Possessed by Possessions: Hoarding Disorder Diagnosis and Treatment
According to the Anxiety and Depression Association of America (ADAA), hoarding is a disorder in which individuals have a tendency to acquire items, regardless of whether these items have value, and fail to discard a large number of these items.1 The disorder not only puts a negative strain on the hoarder but also on family, friends, and others because it has emotional, physical, social, financial, and even legal impacts and leads to lower quality of life.2 The disorder and its impact have been depicted on the A&E television series, Hoarders, a reality show chronicling the struggles of individuals with hoarding disorder and their journey to recovery.
Hoarding Recognized as Separate Anxiety Disorder
Hoarding disorder was recently classified as a separate disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Prior to this new classification, hoarding disorder was listed as a variant of obsessive-compulsive disorder (OCD) but was not well described.2
According to Sanjaya Saxena, MD, director of the Obsessive-Compulsive Disorders Program and Outpatient Psychiatric Services at the University of California in San Diego, “there is a wealth of evidence that demonstrates hoarding disorder may share similarities to obsessive compulsive disorder (OCD) but is not the same thing. Hoarding disorder is a discrete entity of its own. Hoarding disorder is a fairly common disorder and is approximately 1.5 times more common than OCD,” Overall, according to Saxena the disorder affects approximately 2–5% of the population. In the United States, this represents approximately 8–10 million people who meet the diagnostic criteria for the disorder.
Based on the DSM-5 criteria, symptoms of hoarding include but are not limited to excessive acquisition and saving, even if the individual doesn't need or have space for such things. Individuals with hoarding disorder have difficulty discarding possessions, which leads to clutter and congestion in their home, work spaces, or even outside areas. This can compromise the use of rooms, surfaces, and other areas of the home. “Hoarding disorder clearly impacts activities of daily living and causes a significant amount of functional impairment – even risks to physical health in more severe cases, infestations of rodents, falls, mold, dust build up, and fire hazards,” said Saxena.
Hoarding Disorder Is Treatable
The reasons for hoarding vary and can be due to items holding sentimental value, compulsive shopping, a perceived need for items (either now or in the future), and an inability to discard items caused by other psychological factors.
Hoarding disorder is treatable with both anti-anxiety and antidepressant medications such as paroxetine, despite lack of FDA approval and/or non-pharmacologic approaches, including cognitive behavioral therapy (CBT) tailored to hoarding disorder. One novel CBT approach combines standard behavioral techniques with cognitive rehabilitation of neurocognitive abilities and has worked well in clinical practice as well as in research studies, according to Saxena.
In addition, Saxena said that some antidepressant and anti-anxiety medications have worked well in clinical trials for treating hoarding disorder such as paroxetine, which has been shown to improve hoarding and associated symptoms in an open label, prospective study conducted by Saxena and colleagues, with the majority of patients responding. However, according to Saxena, studies of paroxetine have demonstrated to not be tolerated that well by some of the older and middle-aged patients, who had adverse effects such as sedation, fatigue, constipation, and sexual side effects.