OCD is often described as "a disease of doubt." Sufferers experience "pathological doubt" because they are unable to distinguish between what is possible, what is probable, and what is unlikely to happen.
-National Alliance on Mental Illness
So it's a form of Obsessive-Compulsive Disorder, like hand-washing & checking things?
Although Compulsive Hoarding can be a symptom of other disorders,
it is currently classified as a subtype of obsessive-compulsive disorder
(OCD).
The diagnostic status of compulsive hoarding is uncertain. Hoarding is a problem often seen in people with obsessive-compulsive disorder (OCD). It can be associated with any number of other disorders including schizophrenia, dementia, anorexia, depression and even the so called Diogenes syndrome.
Compulsive hoarding has enough in common with other forms of OCD to be classified as a variation of this disorder with some features of impulse control disorders. This particular variety of OCD is common and can be severe and quite difficult to treat. Ultimately, research may clarify questions about differences in neurobiology or genetics of varieties of OCD and tell us where hoarding best
fits. 4
You may be wondering how OCD and hoarding are related. Most of
the research suggests that hoarding is a symptom of OCD, yet only
25 to 35 percent of individuals with OCD actually hoard
(Frost/Steketee-98).
It is associated with OCD mostly because hoarders have
obsessions about their possessions, compulsions to hoard, and
doubt about what to discard.
Hoarders may think a lot about their possessions. They may wonder
where something was placed, whether something was accidentally
thrown out, whether someone touched their belongings, or how to
organize their possessions. They may find it hard to resist the urge
to save and to not discard. Throwing things out causes great
distress, and they avoid the distress by hoarding.
Hoarding is a compulsion that reduces the uncomfortable feelings,
and thus is a form of OCD.
-Overcoming Compulsive Hoarding Book, by Neziroglu/Bubrick/Tobias
Compared to non-hoarding OCD patients, hoarders score higher on anxiety, depression, dependent and schizotypal personality disorder symptoms, and family and social disability. Our group found that compulsive hoarders had significantly higher anxiety and lower global functioning than non-hoarders. They did not respond as well to intensive, multi-modal treatment as non-hoarding OCD patients.
-Sanjaya Saxena, M.D.7
Learn about Impulse Control Disorders with articles recommended by the Mayo Clinic:
Do Compulsive Hoarders Have Different Brain Patterns Than Other OCD Sufferers?
From Sanjaya Saxena, M.D.:
Our group recently conducted a positron emission tomography (PET) brain imaging study that measured cerebral glucose metabolism. This is a measure of brain activity in patients with the compulsive-hoarding syndrome. It was compared with non-hoarding OCD patients and controls without any psychiatric disorder.
We found that compulsive hoarders had a unique pattern of brain activity that was distinct from that seen in either non-hoarding OCD patients or controls. Compulsive hoarders had significantly lower metabolism in the posterior cingulate gyrus and occipital cortex. A brain region involved in visual processing compared to controls. Whereas non-hoarding OCD patients had significantly higher glucose metabolism in bilateral thalamus and caudate, structures previously found to have elevated activity in OCD.
Hoarders and non-hoarding OCD patients also differed from each other. Hoarders had significantly lower metabolism in the dorsal (superior) part of the anterior cingulate gyrus and thalamus than non-hoarding OCD patients. Across all OCD patients studied, hoarding severity was significantly correlated with lower activity throughout the dorsal anterior cingulate gyrus.
Our findings suggest that the compulsive-hoarding syndrome may be a neurobiologically distinct variant of OCD. In addition to the observed differences in cerebral glucose metabolism, our results raise the question of whether compulsive hoarders also have structural brain abnormalities and neurocognitive deficits that differ from those seen in non-hoarding OCD patients. 7
Learn more about what's behind Hoarding by reading...
•Chapter 23 written by Drs. Frost & Steketee
»What some mental health professionals/leaders in research have to say:
Tolin, Saxena, Penzel», Neziroglu
Fact Sheets and Q & A with professionals in the field
»"Why People Hoard"
»List of 107 reasons why
•Degrees/Measurement Scales of compulsive hoarding
»Actual and perceived memory deficits in individuals with Compulsive Hoarding
»Characteristics of chronically disorganized people, National Study Group on Chronic Disorganization.
•Online videos/audio for learning
•Literature and Articles in the News
Compulsive Hoarding & OCD-Two Distinct Disorders?
