Disposophobia

Compulsive hoarding (or disposophobia) is the acquisition of possessions (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, cleaning, hygiene, sanitation, bathroom use and sleeping. It is not clear whether compulsive hoarding is an isolated disorder, or rather a symptom of another condition, such as obsessive-compulsive disorder.

While there is no clear definition of compulsive hoarding in accepted diagnostic criteria (such as the current DSM), there are several defining features: the acquisition of, and failure to discard, a large number of possessions 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; and reluctance or inability to return borrowed items; as boundaries blur, impulsive acquisitiveness could sometimes lead to stealing or kleptomania.

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.

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. 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 (e.g. dolls, toy soldiers, obsolete road maps, clothes, rusty tools, non-functional sewing machines, etc.).

Hoarding has been linked to OCD, but 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. 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. Additionally, those diagnosed with attention-deficit hyperactivity disorder (ADHD) often have hoarding tendencies.

Bibliomania 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, 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 involves keeping larger than usual numbers of animals as pets without having the ability to properly house or care for them, while at the same time denying this inability. Compulsive animal hoarding can be characterized as a symptom of a disorder rather than deliberate cruelty towards animals. Hoarders are deeply attached 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. Along with other compulsive hoarding behaviors, it is linked in the DSM-IV to OCD and OCPD. Alternatively, animal hoarding could be related to addiction or dementia.

Animal hoarders display symptoms of delusional disorder 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, 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.

Brain imaging studies using positron emission tomography 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 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 of the brain tends to cause compulsive hoarding.

Obsessive-compulsive disorders are treated with various antidepressants: from the Tricyclic antidepressant family clomipramine (brand name Anafranil); and from the SSRI families paroxetine (Paxil), fluoxetine (Prozac), fluvoxamine (Luvox), sertraline (Zoloft) and citalopram (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.

Compulsive hoarding is also treated with psychotherapy that allows patients to deal with their emotions and behaviors. Most symptoms of OCD, such as contamination fears, checking, and morbid/ritualistic thinking are effectively treated with ‘Exposure and Response Prevention’ (ERP). ERP consists of two parts: Behavior therapy and cognitive behavioral therapy.

Hoarding has frequently featured in reality television programming. Notable examples include ‘Clean House,’ ‘Hoarders,’ ‘Life Laundry,’ and ‘Hoarding: Buried Alive.’ Hoarding has also occurred as a theme for characters in fictional television shows. These have included Oscar the Grouch from children’s show ‘Sesame Street,’ whose outrageous hoarding behavior is a common theme.

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