CHAPTER ONE – WHAT IS HOARDING?
This chapter describes what hoarding is, summarising its key elements
In reading this book, it will be helpful to have a clear idea of the basics of what hoarding is.
What hoarding encompasses
Hoarding is the persistent difficulty discarding or parting with possessions, regardless of their actual value. Hoarding can be related to compulsive buying (such as never passing up a bargain), the compulsive acquisition of free items (such as collecting flyers), or the compulsive search for perfect or unique items (which may not appear to others as unique, such as an old container).
Hoarding can also encompass a specific habit such as the collection of newspapers or animals, but this should not be mistaken with collecting. In the majority of cases where animals are the animate object hoarded, they are found dead or severely ill.
In general, collectors have a sense of pride about their possessions and they experience joy in displaying and talking about them. They usually keep their collection organized, feel satisfaction when adding to it, and budget their time and money.
In contrast, hoarders tend to experience embarrassment about their possessions and feel uncomfortable when others see them, even though this may not seem obvious to the onlooker. They have clutter, often at the expense of liveable space, feel sad or ashamed after acquiring additional items, and they are often in debt.
Someone who hoards may exhibit the following[1]:
- Inability to throw away possessions. The persistent difficulty with discarding or parting with possessions regardless of value is often due to a perceived need to save the items and distress is associated with discarding them;
- Severe anxiety when attempting to discard items;
- Great difficulty categorising or organising possessions;
- Indecision about what to keep or where to put things;
- Distress, such as feeling overwhelmed or embarrassed by possessions and, or alternatively, impair the social, occupational or other areas of the person’s functioning;
- Suspicion of other people touching items;
- Obsessive thoughts and actions: fear of running out of an item or of needing it in the future; checking the rubbish for accidentally discarded objects;
- Functional impairments, including loss of living space, social isolation, family or marital discord, financial difficulties, health hazards.
These symptoms often result in accumulation and, or alternatively, clutter congesting living areas precluding activities for which those spaces were designed, compromising the use of those areas. It is not uncommon for the affected areas to only be cleared and made cleaner because of the involvement of a third party.
The World Health Organisation (‘WHO’) finally announced recognition of hoarding as a disorder in June 2018. On 18 June 2018, the WHO released its new International Classification of Diseases (ICD-11)25. ICD-11 was presented at the World Health Assembly in May 2019 for adoption by Member States to come into effect on 1 January 2022. That definition is:
“Hoarding disorder is characterised by accumulation of possessions due to excessive acquisition of or difficulty discarding possessions, regardless of their actual value. Excessive acquisition is characterized by repetitive urges or behaviours related to amassing or buying items. Difficulty discarding possessions is characterized by a perceived need to save items and distress associated with discarding them. Accumulation of possessions results in living spaces becoming cluttered to the point that their use or safety is compromised. The symptoms result in significant distress or significant impairment in personal, family, social, educational, occupational or other important areas of functioning.”
Symptoms and Mental Illness
Hoarding is a disorder that may be present on its own or as a symptom of another disorder. Those most often associated with hoarding are obsessive-compulsive personality disorder (‘OCPD’), obsessive-compulsive disorder (‘OCD’), attention-deficit/hyperactivity disorder (‘ADHD’), and depression.
Hoarding is occasionally associated with eating disorders, pica (eating non-food materials), Prader-Willi syndrome, psychosis or dementia[2].
Compulsive Hoarding
Compulsive hoarding is
“(1) the acquisition of, and failure to discard, possessions which appear to be useless or of limited value. (2) living spaces sufficiently cluttered so as to preclude activities for which those spaces were designed; and (3) significant distress or impairment in functioning caused by the hoarding’’ (p. 341)[3]”.
Therefore, there are three symptoms:
- Excessive acquisition of possessions;
- Difficulty discarding – placing of higher values on possessions;
- Clutter that prevents normal use of living spaces.
The causes of hoarding are not fully known. Some people start hoarding after a stressful change, such as bereavement or illness. It may be connected to a trauma, including as far back as childhood. Individuals that are reclusive or a perfectionist, may also be more susceptible.
Obsessive Compulsive Disorder (‘OCD’)
Compulsive hoarding occurs in 20–30% of OCD patients[4].
OCD is a form of anxiety disorder characterised by obsessions (recurring thoughts or images that cause distress) or compulsions (repetitive behaviours) or, both.
- Obsessions include fears of being contaminated by germs or causing of harm to oneself or others;
- Compulsions, on the other hand, can be acts or rituals such as repeatedly checking or washing and putting objects into order.
Hoarding is a sub-type of OCD. The cognitive-behavioural theory of OCD is based on the idea that distorted beliefs, assumptions and thoughts can give rise to feelings of anxiety and distress and if a person responds to these unpleasant feelings, avoidance and/or rituals build up over time.
This often means that hoarders (and particularly those with OCD) have:
- Problems making decisions – this includes deciding whether keeping something is of benefit or not;
- A tendency to be a perfectionist because whatever decision is made must be right but because this is not possible, for fear of the consequences, the object/s are kept, thereby avoiding the need to make a decision. Procrastination becomes commonplace;
- Emotional attachment – sentimental attachment is not uncommon even if the object/s in question appear to the onlooker to be of little functional value. For the individual hoarder, however, the object/s may feel a part of who they are, their identity or provide them comfort;
- Distorted beliefs such as feeling responsible for not wasting things and for using objects properly. They cannot bear to dispose of it because of the belief that they might need it tomorrow or some other day or time in the future, however far into the future that might be.
Can there be a pre-disposition to hoard?
Hoarding behaviour can run in families but whether this is genetic or a learnt behaviour is unknown[5].
It can stem from a loss of a loved one, loss of a pet, ill treatment in the workplace, to name just a few.
Physiologically, the regions of the brain associated with hoarding are the anterior cingulate cortex (‘ACC’) and associated areas. The dorsal ACC is associated with decision making. The ventral ACC concerns motional and motivational salience and experiences[6]. ACC activation is lower in hoarding individuals than in healthy individuals[7].
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[1] Frost R.O. & Steketee G. (1999). Issues in the treatment of compulsive hoarding. Cognitive and Behavioural Practice, 6, 397-407
[2]Hoarding has been observed in a number of other disorders including schizophrenia, anorexia, organic mental disorders, and depression.
[3]Frost R.O. & Gross R.C. (1993). The hoarding of possessions. Behaviour Research & Therapy, 31, 367-381.
[4] Frost R.O. & Steketee G. (1999). Issues in the treatment of compulsive hoarding. Cognitive and Behavioural Practice, 6, 397-407
[5] Winsberg M.E, Cassic K.S. & Koran L.M. (1999). Hoarding in obsessive-compulsive disorder and related disorders: a report of 20 cases. Journal of Clinical Psychiatry, 60, 591- 597
[6] Grisham JR, Baldwin PA. Neuropsychological and neurophysiological insights into hoarding disorder. Neuropsychiatr Dis Treat. 2015;11:951–962
[7] Tolin DF, Stevens MC, Villavicencio AL, et al. Neural mechanisms of decision making in hoarding disorder. Arch Gen Psychiatry. 2012;69:832-84