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Hoarding Disorder

by Katharine A. Phillips, MD, Dan J. Stein, MD, PhD

Hoarding disorder is characterized by persistent difficulty discarding or parting with possessions, regardless of their actual value. This difficulty results in the accumulation of possessions that congest and clutter living areas to the point that the intended use of the areas is substantially compromised.

Hoarding disorder often begins at a mild level during adolescence and gradually worsens with age, causing clinically significant impairment by the mid-30s. At any given point in time, an estimated 2 to 6% of people have this disorder.

Symptoms and Signs

The disorder is typically chronic, with little or no waxing and waning of symptoms or spontaneous remission. Patients have a strong need to save items, and they experience significant distress when parting with the items or contemplating parting with them. Patients accumulate a large number of items for which they have inadequate space; the items congest and clutter the living space so much that large areas become unusable, except for storing hoarded items. For example, stacks of hoarded newspapers may fill the sink and cover the countertops and stove in the kitchen, preventing these areas from being used to prepare meals.

Animal hoarding is a form of hoarding disorder in which patients accumulate a large number of animals and do not provide adequate nutrition, sanitation, and veterinary care despite deterioration of the animals (eg, weight loss, illness) and/or environment (eg, extreme overcrowding, highly unsanitary conditions).

Degree of insight varies. Some patients recognize that the hoarding-related beliefs and behaviors are problematic, others do not.

Diagnosis

  • Clinical criteria

Hoarding is distinguished from transient accumulation and clutter (eg, as when property is inherited) by its persistence and other features; in addition, patients resist giving away or selling hoarded items. Collectors (eg, of books, figurines), like hoarders, can acquire and keep a large number of items, but in contrast to hoarding, collections are organized and systematic and do not significantly impair functioning or the safety of the home environment.

Diagnostic criteria include the following;

  • Patients have persistent difficulty discarding or parting with possessions, regardless of their actual value.

  • The difficulty discarding is due to the perceived need to save the items and to the distress associated with discarding them.

  • The accumulated possessions congest and clutter active living areas (ie, not basements or storage areas) and substantially compromise the intended use of these areas.

  • The hoarding causes significant distress or impairs social, occupational, or other areas of functioning.

Treatment

  • SSRIs

  • Cognitive-behavioral therapy

SSRIs may be helpful, although data on their efficacy are limited. Cognitive-behavioral therapy that is tailored to treat the specific hoarding symptoms may also be helpful.

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