Compulsive hoarding syndrome: symptoms, causes and treatment

Hoarding syndrome, also called hoarding disorder (in the Diagnostic Manual of Mental Disorders, DSM-5), is a new disorder in the latest edition of the manual, although not a new disorder in clinical practice.

It is related to the classically known “Diogenes Syndrome”, although it presents important differences. Throughout this article we will use the name hoarding syndrome to refer to DSM-5 hoarding disorder (they will be interchangeable).

• Related article: "Impulse Control Disorders: Symptoms, Causes, and Treatment"

What is compulsive hoarding syndrome?

Hoarding syndrome is a psychological disturbance linked to the accumulation of objects and possessions of all kinds, from furniture, writings and instruments to plants and other living beings. Being a disorder, it generates significant discomfort for the person who manifests it, or for the people around them.

Differences with Diogenes syndrome

Compulsive hoarding syndrome or hoarding disorder is classified within Obsessive-Compulsive Disorders, and differs from the classic "Diogenes Syndrome" in that

Diogenes Syndrome typically appears in patients with some type of dementia or frontal lesion, as well as in patients with schizophrenia and/or with other significant brain impairments.

In contrast, in compulsive hoarding syndrome there is no other mental disorder that better explains the symptoms, nor nor is it attributable to another medical condition such as brain damage, cerebrovascular disease, or stroke syndrome. Prader-Willy.

In addition, the Diogenes Syndrome does not exist as an official diagnosis in any reference manual (neither in the ICD-10 nor in the DSM); it is rather a “popular” or social nomenclature.

• You may be interested in: "Diogenes syndrome: causes, symptoms and treatment"

Symptoms of Hoarding Syndrome

Symptoms of hoarding syndrome include the following phenomena.

1. Difficulty disposing of possessions

The patient shows great difficulty getting rid of possessions, and does not pay attention to the real value they have (whether they have it or not).

2. upset to discard

The difficulty in discarding things or objects is due to a need that the person perceives to keep the objects; that is, he "needs to keep them." this need carries significant discomfort associated with getting rid of objects.

3. accumulation of possessions

The above symptoms cause a large accumulation of various objects and possessions, be it furniture, old newspapers, broken toys, books, boxes, magazines, bags, etc. This accumulation congests and clutters up the areas of the house intended for living (for example, the bathroom, the kitchen, the living room...), and significantly compromises their use.

In addition, if the areas are tidy, it is thanks to the intervention of third parties (relatives, authorities, cleaning staff...), never thanks to the patient himself who suffers from the accumulation syndrome compulsive.

4. Significant discomfort

The accumulation of objects entails significant psychological discomfort for the patient, and/or a impairment of their daily functioning in all (or almost all) areas of their life (personal, social, labor…).

Besides, the patient's environment can be dangerous for him and/or for others, being the areas of the house accumulated with objects, susceptible to fires, for example.

Specifications

In compulsive hoarding syndrome, it must be specified in its diagnosis if excessive acquisition is also included. This means, if the person also buys, acquires (or requests) unnecessary items or for which there is not enough space in the house.

Other specifications included in the DSM-5 for hoarding syndrome are:

• With good or adjusted disease awareness.
• With poor awareness of illness.
• With absence of consciousness of disease / delusional.

Characteristics

It is estimated that between 2-6% of the US population suffers from it. Regarding its prevalence, in the general population (without mental disorders), it is more prevalent in men than in women. However, in the clinical population (with some other mental disorder), there are more women than men with hoarding syndrome.

It occurs more frequently in older people (especially between 55 and 94 years old), versus young people (between 34 and 44 years old). In addition, at ages 11 and 15 the first symptoms usually appear.

Comorbidity with other disorders

It is considered a chronic disorder, although it can be treated or improved. Regarding its comorbidity with other disorders, major depressive disorders, social phobias, GAD (Generalized Anxiety Disorder) and OCD (Obsessive Compulsive Disorder) are usually associated.

Specifically, 75% of patients with compulsive hoarding syndrome also have a mood or anxiety pathology. On the other hand, 20% of cases with the syndrome also have symptoms that meet OCD criteria. However, we must remember that none of the associated disorders fully explains the symptoms of hoarding syndrome.

• You may be interested in: "Obsessive-Compulsive Disorder (OCD): what is it and how does it manifest itself?"

Causes

As for its etiology, although the causes are not entirely clear, there are some risk factors for developing hoarding syndrome, related to the temperament of the person, their environment (environment) and their genetics.

1. Temper

An indecisive or perfectionist temperament is typical in these patients.

2. Family background

The fact of having a family member with compulsive hoarding syndrome it also increases the likelihood of getting it yourself.

3. stressful events

Going through a particularly stressful period, as well as the occurrence of certain stressful life events, is related to the appearance of hoarding disorder. These events include the death of a loved one, losing possessions in a fire, an eviction, or a divorce, for example.

4. Age

Risk factors are also related to a specific age of onset, as we have already seen; the 11 and 15 years. Over time, symptoms worsen. Older people are also more prone to developing it.

Treatment

psychological treatment may include cognitive-behavioral therapy as well as exposure-response-prevention techniques (for example, exposing the patient to get rid of objects without retrieving them) and emotional support important, especially to alleviate the symptoms that are often accompanied, such as anxiety or depression.

At the psychopharmacological level, they can be administered antidepressants either anxiolytics to treat comorbid symptoms of Compulsive Hoarding Syndrome.

Bibliographic references:

• American Psychiatric Association –APA- (2014). DSM-5. Diagnostic and Statistical Manual of Mental Disorders. Madrid: Pan American.
• Belloch, A.; Sandín, B. and Ramos, F. (2010). Manual of Psychopathology. Volume I and II. Madrid: McGraw-Hill.
• Becerra, J.A., Robles, M.J. (2010). Hoarding disorder characteristics. A new clinical syndrome? Biological Psychiatry, 17(3): 111 - 113.