Compulsive hoarding
Encyclopedia
Compulsive hoarding is the acquisition of possessions
Property
Property is any physical or intangible entity that is owned by a person or jointly by a group of people or a legal entity like a corporation...

 (and failure to use or discard them) in excess of socially normative amounts, even if the items are worthless, hazardous, or unsanitary. Compulsive hoarding may impair mobility and interfere with basic activities, including cooking
Cooking
Cooking is the process of preparing food by use of heat. Cooking techniques and ingredients vary widely across the world, reflecting unique environmental, economic, and cultural traditions. Cooks themselves also vary widely in skill and training...

, cleaning, hygiene
Hygiene
Hygiene refers to the set of practices perceived by a community to be associated with the preservation of health and healthy living. While in modern medical sciences there is a set of standards of hygiene recommended for different situations, what is considered hygienic or not can vary between...

, sanitation
Sanitation
Sanitation is the hygienic means of promoting health through prevention of human contact with the hazards of wastes. Hazards can be either physical, microbiological, biological or chemical agents of disease. Wastes that can cause health problems are human and animal feces, solid wastes, domestic...

, bathroom
Bathroom
A bathroom is a room for bathing in containing a bathtub and/or a shower and optionally a toilet, a sink/hand basin/wash basin and possibly also a bidet....

 use and sleep
Sleep
Sleep is a naturally recurring state characterized by reduced or absent consciousness, relatively suspended sensory activity, and inactivity of nearly all voluntary muscles. It is distinguished from quiet wakefulness by a decreased ability to react to stimuli, and is more easily reversible than...

ing.

It is not clear whether compulsive hoarding is an isolated disorder, or rather a symptom of another condition, such as obsessive-compulsive disorder
Obsessive-compulsive disorder
Obsessive–compulsive disorder is an anxiety disorder characterized by intrusive thoughts that produce uneasiness, apprehension, fear, or worry, by repetitive behaviors aimed at reducing the associated anxiety, or by a combination of such obsessions and compulsions...

. Prevalence rates have been estimated at 2-5% in adults, the odds of which increase with the number of paranoid, schizotypal, avoidant, and obsessive-compulsive traits

Characteristics

While there is no clear definition of compulsive hoarding in accepted diagnostic criteria (such as the current DSM
Diagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...

), Frost and Hartl (1996) provide the following defining features:
  • The acquisition of, and failure to discard, a large number of possessions
    Property
    Property is any physical or intangible entity that is owned by a person or jointly by a group of people or a legal entity like a corporation...

     that appear to be useless or of limited value
  • Living spaces sufficiently cluttered so as to preclude activities for which those spaces were designed
  • Significant distress or impairment in functioning caused by the hoarding
  • Reluctance or inability to return borrowed items; as boundaries blur, impulsive acquisitiveness could sometimes lead to stealing or kleptomania
    Kleptomania
    Kleptomania is an irresistible urge to steal items of trivial value. People with this disorder are compelled to steal things, generally, but not limited to, objects of little or no significant value, such as pens, paper clips, paper and tape...



According to Sanjaya Saxena, MD, director of the Obsessive-Compulsive Disorders Program at the University of California, San Diego
University of California, San Diego
The University of California, San Diego, commonly known as UCSD or UC San Diego, is a public research university located in the La Jolla neighborhood of San Diego, California, United States...

, compulsive hoarding in its worst forms can cause fires, unclean conditions (e.g. rat and roach infestations), injuries from tripping on clutter, and other health and safety hazards
Hazards
Hazards is the only independent, union-friendly magazine to win major international awards. A recurring theme in the magazine is that workplace unions are the best hope for better, safer work - and Hazards says it provides the information and resources to make the union job easier. Hazards looks...

.

The hoarder may believe that the hoarded items are very valuable, or know that the accumulated items are useless but keep them anyway, or attach a strong personal value to items which other people claim would have little or no value
Value
Value or values may refer to:Concepts of worth:* Value theory – overview of approaches in various disciplines* Value ** Value * Value ** Theory of value ** Value investing...

