US Pharm. 2013;38(11):17-18.
Compulsive or Pathological Collecting
Hoarding is defined as collecting too many things and being unable to part with them. Hoarding becomes a disorder when the amount of disorganized clutter interferes with a person’s health or ability to function in his or her daily activities. People who compulsively hoard often isolate themselves in dangerous conditions. Fire and health risks result from piles of clutter. Homes become unlivable because doorways are blocked or there are no paths to move through rooms.
This disorder is a serious psychological problem that has recently been recognized as a treatable condition. Cognitive behavioral therapy and medications that increase brain serotonin, such as antidepressants, can help people who are suffering from hoarding disorder understand the danger of hoarding and help them function again.
An Intense Emotional Attachment to Objects
Although hoarders are sometimes thought of as frugal or lazy, a person with hoarding disorder is usually neither. Hoarding goes beyond having too many possessions or collecting things as a hobby.
What Is Hoarding?
People with hoarding disorder look at possessions differently. They may think it is wasteful to part with items they might need or worry about discarding an item that might be valuable someday. The objects they hoard may remind them of a person dear to them, or a happier time in their lives. They may fear losing important information, or they may simply enjoy something about the objects they keep. Hoarding often involves saving items that are usually thrown away such as newspapers or containers, but hoarded objects can be anything—including animals. The common theme of hoarding is the urge or compulsion to find or buy the object and the comfort of keeping it.
People with hoarding disorder may not be able to leave the house, isolating themselves from others to avoid conflict. They may be so disorganized that it is hard for them to be responsible for duties such as paying their bills. Hoarders often live with dangerously unsanitary conditions, in bug- or rodent-infested homes, or with fire hazards.
Although hoarding was once considered a type of obsessive-compulsive disorder (OCD), doctors now recognize it as a separate disorder. About one-fourth of people with hoarding disorder also have OCD, but hoarders often have other problems, such as attention-deficit/hyperactivity disorder (ADHD), depression, anxiety, or alcoholism. They are more likely to have a family member with hoarding disorder, so there may be a genetic link, as well as an influence from their childhood surroundings.
Researchers believe that there may be two types of hoarding disorder. Hoarding that begins in childhood or adolescence is more likely related to OCD, with symptoms of anxiety temporarily relieved by saving things. In older adults, hoarding may begin with a traumatic life experience, such as divorce or the death of a family member. It may be accompanied by heavy alcohol use. Hoarding may cause a person to become socially isolated to avoid conflicts or embarrassment, or it may begin as a comfort to a person who is lonely and isolated.
Overcoming Denial and Getting Help
Often, individuals with hoarding disorder do not recognize that they have a problem. A relative or friend may try to seek help from a doctor, psychologist, or other healthcare provider on their behalf. Getting people with hoarding disorder to accept their condition and become motivated to change is often difficult. Once a hoarder accepts help, the right therapy can begin.
Cognitive behavioral therapy (CBT) is used to teach people about hoarding and to gradually train hoarders to resist the urge to save things. With the help of CBT, hoarders learn to make sensible decisions and to eventually throw out or give away things as they organize the possessions they decide to keep. Medications that increase brain serotonin (called selective serotonin reuptake inhibitors, or SSRIs) can help make CBT therapy more effective. Hoarders often have other psychological problems that should be identified and treated for the most successful outcome.
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