Like many people, I save and collect various items (in my case, records and CDs). Collecting is a natural human activity and some evolutionary psychologists have argued that it may have had an evolutionary advantage in our past history (e.g., there may have been periods of severe deprivation where hoarding was adaptive and enhanced the probability of reproductive success and human survival). However, for a small minority, collecting and hoarding can become excessive and pathological as demonstrated a few months ago (December 2011), when Channel 4 broadcast a television programme on compulsive hoarders as part of the Cutting Edge series of documentaries
Compulsive hoarding – also known as pathological collecting in some scientific circles – is a behaviour typically characterized by the excessive acquisition and keeping of seemingly worthless objects that have little or no material value. According to a recent review led by Dr Albert Pertusa (Institute of Psychiatry, London), a widely accepted definition of compulsive hoarding is “the excessive collection and failure to discard objects of apparently little value, leading to clutter, distress, and disability” (p.371). The difficulty in discarding or letting go of the accumulated possessions is the critical criterion of pathological hoarding. It is also worth noting that some leading figures in the hoarding field don’t like the term ‘compulsive hoarding’ for many of the same reasons that those in the gambling studies field don’t like the term ‘compulsive gambling’.
There has been a substantial increase in research into the disorder in recent years. Interestingly, it appears to be inversely related to income (as it is far more common among the economically deprived). Based on empirical research, the prevalence of compulsive hoarding is thought to be around 2-5% among adult populations although there are certain socio-demographic groups where the prevalence is known to be higher (e.g., there is a higher prevalence among men and the elderly).
As with most behaviours that involve a compulsive element, there are associated physical health risks with compulsive hoarding. There are also reports that the behaviour can lead to detriments in other areas of the affected person’s life including impaired psychological functioning, financial difficulties, and the compromising of relationships with family and friends.
Given that excessive hoarding impacts on the physical living space of the individual and can take over in every room in an affected person’s home (such as people who never throw away a single newspaper or magazine), it can lead to a negatively detrimental effect on life’s essential activities such as personal hygiene and house sanitation – both of which may lead to increased health risks. Other activities such as sleeping and cooking food can also be seriously affected. Mobility in the person’s day-to-day living space may be affected and some hoarded items (such as newspapers and household waste) may lead to increased fire risks. It has also been noted that at a societal level, compulsive hoarding is a burden on public health in terms of poor physical health, occupational impairment, and the utilization of social services.
Although the collecting behaviour may be pathological, there is still a lot of scientific debate as to whether it is a stand alone disorder or symptomatic of other conditions, most notably obsessive-compulsive disorder [OCD] – particularly as approximately 20%-40% of people with OCD patients are known to have various hoarding compulsions and obsessions. Some researchers also suggest that other psychological traits such as perfectionism and indecisiveness may underpin some hoarding behaviour. Other co-morbidities are known to exist including alcoholism, in addition to paranoid, avoidant, and schizotypal traits. Compulsive hoarding also appears to be similar to impulse control disorders, particularly that of compulsive buying as many hoarders’ homes are full of bought items that are often unopened and still in their original packaging. Approximately three-quarters of hoarders also engage in excessive buying, and over half also accumulate items and possessions for free. Research has indicated that the condition of hoarders’ homes have been described as “merely cluttered” to “squalid”.
In fact, Dr Pertusa and his colleagues claim that the majority of hoarding studies are actually based on the assumption that the behaviour is a form of OCD. However, there is accumulating evidence that hoarding may be a separate entity to OCD. As is also pointed out by Pertusa and colleagues, there is no reference to hoarding behaviour in the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-IV) criteria for OCD. Furthermore, in relation to obsessive-compulsive personality disorder, hoarding is mentioned in only one of the eight diagnostic criteria.
A recent meta-analytic study led by Dr Michael Bloch (Yale School of Medicine, USA) examined 21 worldwide studies with over 5000 OCD individuals and concluded that hoarding is an independent factor in both in children and adults. The study also reported that unlike typical OCD sufferers, compulsive hoarders don’t experience intrusive thoughts about possessions urging them to perform ritualized behaviour. It has also been observed that around a third of compulsive hoarders don’t show any other OCD symptoms. Dr Bloch and colleagues conclude that compulsive hoarding is a more passive behaviour where intense distress is only triggered when the hoarders face the prospect of having to get rid of their accumulated possessions.
Although there are many published studies where compulsive hoarders are treated pharmacologically with serotonin reuptake inhibitors (that show very mixed results in relation to their effectiveness), the most effective treatment appears to be cognitive behavioural therapy (CBT). This typically involves hoarders learning (through cognitive restructuring and response prevention) how to deal with situations that cause intense anxiety. Research also suggests that some types of CBT are better than others. CBT approaches that focus on the hoarder’s motivation, acquisition of new items, and removal of items from the hoarder’s home appear to show the best outcome. Treatment studies also suggest that pathological hoarding may be best classified as a discrete disorder with its own diagnostic criteria rather than as a form of OCD.
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
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