Hoarding Disorder

In Hoarding disorder, Patient has persistent difficulty in discarding or parting with possessions due to:

  • a perceived need to save the items &
  • distress associated with discarding them.

This results in accumulation of possessions that congest & clutter active living areas causing clinically significant distress, interfering in daily life & sometimes posing a risk to self & others.

***Hoarding has its origin in psychoanalytical description of the ‘anal’ character.

Epidemiology:

  • Prevalence = 1.5%
  • Male : Female = 1 : 1
  • Insight is bettter in females.
  • Prevalence of Hoarding Disorder increases with age.

Aetiology:

1. Genetic Factors:

  • Hoarding runs in families.
  • Heritability range from 36-50%.

2. Neurobiology:

  • Hoarding behaviours have been well studied in animals that naturally display hoarding behaviours. For example rodents, birds etc.
  • studies show the role of following brain areas in mediation of hoarding behaviour:
  1. Subcortical Limbic structures (nucleus accumbens, ventral tegmental area, amygdala, hippocampus, thalamus & hypothalamus).
  2. Ventromedial Prefrontal Cortex.
  • Studies also suggest the role ‘dopaminergic system’. This can also explain the relatively poor response to serotonergic drugs.

Clinical Features & Diagnosis:

For making a diagnosis of Hoarding Disorder, following 6 criterias must be met:

1. Criterion A:

Difficulty with discarding or parting with the possessions.

The most common saved items are newspapers, old clothes, books & paperwork. Discarding difficulties are generally motivated by:

  1. Perceived utility or aesthetic value of the items.
  2. a strong sentimental attachment.
  3. fear of losing important information.
  4. a desire to avoid being wasteful.

2. Criterion B:

The prospect of discarding or parting with possessions causes substantial distress to the individual.

3. Criterion C:

These difficulties in discarding result in disorganised accumulation of possessions that congest & clutter active living areas & substantially compromise their intended use.

They may not be able to sleep in their beds, cook in kitchen or sit on the sofas in the living rooms.

4. Criterion D:

Impairement in social, occupational & other areas of functioning, including maintaining a safe environment for self & others.

Hoardings can put individuals at risk of fire, falling, poor sanitation & other health risks.

5. Criterion E:

Symptoms are not due to other general medical conditions.

6. Criterion F:

Symptoms are not due to other mental illness.

***ANIMAL HOARDING : some individuals are known to accumulate large number of animals. They generally fail to provide minimal standards of nutrition, sanitation & veterinary care for the animals. Most individuals who hoard animals also hoard inanimate objects.

Comorbities:

  1. Generalized Anxiety Disorder (31- 37%)
  2. Major Depressive Disorder (26-31%)
  3. Obsessive Compulsive Disorder (15-20%)
  4. Panic Disorder (17%)
  5. Social Anxiety Disorder (14%)
  6. Post Traumatic Stress Disorder (14%).

Course & Prognosis:

  • Mean age of onset = 11-15 years
  • Interference in everyday functioning by 20s.
  • Clinically significant impairment by the mid 30s.
  • A steady worsening of symptoms is seen over each decade of life.
  • Course is usually chronic with a few individuals reporting a waxing & waning course.

Reference:

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