Hoarding is relatively common; we all know someone with a garage full of random trinkets and things that seem of little use; however, there is a certain point where hoarding becomes an issue. For this reason, Hoarding Disorder has been defined by the American Psychiatric Association as “persistent difficulty getting rid of or parting with possessions due to a perceived need to save the items. Attempts to part with possessions create considerable distress and lead to decisions to save them. The resulting clutter disrupts the ability to use living spaces.” Like many psychological issues, hoarding is not necessarily a problem or disorder until it unduly affects someone’s life in a negative way.
What is Hoarding?
The main diagnostic manual used in Australia is the DSM-5, which gives us a few key criteria people have to meet in order to be diagnosed with hoarding disorder (HD). These criteria outline that the hoarding must be excessive and disruptive, meaning the items clutter living areas, and the hoarder refuses to get rid of them regardless.
The DSM-5 criteria also stipulate that hoarding must cause major distress or problems in social, work, or other important areas of life. Like many other disorders, clinicians will also check that it’s not caused by another medical condition like a brain injury and that the behaviour is not mainly caused by symptoms of another condition such as obsessions from obsessive compulsive disorder (OCD), low energy from major depression, delusions from schizophrenia, etc.
Whether you are a fresh graduate or a seasoned psychologist, brushing up on diagnostics is often a good idea, especially when criteria are updated so regularly, as those who are completing a Graduate Certificate in Mental Health online will appreciate.
HD vs OCD
In some cases, hoarding is actually a subtype of OCD. HD and OCD are both mental health conditions, but they differ in key ways. HD involves a persistent difficulty in getting rid of possessions due to a perceived need to save them, leading to cluttered living spaces. People with HD feel distressed at the thought of discarding items. On the other hand, OCD hoarding is a subtype of OCD, where hoarding is a compulsion to relieve anxiety stemming from obsessive thoughts.
The hoarded items in OCD aren’t always useful or sentimental. Aside from that, those who suffer from OCD may have other similar compulsions as well. The main difference lies in motivation: hoarding disorder stems from a belief in the value or future need of items; in contrast, OCD hoarding is an unwanted response to obsessive thoughts and anxiety. Although it is easy to conflate the two, understanding that these are distinct conditions is essential because they have different causes, symptoms, and treatments.
Hoarding Disorder Treatments
Often, in psychology, we can work backwards, looking at what treatments work in order to surmise what is going on. Cognitive behavioural therapy (CBT) is a common place for treatment to start. CBT for HD aims to help individuals understand and change the thoughts and feelings that lead to their hoarding behaviours.
CBT focuses on teaching the patient a range of skills to reduce acquiring and saving behaviours and to organise and declutter their living space. The goal of CBT for hoarding is not just to clear the clutter, but to fundamentally change the thought patterns and behaviours that lead to hoarding, thereby reducing the likelihood of it happening in the future. It’s hugely popular because it is a patient-centred and goal-oriented treatment that can be customised to the individual’s specific needs and circumstances.
OCD Hoarding Treatments
Treatment for OCD hoarding typically involves a combination of medication and CBT, with a specific focus on exposure and response prevention, known as ERP. ERP is a form of CBT where individuals gradually confront situations that trigger obsessions and anxiety, and learn to resist the urge to perform compulsions – in this case, hoarding.
The goal of ERP is to reduce the anxiety associated with these triggers over time, thereby reducing the need for compulsive behaviours such as hoarding. Medication, often selective serotonin reuptake inhibitors (SSRIs), may also be used to help manage symptoms. This combined approach aims to address both the obsessive thoughts and the compulsive behaviours characteristic of OCD hoarding, offering a comprehensive treatment strategy.
Overcoming Hoarding
Dealing with hoarding behaviours can be a challenge. Fortunately, there are a range of treatments that are highly effective in combating it. CBT has shown success rates of over 80%, and there are even groups like Clutterers Anonymous that hold meetings across Australia, running a 12-step programme. Anxiety Australia offers support and resources that can help you or someone you care about.
Hoarding behaviour can occur for a variety of reasons, and it can be much deeper-rooted than many people realise. But there is help and treatment available. Please note this article should not serve as medical advice; if you or someone you care about is struggling, contact one of the many mental health helplines available, or your GP, counsellor, or psychologist.
