of the hoarded items leads in those affected to a high level of discomfort. Even the thought of parting with some of these objects leads in persons with hoarding disorder to an aversive emotional response, e.g. dysphoric mood, anxiety, or irritability.
Most of the hoarded items might be viewed as worthless by other persons, but the persons affected by hoarding disorder experience an overwhelming need to keep those items - either because they might need them in the future and/or might feel uncomfortable or insecure without those items.
Hoarding Disorder: Prevalence
The prevalence of hoarding disorder has been estimated to be about 2 to 5% in the general population.
Hoarding Disorder: Symptoms
Symptoms of hoarding disorder include
- Excessive collecting or saving of items of everyday use.
- Aversive emotional responses, e.g. dysphoric mood, anxiety, or irritability, when being confronted with the idea of having to discard some of the objects hoarded.
- Tolerance with a continuing increase in hoarding activities to achieve the same level of satisfaction.
- Difficulties to control hoarding, with a persistent desire and/or unsuccessful attempts to control, cut back or discontinue the compulsive hoarding.
- Disregard of the harmful consequences of compulsive hoarding, with continued excessive hoarding despite the knowledge of having persistent or recurrent psychological or social problems likely to have been caused or exacerbated by the compulsive hoarding.
- Alleviation of aversive emotions, e.g. feelings of helplessness, loneliness or anxiety, as a (short-term) result of the compulsive hoarding.
- Loss of social contacts, interests, previous hobbies, etc. as a (long-term) result of the compulsive hoarding.
- Deception of family members, friends, therapist, etc. - and oneself - about the actual level of compulsive hoarding.
Hoarding Disorder: Diagnosis
Hoarding disorder is characterized by the following signs and symptoms:
- Difficulties discarding items because of a strong perceived need to save these items and/or distress associated with discarding these items.
- Accumulation of a large number of items that congest areas of the home or workplace to the extent that their intended use is no longer possible or substantially impaired.
- The compulsive hoarding causes clinically significant distress or impairment in social, occupational or other important areas of function, including maintaining a safe environment for oneself and others.
- The compulsive hoarding is not better explained by another medical condition or better accounted for by the symptoms of another mental disorder, e.g. bipolar affective disorder or psychotic disorders.
Hoarding Disorder: DSM-5 300.3
The American Psychiatric Association (APA) included Hoarding Disorder as a discrete disorder in the 5th revision of the Diagnostic and Statistical Manual of Mental Disorders, DSM-5 (300.3).
Hoarding Disorder: ICD-11 6B44
The World Health Organization (WHO) is planning to include Hoarding Disorder in the 11th revision of the International Classification of Diseases, ICD-11 (ICD-11 Beta Draft: hoarding disorder 6B44).
Hoarding Disorder: Treatment
In the treatment of hoarding disorder psychotherapy, especially Cognitive Behavioral Therapy (CBT), and medication might be effective.