Diagnostics on Hoarding the Diagnostics

Diagnostics on Hoarding

The Diagnostics of Hoarding

Hoarding is a problem that the DSM has generally classified under OCD. However, it is very likely that the next edition of the DSM will show hoarding as a separate disorder when the manual is released in 2012. This is something for which clinicians and others have hoped for some time, because hoarding and OCD have differences that are important. In addition, while many hoarders have tendencies of OCD, not all people who have OCD are hoarders. The two really should be separated, so that it is possible to diagnose one or the other and differentiate them properly. In order to differentiate them, however, it is vital that one understands the diagnostic status of hoarding and the traits and actions that are used to conclude that someone has a hoarding disorder. In order to do that effectively, a clear distinction must be made between OCD and hoarding, and the traits that are used to identify hoarding behavior must also be discussed.

OCD vs. Hoarding

People who hoard do have a form of OCD, but many people who have OCD exhibit behaviors that are completely unrelated to hoarding. Because of that, the two disorders are not the same. However, some similar traits, such as a desire to have control over one's surroundings, are found in both of the disorders - and they can certainly coexist together in the same person (Tolin & Villavicencio, 2011; Tolin, et al., 2011). For many years, psychiatrists and psychologists placed hoarding under the umbrella of OCD, because the person who hoarded items was fixated on a behavior and kept doing that behavior over and over again. He or she had an obsession with keeping everything, or a compulsion to purchase more and more things. That included both the obsessive and compulsive areas of OCD, making it easy to say that people who hoarded items were obsessive-compulsive and should be classified as such.

As more was learned about hoarding, though, it became clear that there was much more to the disorder than whether a person kept items instead of throwing them away, or whether he or she purchased things that were not needed. There were often deep-seated reasons for the collection of what most people would call garbage, and everyone's reasons for collecting things were different (Tolin & Villavicencio, 2011). Some did it because they did not have much as children, others did it to have control over at least one part of their lives, and still others did it for reasons that they could not easily articulate or explain (Tolin, et al., 2011). No matter why a hoarder started keeping everything instead of discarding things that were not needed, treatment was necessary. When hoarding was considered part of OCD, standard OCD treatment was used. Now that the DSM is going to classify hoarding as something separate, there is a much higher chance that treatments for hoarding will be more appropriate to the actual problem. That can result in better outcomes for anyone who struggles with hoarding.

Ability to Discard

The ability to discard items that are not needed or wanted anymore is something that most people have. They can get rid of those items quite easily by either throwing them in the trash or donating them to charity. Hoarders, however, do not have the ability to discard (Anderson, Domasio, & Domasio, 2005). They may be able to throw out actual trash - but what constitutes trash? There are issues with rationalizing that go on in the mind of a hoarder in far different ways than in the minds of those who do not have the disorder. In the mind of a hoarder, there is no need to discard anything. What if they need it later? What if they can use it for something else, repair it, or find the missing pieces of it? They do not want to throw anything away because they are holding onto the promise of what that item might be in the future (Tolin, et al., 2011). More often than not, the item really has no future, but the hoarder does not see things that way. He or she sees potential, and one should not throw out potential.

The ability to discard is something that can be worked on over time, but only with the right therapy. In order to determine whether someone is able to discard items, one only has to see that person's house. Is it full of clutter? Is there trash that has not been thrown away for months or even years? If that is the case, the ability to discard may be very low - and that is something that can be improved upon. It may take some time for a hoarder to acquire the ability to discard, since he or she has a deep-seated need not to throw anything away or get rid of anything that might have some value (Anderson, Domasio, & Domasio, 2005). Eventually, even items that basically have no value are also kept, and the hoarder stops throwing anything away at all. That can harm family life, pose a danger to pets, and be a danger to the hoarder who may get buried under shifting boxes or trip and fall over piles of items on the floor (Tolin, et al., 2008).

Acquisition

Along with a seeming inability to discard anything, hoarders also have problems with acquisition (Tolin, et al., 2008). They shop frequently, bringing things home from garage sales, thrift stores, and department stores. Some of them will hoard food, and they will eat it even if it is very outdated. That can make them sick. More often than not, however, they hoard items that they buy "to use later" - only later never seems to come. There are many unfinished projects in the home of a hoarder, and there are materials which can be used to create many more projects. There are also plenty of unusable items. Hoarders may also "dumpster dive" by picking up items that others have put out for trash or recycling, or by actually climbing into and digging through dumpsters for items that they see as valuable, even though someone else has thrown those items away as trash (Tolin, et al., 2008). A hoarder will acquire items in all kinds of different ways, but he or she is always bringing new things home. Some hoarders even have storage units where they store more items when their home gets full (Tolin, et al., 2008; Tolin, et al., 2011).

