Hoarding Disorder (HD)

What is Hoarding Disorder (HD)?

Hoarding Disorder is new to the most recent edition of the clinician’s diagnostic manual (DSM-5), with hoarding previously categorized as a subtype of obsessive-compulsive disorder (OCD). Although individuals with OCD can engage in hoarding as a compulsion, most individuals with HD do not have OCD.

Hoarding disorder is associated with three key features:

  1. Ongoing and significant difficulty getting rid of possessions (i.e., throwing away, recycling, selling, etc.), regardless of their value; and strong urges to save and/or acquire new, often non-essential, items, that if prevented leads to extreme distress. Non-essential includes items that are both useless (i.e., broken), as well as those with limited value (e.g., 10 skirts in every color but never worn)
  2. Living space becomes severely compromised with extreme clutter, preventing one from using that space for its intended purpose.
  3. Significant impairment in social, occupational, and other important areas of functioning as evidenced by:
  • Impaired physical health
  • Missed work and compromised employment
  • Financial problems
  • Housing instability including threat of, or actual, eviction
  • Social isolation
  • Emotional distress
  • Family stress

Two additional specifications include:

  1. Whether the individual is also engaged in excessive acquisition (It is currently estimated that upwards of 80-90% of individuals with hoarding also experience excessive acquisition of items through collecting, buying, and even theft.), and,
  2. Whether the individual has any insight or awareness that their behaviour is problematic.

Hoarding as a behaviour can exist in other mental health conditions such as Schizophrenia, Dementia and Neurodegenerative Disorders, Genetic Disorders, Brain Injury, Autism Spectrum Disorder, and Affective Disorders. However, a comprehensive assessment of the function of the hoarding behaviour will assist in determining whether a diagnosis of HD is warranted, or whether the hoarding behaviour is part of another disorder. Once again, as this can involve some complex distinctions, we recommend assistance from a mental health professional.

Common features often present in Hoarding Disorder

  • Acquiring and/or having trouble discarding items that have little to no value (e.g., broken lamps, a new fondue set when you already own 2, stacks of expired coupons, etc.). This is distinct from a hobby such as stamp collecting and owning thousands of stamps, or an interest in car restoration and having a garage full of parts and equipment.  
  • Commonly saved items include:
    • Newspapers
    • Magazines
    • Old clothing
    • Bags
    • Books
    • Mail
    • Paperwork
  • Items take on special significance such as an emotional connection, being part of one’s identity, or offering a sense of safety and security.
  • Clutter results from items being kept in unrelated groupings or piles, and in locations designed for other purposes.  For example, important bills and paperwork are kept with expired advertisement mailings, on a pile in the bathtub.
  • Striving for perfection, including a sense of responsibility to fulfill the potential of an item or not to be wasteful.
  • Feeling good not bad. Individuals with hoarding report positive feelings when they acquire items, and/or relief from fear, sadness, grief, and other negative emotions, that would occur were they made to discard items.
  • Living space becomes severely hampered or impossible to use. For example, the oven or bath are filled with items preventing one from cooking or bathing, or a bedroom is filled to capacity so one cannot sleep in the bed.
  • Problems with thought processes are well documented, including:
    • Challenges in sustaining attention to important tasks
    • Disorganization, and difficulties sorting and categorizing items
    • Poor decision making- what to keep and what to remove
    • Too many ideas of how to re-use/fix a discarded item
    • Memory difficulties-use of visual cues to aid memory that goes awry
  • All of the above features contribute to significant functional impairment and /or emotional distress.
  • Less common features involve the hoarding of animals, hoarding in the elderly, and the role of theft in item acquisition.

Facts

  • Hoarding occurs in 2-6% of children and adults during their lifetime, with the average age of onset in late childhood and early adolescence
  • There are no gender differences
  • Hoarding runs in families
  • Onset is often preceded by a stressful or traumatic life event
  • In individuals with HD approximately ½ also have depressive disorder; ¼ have generalized anxiety, social anxiety, or attention deficit/hyperactive disorder-inattentive type; and 1/5 have OCD

Typical Thoughts and Beliefs

“It might be important or useful someday”

“It makes me feel safe and secure”

“I must not be wasteful”

“Its my responsibility to ensure its used”

“I cannot make mistakes”

“I’m really attached to it. Its part of who I am.”

Common Situations or Affected Areas

  • Job absenteeism
  • Compromised physical and mental health
  • Living conditions
  • Organization and focus
  • Personal relationships
  • Personal hygiene
  • Financial strain
  • Social isolation

My Anxiety Plan for Hoarding Disorder (HD)

For your Hoarding Disoder (HD) MAP click here.

 

Ralph's Story

Ralph is a retired English professor who has never married. He has lived in the same home for forty years, but has recently decided to move to Florida to be close to his sister. However, his first meeting with his realtor did not go well. Much to Ralph’s surprise the realtor seemed astonished at the amount of items in his home and expressed concern that he was not ready to sell. Ralph has since taken a closer look at his home and thinks she over reacted. While he knows he is a bit of a “pack rat” he doesn’t see the problem. Yes, he cannot access his third bedroom properly as there are so many stacks of books and old journals in there, but this is his collection, and while he only uses half of his kitchen this is because he is not much of a cook, not because he is using the other half to store broken appliances with which he likes to tinker. After all, he only started storing them in that part of the kitchen because he wasn’t using it. And in all fairness, he has been in his home for forty years so of course all his drawers and surfaces are filled with stuff- surely this is the case in the homes of others? Ralph feels hurt and angry at the realtor’s words, but realizes he may have to part with some things to sell his home. However, this scares him as he has become quite attached to his things and feels overwhelmed at where to begin.