. A hoarder of the first kind may show off a cutlery set claiming it to be made of silver and mother-of-pearl, disregarding the fact that the packaging clearly states the cutlery is made of steel and plastic.

A hoarder of the second type may have a refrigerator filled with uneaten food items months past their expiration dates, but in some cases vehemently resists any attempts by relatives to dispose of the unusable food. In other cases, the hoarder will recognize the need to clean the refrigerator but due (in part) to feelings that doing so would be an exercise in futility, and overwhelmed by the similar condition of the rest of their living space, fails to do so.

Hoarders of the third type often keep "collections" as a hobby, for example dolls, toy soldiers, obsolete road maps, clothes, rusty tools, and non-functional sewing machines.

Case studies

The following (edited) case study is taken from a published account of compulsive hoarding:
The following case study is taken from a published account of compulsive hoarding:

Obsessive–compulsive disorder

It is not clear whether compulsive hoarding is a condition in itself, or rather, a symptom of other related conditions. Several studies have reported a correlation between hoarding and the presence and/or severity of obsessive–compulsive disorder (OCD). Compulsive hoarding does not seem to involve the same neurological mechanisms as more familiar forms of obsessive–compulsive disorder and does not respond to the same drugs, which target serotonin
Serotonin
Serotonin or 5-hydroxytryptamine is a monoamine neurotransmitter. Biochemically derived from tryptophan, serotonin is primarily found in the gastrointestinal tract, platelets, and in the central nervous system of animals including humans...

.

Hoarding behavior is also related to obsessive–compulsive personality disorder (OCPD). There may be an overlap with a condition known as impulse control disorder (ICD), particularly when compulsive hoarding is linked to compulsive buying or acquisition behavior. However, some people displaying compulsive hoarding behavior show no other signs of what is usually considered to be OCD, OCPD, or ICD. Those diagnosed with attention-deficit hyperactivity disorder
Attention-deficit hyperactivity disorder
Attention deficit hyperactivity disorder is a developmental disorder. It is primarily characterized by "the co-existence of attentional problems and hyperactivity, with each behavior occurring infrequently alone" and symptoms starting before seven years of age.ADHD is the most commonly studied and...

 (ADHD) often have hoarding tendencies.

Book hoarding

Bibliomania
Bibliomania
Bibliomania can be a symptom of obsessive–compulsive disorder which involves the collecting or even hoarding of books to the point where social relations or health are damaged.-Description:...

 is a disorder involving the collecting or hoarding of books to the point where social relations or health are damaged. One of several psychological disorders associated with books (such as bibliophagy or bibliokleptomania), bibliomania is characterized by the collecting of books which have no use to the collector nor any great intrinsic value to a more conventional book collector. The purchase of multiple copies of the same book and edition and the accumulation of books beyond possible capacity of use or enjoyment are frequent symptoms of bibliomania.

Animal hoarding

Animal hoarding
Animal hoarding
Animal hoarding involves keeping higher than usual numbers of animals as domestic pets without having the ability to properly house or care for them, while at the same time denying this inability. Compulsive hoarding can be characterized as a symptom of mental disorder rather than deliberate...

 involves keeping larger than usual numbers of animals as pet
Pet
A pet is a household animal kept for companionship and a person's enjoyment, as opposed to wild animals or to livestock, laboratory animals, working animals or sport animals, which are kept for economic or productive reasons. The most popular pets are noted for their loyal or playful...

s without having the ability to properly house or care for them, while at the same time denying
Denial
Denial is a defense mechanism postulated by Sigmund Freud, in which a person is faced with a fact that is too uncomfortable to accept and rejects it instead, insisting that it is not true despite what may be overwhelming evidence.The subject may use:* simple denial: deny the reality of the...

