DSM Hoarding Disorder

Hoarding Disorder
The work group is recommending that this be included in DSM-5 but is still examining the evidence as to whether inclusion is merited in the main manual or in an Appendix for Further Research.

-Persistent difficulty discarding or parting with personal possessions, even those of apparently useless or limited value, due to strong urges to save items, distress, and/or indecision associated with discarding.

-The symptoms result in the accumulation of a large number of possessions that fill up and clutter the active living areas of the home, workplace, or other personal surroundings (e.g., office, vehicle, yard) and prevent normal use of the space. If all living areas are uncluttered, it is only because of others’ efforts (e.g., family members, authorities) to keep these areas free of possessions.

-The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others).

-The hoarding symptoms are not due to a general medical condition (e.g., brain injury, cerebrovascular disease).

-The hoarding symptoms are not restricted to the symptoms of another mental disorder (e.g., hoarding due to obsessions in Obsessive-Compulsive Disorder, lack of motivation in Major Depressive Disorder, delusions in Schizophrenia or another Psychotic Disorder, cognitive deficits in Dementia, restricted interests in Autistic Disorder, food storing in Prader-Willi Syndrome).

Specify if:
With Excessive Acquisition: If symptoms are accompanied by excessive collecting or buying or stealing of items that are not needed or for which there is no available space.

Specify whether hoarding beliefs and behaviors are currently characterized by:
Good or fair insight: Recognizes that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are problematic।

Poor insight: Mostly convinced that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are not problematic despite evidence to the contrary।

Delusional: Completely convinced that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are not problematic despite evidence to the contrary..." Link

American Psychiatric Association: DSM-5 Development

Proposed Revisions

301.4 Obsessive-Compulsive Personality Disorder

The work group is recommending that this disorder be reforumulated as the Obsessive-Compulsive Type.

Individuals who match this personality disorder type are ruled by their need for order, precision, and perfection. Activities are conducted in super-methodical and overly detailed ways. They have intense concerns with time, punctuality, schedules, and rules. Affected individuals exhibit an overdeveloped sense of duty and obligation, and a need to try to complete all tasks thoroughly and meticulously. The need to try to do things perfectly may result in a paralysis of indecision, as the pros and cons of alternatives are weighed, such that important tasks may not ever be completed. Tasks, problems, and people are approached rigidly, and there is limited capacity to adapt to changing demands or circumstances. For the most part, strong emotions – both positive (e.g., love) and negative (e.g., anger) – are not consciously experienced or expressed. At times, however, the individual may show significant insecurity, lack of self confidence, and anxiety subsequent to guilt or shame over real or perceived deficiencies or failures.Additionally, individuals with this type are controlling of others, competitive with them, and critical of them. They are conflicted about authority (e.g., they may feel they must submit to it or rebel against it), prone to get into power struggles either overtly or covertly, and act self-righteous or moralistic. They are unable to appreciate or understand the ideas, emotions, and behaviors of other people.

Instructions

A. Type rating. Rate the patient’s personality using the 5-point rating scale shown below. Circle the number that best describes the patient’s personality.

5 = Very Good Match: patient exemplifies this type

4 = Good Match: patient significantly resembles this type

3 = Moderate Match: patient has prominent features of this type

2 = Slight Match: patient has minor features of this type

1 = No Match: description does not apply

B. Trait ratings. Rate extent to which the following traits associated with the Obsessive-Compulsive Type are descriptive of the patient using this four-point scale:

0 = Very little or not at all descriptive

1 = Mildly descriptive

2 = Moderately descriptive

3 = Extremely descriptive

1. Compulsivity: Perfectionism

Insistence on everything being flawless, without errors or faults, including own and others’ performance; conviction that reality should conform to one’s own ideal vision; holding oneself and others to unrealistically high standards; sacrificing of timeliness to ensure every detail is correct

2. Compulsivity: Rigidity

Being rule- and habit-governed; belief that there is only one right way to do things; insistence on an unchanging routine; difficulty adapting behaviors to changing circumstances; processing of information on the basis of fixed ideas and expectations; difficulty changing ideas and/or viewpoint, even with overwhelming contrary evidence

3. Compulsivity: Orderliness

Need for order and structure; insistence on everything having a correct place or order and on keeping them so; intolerance of things being “out of place”; concern with details, lists, arrangements, schedules

4. Compulsivity: Perseveration

Persistence at tasks long after behavior has ceased to be functional or effective; belief that lack of success is due solely to lack of effort or skill; continuance of the same behavior despite repeated failures.

5. Negative Emotionality: Anxiousness

Feelings of nervousness, tenseness, and/or being on edge; worry about past unpleasant experiences and future negative possibilities; feeling fearful and threatened by uncertainty

6. Negative Emotionality: Pessimism

Having a negative outlook on life; focusing on and accentuating the worst aspects of current circumstances; expecting the worst outcome

7. Negative Emotionality: Guilt/shame

Having frequent and persistent feelings of guilt/ shame/ blameworthiness, even over minor matters; believing one deserves punishment for wrongdoing

8. Introversion: Restricted Affectivity

Lack of emotional experience and display; emotional reactions, when evident, are shallow and transitory; unemotional, even in normally emotionally arousing situations

9. Antagonism: Oppositionality

Displaying defiance by refusing to cooperate with requests, meet obligations, or complete tasks; behavioral resistance to performance expectations; resentment and undermining of authority figures

Obsessive-Compulsive Personality Disorder

A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

(1) is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost

(2) shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met)

(3) is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity)

(4) is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification)

(5) is unable to discard worn-out or worthless objects even when they have no sentimental value

(6) is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things

(7) adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes

(8) shows rigidity and stubbornness

More

The process:

DSM-5: The Future of Psychiatric Diagnosis

Publication of the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in May 2013 will mark one the most anticipated events in the mental health field. As part of the development process, the preliminary draft revisions to the current diagnostic criteria for psychiatric diagnoses are now available for public review and comment. We thank you for your interest in DSM-5 and hope that you use this opportunity not only to learn more about the proposed changes in DSM-5, but also about its history, its impact, and its developers. Please continue to check this site for updates to criteria and for more information about the development process...." More