Hoarding disorder: more than just a problem of too much stuff.

Abstract

Compulsive or problematic hoarding behaviors occur in a variety of neuropsychiatric disorders, including obsessive compulsive disorder (OCD), schizophrenia, and dementia. Such behaviors have until recently been considered as a subtype of obsessive compulsive disorder (OCD), despite the fact that clinicians and researchers have long known that these symptoms often occur independently of OCD or other neuropsychiatric disorders. However, with the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Hoarding Disorder (HD) has at long last achieved recognition as a clinical syndrome in its own right(1). Research suggests that this recognition is appropriate, despite the current trend away from disorder-specific approaches and towards cross-diagnostic approaches. HD is defined as a pattern of persistent difficulties with discarding personal possessions, even those with no clear value, because of strong desires to save along with distress or indecision about what to discard. Difficulty discarding is often, but not always, accompanied by excessive acquiring of unneeded objects, and, in the absence of intervention, leads over time to the accumulation of so many items that the space or room cannot be used for its usual purposes, and thus to substantial functional impairment(1). This definition allows for a distinction to be made between HD, where the core problem is desire to save leading to difficulty discarding, and hoarding behaviors typically seen in other neuropsychiatric disorders, where the main feature is often excessive collecting or acquiring of rubbish (e.g., cigarette butts, bottles from garbage cans, etc) or passive difficulties with discarding(2, 3). HD does co-occur with OCD, however, and there is evidence of etiological overlap between the two disorders. Nevertheless, HD occurs independently of OCD in 60-80% of cases, these disorders have different epidemiological and neurocognitive profiles, and most importantly, different treatment outcomes(4).