 this inability. Compulsive animal hoarding can be characterized as a symptom of a disorder rather than deliberate cruelty towards animals. Hoarders are deeply attached
Attachment theory
Attachment theory describes the dynamics of long-term relationships between humans. Its most important tenet is that an infant needs to develop a relationship with at least one primary caregiver for social and emotional development to occur normally. Attachment theory is an interdisciplinary study...

 to their pets and find it extremely difficult to let them go. They typically cannot comprehend that they are harming their pets by failing to provide them with proper care. Hoarders tend to believe that they provide the right amount of care for their pets. The American Society for the Prevention of Cruelty to Animals
American Society for the Prevention of Cruelty to Animals
The American Society for the Prevention of Cruelty to Animals is a non-profit organization dedicated to preventing cruelty towards animals...

 provides a "Hoarding Prevention Team," which works with hoarders to help them attain a manageable and healthy number of pets. Along with other compulsive hoarding behaviors, it is linked in the DSM-IV to obsessive–compulsive disorder and obsessive–compulsive personality disorder. Alternatively, animal hoarding could be related to addiction
Behavioral addiction
Behavioral addiction is a form of addiction which does not rely on drugs or alcohol. Increasingly referred to as process addiction or non-substance-related addiction ) behavioral addiction includes a compulsion to repeatedly engage in an action until said action causes serious negative consequences...

, dementia
Dementia
Dementia is a serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging...

, or even focal delusion.

Animal hoarders display symptoms of delusional disorder
Delusional disorder
Delusional disorder is an uncommon psychiatric condition in which patients present with circumscribed symptoms of non-bizarre delusions, but with the absence of prominent hallucinations and no thought disorder, mood disorder, or significant flattening of affect...

 in that they have a "belief system out of touch with reality". Virtually all hoarders lack insight into the extent of deterioration in their habitation and the health of their animals, refusing to acknowledge that anything is wrong. Delusional disorder is an effective model in that it offers an explanation of hoarders' apparent blindness to the realities of their situations. Another model that has been suggested to explain animal hoarding is attachment disorder
Attachment disorder
Attachment disorder is a broad term intended to describe disorders of mood, behavior, and social relationships arising from a failure to form normal attachments to primary care giving figures in early childhood, resulting in problematic social expectations and behaviors...

, which is primarily caused by poor parent-child relationships during childhood.

As a result, those suffering from attachment disorder may turn to possessions, such as animals, to fill their need for a loving relationship. Interviews with animal hoarders have revealed that often, hoarders experienced domestic trauma in childhood, providing evidence for this model. Perhaps the strongest psychological model put forward to explain animal hoarding is obsessive–compulsive disorder (OCD).

Neurophysiology

Brain imaging studies using positron emission tomography (PET) scans that detect the effectiveness of long-term treatment have shown that the cerebral glucose metabolism patterns seen in OCD hoarders were distinct from the patterns in non-hoarding OCD. The most notable difference in these patterns was the decreased activity of the dorsal anterior cingulated gyrus, a part of the brain that is responsible for focus, attention and decision making. A 2004 University of Iowa study found that damage to the frontal lobes of the brain can lead to poor judgment and emotional disturbances, while damage to the right medial prefrontal cortex
Prefrontal cortex
The prefrontal cortex is the anterior part of the frontal lobes of the brain, lying in front of the motor and premotor areas.This brain region has been implicated in planning complex cognitive behaviors, personality expression, decision making and moderating correct social behavior...

 of the brain tends to cause compulsive hoarding.

Some evidence based on brain lesion case studies also suggests that the anterior ventromedial prefrontal and cingulate cortices may be involved in abnormal hoarding behaviors, but sufferers of such injuries display less purposeful behavior than other individuals that compulsively hoard, thus making the implication of these brain structures unclear.

