Hoarding Disorder

Among obsessive-compulsive disorders, there is Hoarding Disorder. Let's understand what is hoarded, how it is hoarded, why it is hoarded, and when this behavior warrants the attention of a clinician. I'll try to answer these questions in my own words.

What is hoarded? Hoarding means amassing or collecting gradually. In Hoarding Disorder, people often intentionally collect objects. Commonly hoarded items include magazines, books, bags, and clothes. Some people may also hoard animals, accumulating them in such numbers that they cannot adequately provide for their basic needs (food, hygiene, and care).

How is hoarding manifested? Hoarding behavior (when atypical) results in clutter in the living spaces of the home. For example, hoarding in the basement or garage might not be classified as a symptom, but if hoarding occurs in the kitchen to the extent that it hinders cooking or in the bedroom such that it disrupts sleep, then the clutter is affecting a vital space and significantly impacting the person's life. In severe cases, the living conditions may become unsanitary.

Why does hoarding happen? The clutter results from difficulty discarding items, regardless of their actual value. The perceived utility, aesthetic value, or emotional attachment to items can prevent the normal process of letting go of possessions.

When does it warrant clinical attention? According to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition), Hoarding Disorder is characterized by:

• Persistent difficulty discarding or parting with possessions.
• The difficulty is due to a perceived need to save the items and distress associated with discarding them.
• The hoarding behavior results in significant distress or impairment.
• There is no better explanation for the symptoms.

Additionally, the level of insight (awareness of the disorder) should be specified, as well as whether there is excessive acquisition of items through purchasing or obtaining free items.

Sources:

• American Psychiatric Association (2013) - Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
• Bernhill, J. W. (2014) - DSM-5 Clinical Cases.

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