Compulsive Hoarding - Diagnosis

Diagnosis

While the disorder is not listed in DSM-IV, the currently proposed DSM-V diagnostic criteria for hoarding disorder are:

1. Persistent difficulty discarding or parting with possessions, regardless of the value others may attribute to these possessions. (The Work Group is considering alternative wording: "Persistent difficulty discarding or parting with possessions, regardless of their actual value.")
2. This difficulty is due to strong urges to save items and/or distress associated with discarding
3. The symptoms result in the accumulation of a large number of possessions that fill up and clutter active living areas of the home or workplace to the extent that their intended use is no longer possible. If all living areas become decluttered, it is only because of the interventions of third parties (e.g., family members, cleaners, authorities).
4. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others).
5. The hoarding symptoms are not due to a general medical condition (e.g., brain injury, cerebrovascular disease).
6. The hoarding symptoms are not restricted to the symptoms of another mental disorder (e.g., hoarding due to obsessions in Obsessive-Compulsive Disorder, decreased energy in Major Depressive Disorder, delusions in Schizophrenia or another Psychotic Disorder, cognitive deficits in Dementia, restricted interests in Autism Spectrum Disorder, food storing in Prader–Willi syndrome).

Understanding the age of onset of hoarding behavior can help develop methods of treatment for this “substantial functional impairment”. Hoarders are dangers to not only themselves, but others as well. The prevalence of compulsive hoarding in the community has been estimated at between two and five percent, significantly higher than the rates of OCD and other disorders, such as panic disorder and schizophrenia.

751 people were chosen for a study in which the persons self-reported their hoarding behavior. Of these individuals, most reported the onset of their hoarding symptoms between the ages of 11 and 20 years old, with 70% reporting the behaviors before the age of 21. Fewer than 4% of people reported the onset of their symptoms after the age of 40. The data shows that compulsive hoarding begins early, but often does not become more prominent until after age 40. Different reasons have been given for this such as the presence of family members is more prominent early in life and limits acquisition and facilitates the removal of clutter. The understanding of early onset hoarding behavior may help in the future to be able to distinguish hoarding behavior from “normal” childhood collecting behaviors.

A second key part of this study was to determine if stressful life events are linked to the onset of hoarding symptoms. Similar to self-harming, a traumatized person may create "a problem" for themselves in order not to face their real anxiety or trauma and do something about it. Facing their real issues may be too difficult for them, so they "create" a kind of "artificial" problem (in their case, hoarding) and prefer to battle with it rather than determine, face, or do something about their real anxieties, face their inner demons. A hoarder may suppress his/her psychological pain by "hoarding". The study shows that adults who hoard report a greater lifetime incidence of having possessions taken by force, forced sexual activity as either an adult or a child, including forced intercourse, and being physically handled roughly during childhood, thus proving traumatic events are positively correlated with the severity of hoarding.For each five years of life the participant would rate from 1 to 4, 4 being the most severe, the severity of their hoarding symptoms. 548 participants reported a chronic course, 159 an increasing course and 39 people, a decreasing course of illness. The incidents of increased hoarding behavior were usually correlated to five categories of stressful life events.