An estimated 5 to 14 million people in the U.S. are compulsive hoarders, over double the number of people with Obsessive Compulsive Disorder (3.3 million). Yet compulsive hoarding is not a diagnosable mental disorder… yet. This May, Compulsive Hoarding Syndrome (or Hoarding Disorder) will be included in the new DSM-V.

Only recently was hoarding medically distinguished from OCD. While sometimes these two mental disorders coincide, hoarding often appears without the presence of other OCD symptoms. Most importantly, hoarders do not feel distressed about their hoarding, while people with OCD view their rituals as unwanted, inconvenient intrusions into their lives. Hoarders are far less likely to respond to certain medications than those with other forms of OCD (as few as 14% compared to 50-80%). Emotions felt by hoarders when they are forced to discard something are more grief like, while OCD is more linked to feelings of anxiety. The difficulty in diagnosis is compounded by the fact that hoarding usually occurs in tandem with other mental disorders, such as major depressive disorders (50%), either anxiety or social phobia (48%), and ADHD (30%).

There are three components to hoarding: collecting too many items, difficulty getting rid of items, and problems with organization. Often hoarders do not realize they have a problem (only 15% admit that their behavior is irrational). There is a strong family connection in hoarding, with 12% of hoarders having first-degree relatives who were also hoarders, according to a John Hopkins study.

Hoarding Specific forms of Cognitive Behavioral Therapy are being developed to help hoarders. Three questions patients are told to ask before buying a new item are:

• Can I afford this?
• Do I have the space for this object?
• Do I really need it?

The book Buried in Treasures outlines a method for overcoming hoarding. Free workshops started in Massachusetts and now also exist in San Francisco, Miami, and soon New York City. One study found that 73% of participants are much or very much improved by the end of the group.  The process involves 15 sessions spread over 20 weeks, and each session focuses on a chapter in the book. It is incremental and activities include topics such as acquisition, discarding and disorganization.

When trying to confront a loved one about their hoarding problem, there are some strategies that help. First of all, do not use language that is judgmental or devalues their possessions. Calling their objects “trash” or “junk” devalues them and their thought processes. You need to attempt to put yourself into the hoarder’s mindset. Try to use encouraging language and focus on safety aspects. For example, “It’s great that you keep things out of the way so you can get through this pathway, but a firefighter or emergency responder might have trouble getting through here because they are wearing bulky clothes or carrying equipment.” Start with safety and organization and wait on talk about discarding things. Additionally, recommending the person seek advice from others who have the same problem is very helpful.

Additional Resources

The Scientific American, Step Inside the Real World of Compulsive Hoarders, http://www.scientificamerican.com/article.cfm?id=real-world-hoarding

Mayo Clinic, Hoarding: http://www.mayoclinic.com/health/hoarding/DS00966

International OCD Foundation, hoarding: http://www.ocfoundation.org/hoarding/

Anxiety and Depression Association of America, Hoarding: http://www.adaa.org/understanding-anxiety/obsessive-compulsive-disorder-ocd/hoarding-basics

Psych Central, The Genetics of Compulsive Hoarding: http://psychcentral.com/lib/2009/the-genetics-of-compulsive-hoarding/

Pet-Abuse, Animal Abuse Crime Database: http://www.pet-abuse.com/pages/cruelty_database.php