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A brief overview of compulsive hoarding

Compulsive hoarding – also known as pathological collecting in some scientific circles – is a behavior typically characterized by the excessive acquisition and keeping of seemingly worthless objects that have little or no material value. According to a 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”. 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 behaviors that involve a compulsive element, there are associated physical health risks with compulsive hoarding. There are also reports that the behavior 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.

Although the collecting behavior 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 behavior. 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”.

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-behavioral 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.

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