Presenting………ocdtalk’s first guest post of 2013. Dr. Marla Deibler writes about hoarding and its connection to OCD:
Hoarding is an often misunderstood problem, which has, in recent years, garnered quite a bit of media attention. In fact, some of the facts may be surprising.
Technically, hoarding is not currently a psychiatric diagnosis. In fact, hoarding is only mentioned in our current diagnostic manual (DSM-IV-TR) as a possible symptom of obsessive-compulsive personality disorder. Hoarding disorder, however, will be included in the new diagnostic manual (DSM-V) as a distinct disorder unto itself, which is slated for 2013 publication. This is an exciting development, as it will help to legitimize the struggles of those who suffer from hoarding difficulties as well as help to educate others regarding its distinction from obsessive compulsive disorder (OCD).
Hoarding disorder involves the accumulation of belongings to such an extent that the resulting clutter renders parts of the living space unusable. It involves the acquisition and failure to discard a large number of items/possession that are considered by most to be of little or no value. These possessions clutter the living space, rendering the space unable to be used in the manner in which it was intended. The hoarding behavior causes marked distress or interferes with one’s daily functioning.
So why do hoarders hoard? What drives and maintains this behavior?
1. Emotional Attachment – Individuals with compulsive hoarding tend to have strong emotional attachment to objects, finding each unique or meaningful to them and thus have difficulty parting with the items. They often prefer to have control of the items, including who is permitted to touch or sort through them.
2. Information Processing – Individuals with compulsive hoarding tend to report difficulties in remembering the location of items and like to have items visible or have visual reminders. They often worry that they might forget something and thus hold on to items as reminders. They have difficulty in utilizing broad categorization skills and find it difficult to make decisions regarding the disposition of possessions.
3. Erroneous Beliefs – Individual with compulsive hoarding tend to have erroneous beliefs regarding their possessions related to perfectionism, control, responsibility, value of individual items, and potential utility of items.
4. Distress Regarding Discarding/Acquiring – Individuals with compulsive hoarding experience significant distress and anxiety when faced with having to decide whether to discard a possession. They may also experience anxiety when they feel a need to acquire an object they desire and believe that this feeling can only be relieved through acquisition of the item.
5. Negative Reinforcement – Compulsive hoarding behavior is maintained through negative reinforcement; in other words, individuals are able to relieve their distress by putting off making decisions about disposition or discarding items, which leads to increased clutter and continued avoidance of sorting and/or discarding.
Essentially, it’s not about the clutter. It’s about the stuff. Hoarders form very powerful attachments to objects. The thought of parting with them may lead them to feel as though they are losing part of their lives.
Is it related to obsessive compulsive disorder?
Hoarding is considered to be related to obsessive-compulsive disorder (OCD), an anxiety disorder characterized by recurrent unwanted thoughts (obsessions) and repetitive behaviors (compulsions) enacted to reduce the distress associated with obsessions; however it is most recently considered to be a distinct disorder in and of itself, as a growing body of research has differentiated the two.
Compulsive hoarding is a complex disorder and may involve co-occurring disorders, trauma history, genetic factors, and/or learned behavior (modeling). Hoarding behavior typically begins in late childhood/early adolescence and progresses throughout the lifespan. Although its exact prevalence is unknown, it is believed that approximately 1% – 5% of the population exhibits compulsive hoarding. Studies suggest that 20% – 30% of individuals with OCD exhibit compulsive hoarding behavior, but only 5% – 15% of hoarding behavior can be attributed to OCD. Insight into the seriousness of the problem may be limited and relatives may be most concerned about the behavior.
What can be done to help individuals who struggle with hoarding?
Although some individuals with compulsive hoarding respond to antidepressant medication, many individuals do not. Cognitive-behavioral therapy has been demonstrated to be effective in the treatment of compulsive hoarding which involves helping individuals to change the way they think about and make decisions about their possessions in order to control their behavior and their emotional attachment to possessions. This process involves a thorough behavior assessment (to learn each individual’s contributing factors), psychoeducation (to improve insight and knowledge of the disorder), exposure/response prevention (E/RP) (for those who actively acquire, this involves exposing them to situations in which they have the opportunity to acquire, while having them refrain from acquiring – – this may be difficult for them initially, but with repeated E/RP, they habituate, or get used to, the situation and their distress decreases), cognitive restructuring (helping them to identify the flaws/distortions in their thought processes and change them to more adaptive/accurate/positive thoughts), and excavation exposure (exposing them to having to engage in the process of de-cluttering by sorting through their items while utilizing and practicing improved decision-making skills).
Thank you Dr. Deibler for this informative post. I certainly learned a lot!
Dr. Marla Deibler is a clinical psychologist and the Founder and Executive Director of The Center for Emotional Health of Greater Philadelphia in Cherry Hill and Princeton, New Jersey, specializing in the evidence-based treatment of obsessive compulsive spectrum disorders. She serves on the Board of Directors of OCDNJ, the NJ affiliate of the International OCD Foundation (IOCDF) and serves as a consultant to media outlets regarding OCD and related disorders. Dr. Deibler also contributes to PsychCentral in her blog, “Therapy That Works.”