Psychopharmacological Interventions

Obsessive-compulsive disorders are treated with various antidepressants: from the Tricyclic antidepressant
Tricyclic antidepressant
Tricyclic antidepressants are heterocyclic chemical compounds used primarily as antidepressants. The TCAs were first discovered in the early 1950s and were subsequently introduced later in the decade; they are named after their chemical structure, which contains three rings of atoms...

 family clomipramine
Clomipramine
Clomipramine is a tricyclic antidepressant . It was developed in the 1960s by the Swiss drug manufacturer Geigy and has been in clinical use worldwide ever since.- Indications :...

 (brand name Anafranil); and from the SSRI families paroxetine
Paroxetine
Paroxetine is an SSRI antidepressant. Marketing of the drug began in 1992 by the pharmaceutical company SmithKline Beecham, now GlaxoSmithKline...

 (Paxil), fluoxetine
Fluoxetine
Fluoxetine is an antidepressant of the selective serotonin reuptake inhibitor class. It is manufactured and marketed by Eli Lilly and Company...

 (Prozac), fluvoxamine
Fluvoxamine
Fluvoxamine is an antidepressant which functions as a selective serotonin reuptake inhibitor . Fluvoxamine was first approved by the U.S. Food and Drug Administration in 1993 for the treatment of obsessive compulsive disorder . Fluvoxamine CR is approved to treat social anxiety disorder...

 (Luvox), sertraline
Sertraline
Sertraline hydrochloride is an antidepressant of the selective serotonin reuptake inhibitor class. It was introduced to the market by Pfizer in 1991. Sertraline is primarily used to treat major depression in adult outpatients as well as obsessive–compulsive, panic, and social anxiety disorders in...

 (Zoloft) and citalopram
Citalopram
Citalopram brand names: Celexa, Cipramil) is an antidepressant drug of the selective serotonin reuptake inhibitor class. It has U.S...

 (Celexa). With existing drug therapy, OCD symptoms can be controlled but not cured. Several of these compounds (including paroxetine, which has an FDA indication) have been tested successfully in conjunction with OCD hoarding.

Therapeutic Interventions

Cognitive-behavioral therapy (CBT) is a commonly implemented therapeutic intervention for compulsive hoarding. This modality of treatment usually involves exposure and response prevention to situations that cause anxiety and cognitive restructuring
Cognitive restructuring
Cognitive restructuring, sometimes used synonymously with Debating, is the process of learning to identify irrational or maladaptive thoughts and challenge their veracity using strategies such as logical disputation....

 of beliefs related to hoarding. Furthermore, research has also shown that certain CBT protocols have been more effective in treatment than others. CBT programs that specifically address the motivation of the sufferer, organization, acquiring new clutter, and removing current clutter from the home have shown promising results. This type of treatment typically involves in home work with a therapist combined with between-session homework, the completion of which is associated with better treatment outcomes. Research on internet-based CBT treatment for the disorder has also shown promising results.

Books

  • Plyushkin
    Plyushkin
    Plyushkin is a fictional character in Nikolai Gogol's novel Dead Souls. He is a landowner who obsessively collects and saves everything he finds, to the point that when he wants to celebrate a deal with the protagonist, he orders one of his serfs to find a cake that a visitor brought several years...

     is a fictional Russian hoarder in Nikolai Gogol
    Nikolai Gogol
    Nikolai Vasilievich Gogol was a Ukrainian-born Russian dramatist and novelist.Considered by his contemporaries one of the preeminent figures of the natural school of Russian literary realism, later critics have found in Gogol's work a fundamentally romantic sensibility, with strains of Surrealism...

    's novel Dead Souls
    Dead Souls
    Dead Souls is a novel by Nikolai Gogol, first published in 1842, and widely regarded as an exemplar of 19th-century Russian literature. Gogol himself saw it as an "epic poem in prose", and within the book as a "novel in verse". Despite supposedly completing the trilogy's second part, Gogol...

