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.
- Prevalence = 1.5%
- Male : Female = 1 : 1
- Insight is bettter in females.
- Prevalence of Hoarding Disorder increases with age.
1. Genetic Factors:
- Hoarding runs in families.
- Heritability range from 36-50%.
- 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:
- Subcortical Limbic structures (nucleus accumbens, ventral tegmental area, amygdala, hippocampus, thalamus & hypothalamus).
- 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:
- Perceived utility or aesthetic value of the items.
- a strong sentimental attachment.
- fear of losing important information.
- 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.
- Generalized Anxiety Disorder (31- 37%)
- Major Depressive Disorder (26-31%)
- Obsessive Compulsive Disorder (15-20%)
- Panic Disorder (17%)
- Social Anxiety Disorder (14%)
- 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.
- New Oxford Textbook of Psychiatry (3rd edition) (https://amzn.to/3IX1Sn8)
- Kaplan & Sadock’s Synopsis of Psychiatry (12th Edition). https://amzn.to/3B7PVIv