Refining the diagnostic boundaries of compulsive hoarding: A critical review

By: Alberto Pertusa , Randy O. Frost, Miguel A. Fullana, Jack Samuels, Gail Steketee, David Tolin, Sanjaya Saxena, James F. Leckman, David Mataix-Cols

Abstract:
Like most human behaviors, saving and collecting possessions can range from totally normal and adaptive to excessive or pathological. Hoarding, or compulsive hoarding, are some of the more commonly used terms to refer to this excessive form of collectionism. Hoarding is highly prevalent and, when severe, it is associated with substantial functional disability and represents a great burden for the sufferers, their families, and society in general. It is generally considered difficult to treat. Hoarding can occur in the context of a variety of neurological and psychiatric conditions. Although it has frequently been considered a symptom (or symptom dimension) of obsessive–compulsive disorder, and is listed as one of the diagnostic criteria for obsessive– compulsive personality disorder, its diagnostic boundaries are still a matter of debate. Recent data suggest that compulsive hoarding can also be a standalone problem. Growing evidence from epidemiological, phenomenological, neurobiological, and treatment studies suggests that compulsive hoarding may be best classified as a discrete disorder with its own diagnostic criteria..." More

Too much clutter could signal danger

BY WEVONNEDA MINIS

When clutter in a home creates chaos, and the thought of eliminating some objects is overwhelming, there is a problem, experts say. A home should not contain so many acquisitions that they pose a serious risk of injury, illness or fire.

Those who live in residences where objects blanket floors, furniture and other areas have a problem, according to medical experts. Those people may say they hold onto items because they will be needed someday, but there is more to it than that.

"When they cannot bring themselves to part with emotional items such as pictures or clothing, it is not just a matter of them having too much clutter," says Dr. Olga Brawman-Mintzer, MUSC professor of psychiatry. When someone gets to the point where their acquiring and inability to dispose of things precludes them from normal daily activities, it is considered compulsive hoarding.

"It's a condition that many researchers have found has a genetic component," she says. "Environmental stressors may also play a role."

It's difficult to estimate the number of hoarders because they tend to live alone and do not entertain, say researchers in an article on WebMD. The Web site gives 2 million Americans as a ballpark figure.

The researchers are Randy Frost, Israel professor of psychology at Smith College in Massachusetts, and Dr. Sanjaya Saxena, associate professor of psychiatry, University of California San Diego School of Medicine, La Jolla.

Hoarding, a medical illness, is spotlighted by the popular A&E television show "Hoarders," which demonstrates that it's nearly impossible for them to part with belongings.

Within the spectrum of hoarders, there are a number of behaviors and symptoms, Brawman-Mintzer says. They have problems resisting the urge to acquire possessions and may frequent thrift stores or garage sales. They acquire multiples of the items and have difficulty parting with them..." More

Why People Hoard Stuff

Jane Collingswood

Is compulsive hoarding inherited?

People who compulsively acquire and hoard clutter to the extent that it impairs their daily activities are labeled "compulsive hoarders." The condition is classed as a subtype of obsessive-compulsive disorder (OCD), present in 30 to 40 percent of individuals affected with OCD. It may damage relationships, cut the individual off from society, and even endanger lives.

Compulsive hoarding is distinct from bad planning and disorganization because it is believed to be a pathological brain disorder. It is often a symptom of other disorders, such as impulse control disorder orattention-deficit hyperactivity disorder. Bereavement or another significant life event can trigger excessive hoarding behavior.

Hoarding often runs in families, but it is uncertain whether DNA is involved. "People with this problem tend to have a first-degree relative who also does," says Randy O. Frost, Ph.D., a psychologist at Smith College, Northampton, Massachusetts. "So it might be genetic, or it might be a modeling effect."

Gene research suggests that a region on chromosome 14 may be linked with compulsive hoarding in families with OCD. The study, carried out by a team from Johns Hopkins University School of Medicine in March 2007, analyzed samples from 999 OCD patients in 219 families. Families with two or more hoarding relatives showed a unique pattern on chromosome 14, whereas the other families' OCD was linked to chromosome 3.

This was the third study to find genetic markers specifically associated with compulsive hoarding, according to Sanjaya Saxena, M.D., director of the University of California, San Diego, Obsessive-Compulsive Disorders Program..." More