    .
  • Unknown Subject 522 (hoarder) in The Broken Window
    The Broken Window
    The Broken Window is a crime thriller novel written by Jeffery Deaver. It is the eighth book in the Lincoln Rhyme series.A killer has access to the world's greatest data miner called Strategic Systems Datacorp. He is using detailed information to commit crimes and blame them on innocents...

    by Jeffery Deaver
    Jeffery Deaver
    Jeffery Deaver is an American mystery/crime writer. He has a bachelor of journalism degree from the University of Missouri and a law degree from Fordham University and originally started working as a journalist. He later practiced law before embarking on a successful career as a best-selling...

    .
  • Homer & Langley by E.L. Doctorow.

Television

Hoarding has frequently featured in reality television
Reality television
Reality television is a genre of television programming that presents purportedly unscripted dramatic or humorous situations, documents actual events, and usually features ordinary people instead of professional actors, sometimes in a contest or other situation where a prize is awarded...

 programming. Notable examples include Clean House
Clean House
Clean House is a home makeover and interior design television show, originally broadcast in 2003 which has aired 9 seasons of programs on the Style Network...

on the Style Network
Style Network
The Style Network is an American cable television network based in Los Angeles.Owned by NBCUniversal, a subsidiary of General Electric and Comcast, its sister channels include E! Entertainment Television, USA Network, Syfy, G4, Golf Channel, and Versus, among others.-Network Overview:Style's...

, Hoarders
Hoarders
Hoarders is an American documentary series that airs on A&E. The series depicts the real-life struggles and treatment of people who suffer from compulsive hoarding. The first episode aired August 17, 2009, and has since aired three full seasons. The fourth season debuted June 20,...

on A&E
A&E Network
The A&E Network is a United States-based cable and satellite television network with headquarters in New York City and offices in Atlanta, Chicago, Detroit, London, Los Angeles and Stamford. A&E also airs in Canada and Latin America. Initially named the Arts & Entertainment Network, A&E launched...

, Life Laundry
Life Laundry
The Life Laundry was a BBC reality TV show that ran for three series from 2002 to 2004. It was first broadcast on BBC Two on 30 January 2002....

on the BBC
BBC
The British Broadcasting Corporation is a British public service broadcaster. Its headquarters is at Broadcasting House in the City of Westminster, London. It is the largest broadcaster in the world, with about 23,000 staff...

, and Hoarding: Buried Alive
Hoarding: Buried Alive
Hoarding: Buried Alive is an American documentary television series that premiered on TLC on March 14, 2010. The show follows hoarders through their life experiences and helps them learn to manage their illness.- Overview :...

on TLC
TLC (TV channel)
TLC is an American cable TV specialty channel which initially focused on educational content. Since 1991 TLC has been owned by Discovery Communications, the same company that operates the Discovery Channel, Animal Planet and The Science Channel, as well as other learning-themed networks...

, which had also previously aired one-time programs on the subject (Help! I'm a Hoarder and Truth be Told: I'm a Hoarder).

Hoarding has also occurred as a theme for characters in fictional television shows. These have included Oscar the Grouch
Oscar the Grouch
Oscar the Grouch is a Muppet character on the television program Sesame Street. He has a green body , has no nose , and lives in a trash can. His favorite thing in life is trash; evidence for this is the song "I Love Trash". A running theme is his compulsive hoarding of seemingly useless items...

 from children's show Sesame Street
Sesame Street
Sesame Street has undergone significant changes in its history. According to writer Michael Davis, by the mid-1970s the show had become "an American institution". The cast and crew expanded during this time, including the hiring of women in the crew and additional minorities in the cast. The...

, whose outrageous hoarding behavior is a common theme; Ambrose Monk from comedy-drama Monk
Monk (TV series)
Monk is an American comedy-drama detective mystery television series created by Andy Breckman and starring Tony Shalhoub as the titular character, Adrian Monk. It originally ran from 2002 to 2009 and is primarily a mystery series, although it has dark and comic touches.The series debuted on July...

, and Eli Goldsworthy from teen drama Degrassi: The Next Generation
Degrassi: The Next Generation
Degrassi: The Next Generation is a Canadian teen drama television series set in the Degrassi universe, which was created by Linda Schuyler and Kit Hood in 1979. Degrassi is the fourth fictional series in the Degrassi franchise, and follows The Kids of Degrassi Street, Degrassi Junior High, and...

