DSM-V: Hoarding New Mental-Disorder Diagnoses
Hoarding disorder is the name of a psychiatric condition that produces symptoms such as the compulsive urge to acquire unusually large amounts of possessions and an inability to voluntarily get rid of those possessions, even when they have no practical usefulness or monetary value. Until recently, mental health guidelines in the United States viewed hoarding as a specific form of another condition called obsessive-compulsive disorder (OCD). However, in line with recent findings from a number of reputable studies, the American Psychiatric Assn. designated the disorder as a distinct form of mental illness in May 2013.
Hoarding Disorder Basics
The American Psychiatric Assn. is a professional organization widely viewed as the authority of record on mental health issues in the U.S. This organization defines the criteria for all forms of officially recognized mental illness in a guide called the Diagnostic and Statistical Manual of Mental Disorders, or DSM. According to the definition established in the new version of this guide (known as DSM 5), released in 2013, people with hoarding disorder have a conscious, ongoing urge to accumulate possessions, as well as corresponding feelings of anxiety or mental anguish whenever those possessions get thrown away. While some people affected by the disorder accumulate valuable items, most affected individuals accumulate things with limited or no real-world value, such as books, old magazines or newspapers, self-made notes, outdated clothing, or old mail.
People with hoarding disorder may accumulate possessions in locations that include their houses, yards or vehicles, or in their offices or other workplace settings. Whatever the specific location involved, the collected material typically produces enough clutter to limit or prevent the practical use of that space. In some cases, the collected material also produces an active, ongoing danger in the form of such things as fire hazards or hygiene hazards. In addition, in order to qualify for a hoarding disorder diagnosis, affected individuals must experience a disruption in important aspects of their lives (work, home life, social interaction, etc.) as a direct result of their hoarding behaviors.
According to the International OCD Foundation, hoarders commonly give certain rationales or justifications for their behaviors. Examples of these rationales and justifications include a desire to keep items or objects that may be needed in the future, a fear of discarding information that may have use in the future, a sense of emotional attachment to specific hoarded items, a sense of self-identification with specific hoarded items, and an artistic or aesthetic attachment to specific features of hoarded items (such as an item’s texture or color).
Reasons for Creating Hoarding Disorder
Mental health professionals have previously viewed compulsive hoarding as a specific manifestation of obsessive-compulsive disorder. (People affected by OCD have symptoms that typically center on the presence of persistent mental fixations (i.e., obsessions), as well as the presence of compulsive behaviors or rituals that temporarily ease the strain caused by those fixations.) According to this perspective, people who engage in hoarding, collecting and/or saving behaviors constitute one of the four potential sub-categories of OCD.
However, a number of modern studies indicate that this point of view is incorrect. For example, a combined study and study review published in 2004 in the American Journal of Psychiatry concluded that people affected by compulsive hoarding differ from people affected by OCD in several important respects. From the hoarding perspective, examples of these differences include a relative lack of awareness regarding the condition’s real-world impact, a relative decline in overall mental function, and an increased likelihood of having co-occurring mental health conditions such as personality disorders, anxiety or depression. Compulsive hoarders also typically have certain genetic characteristics that clearly differentiate them from people with OCD. In addition, two of the treatments most commonly used to address the symptoms of OCD (a form of psychotherapy called cognitive behavioral therapy and antidepressant medications called SSRIs) don’t work very well in addressing the symptoms of compulsive hoarding.
Some people with hoarding behaviors will still probably merit an OCD diagnosis, not a hoarding disorder diagnosis, the International OCD Foundation explains. Unlike people with true hoarding disorder, these individuals have specific obsessions not directly related to hoarding that inadvertently result in the accumulation of possessions. In addition, unlike people with hoarding disorder, individuals affected by OCD-based hoarding find their behaviors unpleasant or troublesome, have no particular interest in the items they accumulate, and don’t typically set out to acquire excessive amounts of a specific item or items.