Input from Researchers-Letters to editor/American Journal of Psychiatry
American Journal of Psychiatry,
164:1435, September 2007-
doi: 10.1176/appi.ajp.2007.07030425
© 2007 American Psychiatric Association
Letter to the Editor
»Compulsive Hoarding and OCD: Two Distinct Disorders?
DANIEL S. VAN GROOTHEEST, M.D. and DANIELLE C. CATH, M.D., Ph.D.
Amsterdam, the Netherlands
To The Editor: The editorial by Sanjaya Saxena, M.D.» (1), in the March 2007 issue of the
Journal, implicates that there is enough research-based evidence to justify that compulsive
hoarding constitutes a discrete entity, apart from obsessive-compulsive disorder (OCD) as
such, to be placed separately in the future DSM-V classification system. The important
article by Jack Samuels, Ph.D., et al. (2), also published in the March 2007 issue of the
Journal, contains several results that cast doubts on this conclusion.
First, all but six of the hoarding individuals in the cohort assessed by Dr. Samuels et al. (2)
had additional obsessions and compulsions, especially symmetry and somatic obsessions,
as well as repeating, counting, and ordering compulsions (3), indicating substantial
symptom overlap with other perhaps intuitively more "typical" OCD symptom dimensions.
We therefore do not agree with the authors that many of the hoarders do not have
other OCD symptoms. Second, as also mentioned by Samuels et al. (2), hoarding in itself
seems to be heterogeneous. In our opinion, the "hoarding" criterion of obsessive-
compulsive personality disorder, characterized by thrift, differs from the three core
symptoms of clinically significant compulsive hoarding. Moreover, within groups of patients
with significant compulsive hoarding, we observe clinical heterogeneity.
Furthermore, hoarding can arise as a secondary condition from other disorders, such as
schizophrenia, dementia, and Prader-Willi syndrome. Third, the linkage study conducted by
Samuels et al. (2) was done so on the presence of any hoarding symptom in a potentially
heterogeneous group of hoarding individuals instead of a group with clinically significant
compulsive hoarding.
We therefore feel that their results do not add evidence with respect to the hypothesis
that compulsive hoarding is an etiologically discrete phenotype from OCD.
In addition, Samuels et al. (2) noted that they found linkage peaks at a chromosome
different from that reported in a previous linkage study on hoarding. Replication of these
findings is needed before we can conclude that there is a special susceptibility locus for
hoarding.
In summary, the points mentioned in the article by Samuels et al. (2) suggest that evidence for hoarding as a distinctive syndrome is not very sound, since hoarding
seems both phenomenologically and genetically heterogeneous, possibly with subtypes
related and subtypes unrelated to OCD. Therefore, much more research on hoarding is
needed before implications for a new diagnostic classification can be made.
---
American Journal of Psychiatry-
164:1436, September 2007,
doi: 10.1176/appi.ajp.2007.07030425r2,
© 2007 American Psychiatric Association,
Letter to the Editor
Dr. Samuels Replies»
JACK SAMUELS, Ph.D.,
Baltimore, Md.
To The Editor:
We agree with Drs. Grootheest and Cath that hoarding behavior may be heterogeneous,"possibly with subtypes related and subtypes unrelated to OCD." Indeed, on page 498 of
our article, we noted that hoarding behavior can occur in conditions other than OCD, and
we wrote that "we suspect that hoarding behavior itself is heterogeneous, and that the
etiology of hoarding behavior is different in various syndromes."
However, as noted by Dr. Saxena, all of the families in our cohort were recruited
because they had two or more relatives affected with OCD, and thus OCD was over-
represented in the hoarding participants. On page 497, we suggested that Zhang et al.
(1) may have found different linkage peaks for hoarding in their study because they
selected families with multiple siblings affected with Tourette’s syndrome, not OCD (1).
Certainly, more work is needed in order to refine the phenotypic definition of hoarding,
including the clinical features outlined by Dr. Saxena.
As pointed out by Drs. Van Grootheest and Cath, there was a range of severity in the
hoarding individuals in our cohort, but the majority (68%) reported spending at least 1
hour per day and/or experiencing moderate, severe, or extreme distress that was
frequent and disturbing during the worst period of their hoarding behavior.
We stand by our conclusion that the findings of our study suggest that a region on
chromosome 14 is linked to compulsive hoarding behavior in these OCD families. We
hypothesize that there is a genetic variant in this region that increases the risk of
hoarding behavior in individuals who are susceptible to OCD. Additional genetic studies
are required to replicate these findings and to characterize the genetic variant that may be
involved.
---
»DSM-V Planning & Research Website