Naturally, getting a handle on this disorder requires the hoarder to stop acquiring possessions. It is not enough to just learn to discard things, because bringing more things in can mean that a house will continue to fill up, even if some things have been discarded. Hoarders are not simply messy people who have a lot of stuff, or collectors of a particular item. They are people who have a mental illness and for whom treatment is available if they want it and if they want to get better. Learning to stop bringing things home can be difficult, because sometimes things really are needed. For example, a legitimate amount of food, clothing, household items, and knickknacks are to be expected in anyone's home. Learning to bring home those things and keep them at a specific level is difficult for a hoarder, and is one of the areas in which many of them struggle (Frost & Gross, 1993). That struggle can go on long after they have received treatment, because there is generally always a part of them that wants to buy more, "just in case." Learning to stand firm against that part of themselves and only purchase what they need and will use is vital for a hoarder.

Health Risk

It is no secret that hoarding can be unhealthy (Saxena, et al., 2011). Whether there is a risk of getting sick from spoiled food that is far out of date, or whether the hoarder has animals that leave urine and feces all throughout the house, there are dangers. Even people who do not hoard animals can have trouble keeping up with the animals they do have if their houses are heavily cluttered. There is also the problem of what to do with the animals' waste. If a hoarder cleans the litterbox, he or she may have trouble throwing away the used litter. Many hoarders have not thrown anything at all in their home away, sometimes for years. Of course, feces and spoiled food are not the only dangers that hoarders face. There are also risks that are simply related to the sheer volume of items they have in their homes.

These risks can include things like trips and falls. They can also include medical emergencies, because the paramedics may not be able to properly get to the person to care for him or her. Stretchers and other medical equipment may not fit through the door of a hoarder's home, and there may be little that can be done to help that person (Saxena, et al., 2011). Since hoarders are less likely to be married, it is possible that help for a hoarder who has fallen or otherwise become injured may be severely delayed. Sometimes, it can be too late. Fire is another danger faced by a hoarder. Such a large number of items can make a house more flammable, and also make it highly difficult to escape if a fire does get started (Saxena, et al., 2011). That is something that should be taken into consideration.

Impairment and Insight

The levels of impairment and insight vary with hoarders. Some of them see that they have a serious problem for which they need to get help, and some of them do not see what is wrong with the way they are living (Steketee, et al., 2010). They are generally very reluctant to part with any of their things, and they can become resentful of family and friends who are only trying to help them free their lives from all of the clutter. Intelligence is not the issue. Many hoarders are of average or above average intelligence, so it is not the mentally deficient that usually hoard (Tolin, et al., 2011). Often, hoarders hold onto possessions because of emotional conflicts and problems (Steketee, et al., 2010). For example, a man who has lost his wife suddenly and unexpectedly may be reluctant to dispose of any of her things. He may also look for something to fill the void in his life, and may see things in stores and other places that his wife would have liked. Bringing those things home may make him feel closer to her, so he continues to do so.

There are, of course, other reasons why people hoard. Loss does not have to be part of the issue, and control may be more significant (Tolin, et al., 2011). Someone who was very sheltered and controlled as a child may hoard as an adult in order to feel as though he or she is in control of the future. Overall, the insight and impairment that hoarders have is not static and is not shared across all hoarders. Each one is different, and each one has his or her own ideas and beliefs about the hoarding and about why it is taking place. Some are defiant as to the hoarding, others are embarrassed, and still others seem to have very little emotion about it unless someone suggests getting rid of the clutter (Steketee, et al., 2010). Impairment from an intelligence sense is really not the issue, but insight into the problem is clearly important. Hoarders must come face-to-face with the reasons behind their hoarding behaviors (Tolin, et al., 2011).

Level of Clutter

The level of clutter that is seen in the home of a hoarder goes far beyond what someone would consider "a little cluttered," or "a messy house." Many people do not have time to keep their houses picked up well. Others are tired or not well, and they may let things pile up here and there. However, hoarding is so far beyond that as to be noticeable even for those who do not have experience with hoarders or with treating them for their problems. The level of clutter in a hoarder's home is often to the point that sometimes just getting in through the front door may be difficult. The hallways are full of boxes and stacks and piles of items, as are the rooms. There are generally narrow passageways that are used by the hoarder to get from one room to the next (Tolin, et al., 2011). Some of the rooms are completely full and are not used at all. Others may require the hoarder to climb over or walk on items in order to navigate through the house. Slowly, the items have taken over the home - and the hoarder's life. That did not happen overnight, and will not be fixed overnight (Steketee, et al., 2010).