. Hoarding has additionally served as the story basis for episodes of CSI: Crime Scene Investigation
CSI: Crime Scene Investigation
CSI: Crime Scene Investigation is an American crime drama television series, which premiered on CBS on October 6, 2000. The show was created by Anthony E. Zuiker and produced by Jerry Bruckheimer...

, South Park, Necessary Roughness
Necessary Roughness (TV series)
Necessary Roughness is a USA Network television series starring Callie Thorne and Marc Blucas. The one-hour drama series was picked up for 12 episodes on January 19, 2011...

, The Simpsons, 2 Broke Girls
2 Broke Girls
2 Broke Girls is an North American television comedy series that debuted on CBS during the 2011–12 television season. The first episode aired at 9:30 pm after Two and a Half Men on September 19, 2011. Later episodes followed How I Met Your Mother on Monday nights at 8:30 pm . The series was...

and House
House (TV series)
House is an American television medical drama that debuted on the Fox network on November 16, 2004. The show's central character is Dr. Gregory House , an unconventional and misanthropic medical genius who heads a team of diagnosticians at the fictional Princeton-Plainsboro Teaching Hospital in...

.

See also

  • Bibliomania
    Bibliomania
    Bibliomania can be a symptom of obsessive–compulsive disorder which involves the collecting or even hoarding of books to the point where social relations or health are damaged.-Description:...

  • Collecting
    Collecting
    The hobby of collecting includes seeking, locating, acquiring, organizing, cataloging, displaying, storing, and maintaining whatever items are of interest to the individual collector. Some collectors are generalists, accumulating merchandise, or stamps from all countries of the world...

  • Diogenes syndrome
    Diogenes syndrome
    Diogenes syndrome, also known as senile squalor syndrome, is a disorder characterized by extreme self-neglect, domestic squalor, social withdrawal, apathy, compulsive hoarding of rubbish, and lack of shame....

  • Hoarding
    Hoarding
    Hoarding or caching is a general term for a behavior that leads people or animals to accumulate food or other items in anticipation of future need or scarcity.-Animal behavior:...

  • Impulse control disorder
    Impulse control disorder
    Impulse control disorder is a set of psychiatric disorders including intermittent explosive disorder, kleptomania, pathological gambling, pyromania , and three body-focused repetitive or compulsive behaviors of trichotillomania , onychophagia and dermatillomania...

  • Collyer brothers
    Collyer brothers
    Homer Lusk Collyer and Langley Wakeman Collyer , known as the Collyer brothers, were two American brothers who became famous because of their bizarre nature and compulsive hoarding...

    , notable hoarders
  • Edmund Trebus
    Edmund Trebus
    Edmund Zygfryd Trebus was a Polish-born English man and compulsive hoarder, who came to fame when he was featured on the British television documentary series A Life of Grime.-Biography:...

    , notable hoarder
  • Alexander Kennedy Miller
    Alexander Kennedy Miller
    Alexander Kennedy Miller , also known as A. K. Miller, was an eccentric recluse who operated Miller's Flying Service in 1930, in Montclair, New Jersey, USA. Miller provided mail and other delivery services by means of an autogyro, as well as listing "Expert Automobile Repairing" and "Aeroplanes...

    , hoarded about 30 Stutz
    Stutz Motor Company
    The Stutz Motor Company was a producer of luxury cars based in Indianapolis, Indiana, USA. Production began in 1911 and continued through 1935. The marque reappeared in 1968 under the aegis of Stutz Motor Car of America, Inc., and with a newly defined modern retro-look. Although the company is...

     automobiles
  • Simple living
    Simple living
    Simple living encompasses a number of different voluntary practices to simplify one's lifestyle. These may include reducing one's possessions or increasing self-sufficiency, for example. Simple living may be characterized by individuals being satisfied with what they need rather than want...



External links

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