Compulsive hoarding is a kind of compulsive behavior accompanied by collection and storage of unused items in a large quantity (Frost & Steketee, 2014). This can lead to inability to use the room for its intended purpose, reduced quality of life and other difficulties. A similar disorder may accompany schizophrenia or senile dementia (vascular origin). People suffering from compulsive hoarding, often fill their homes with heaps of useless things, leaving only narrow passages between them (Mataix-Cols, Billotti, Fernández De La Cruz, & Nordsletten, 2014). Furthermore, this disease can manifest in a form of one collecting at home tens, and even hundreds of animals (such as cats), and living in unsanitary conditions. Compulsive hoarding can be an expression of obsessive-compulsive disorder (OCD) (Frost & Steketee, 2014). Nonetheless, many people diagnosed with hoarding disease have no other symptoms of OCD (Mataix-Cols et al., 2014). The goal of this paper is to shed the light on the symptoms, origin, risk factors and possible interventions of the hoarding disorder.
Symptoms, Origin and Diagnosis
Previously, experts said that hoarding was one of the manifestations of obsessive-compulsive disorder (Frost & Steketee, 2014). Currently, researches and studies do not confirm the link between the two disorders (Mataix-Cols et al., 2014). However, there are points of interception between hoarding and depression, as well as vascular delusional disorder, schizophrenia and neurosis (Mataix-Cols et al., 2014).
According to some studies of uncontrolled collection of items, certain parts of the cortex of the brain, such as frontal lobe, are responsible for decision-making processes (Frost & Steketee, 2014). This part of the brain plays an important role in decision-making and analyzing processes. An analysis of clinical data revealed that the damage of the frontal lobe, as a consequence of an injury, surgery or recent infection, leads people who have not previously suffered from compulsive hoarding to start storing unnecessary things, all sorts of rubbish and useless garbage (Mataix-Cols et al., 2014).
Additionally, a group of scientists using functional magnetic resonance imaging explored the neural activity in different brain regions of 43 patients with hoarding syndrome, 31 patients suffering from obsessive-compulsive disorder and 33 participants composing the control group (Frost & Steketee, 2014). In the study, the subjects were placed in a situation where they had to decide what to do with various objects, which either belong to them or not, whether leave them alone or discard. It has been found that patients with the compulsive hoarding have abnormalities in comparison with other groups. The abnormalities were found by the test of two areas of the cortex – anterior cingulate and islets, which are usually involved in the decision making process (Frost & Steketee, 2014). Later, as the depression progresses, people appoint a certain emotional significance to the acquired things and can obtain new things as a supplement to the collection. Besides, a person develops a strong emotional attachment to all the items. Thus, the idea to throw away the most insignificant thing, whether it is a package or a broken umbrella, can cause severe mental anguish (Green, 2015).
In the case where an emotional attachment to collect items is lost, and hoarding is not going away, it is possible to think about the development of delusional disorder or schizophrenia within the vascular process. In schizophrenia, compulsive hoarding is characterized by overvalued ideas. It is impossible to persuade one to give up unnecessary things (Mataix-Cols et al., 2014). The patient’s mind is embraced with the idea of collecting and, as a rule it has only slight connection to any traumatic situations (Pato, Steketee, Eisen, Yip, & Phillips, 2015). In gerontological psychiatry, pathologic hoarding is a manifestation of vascular delusional disorders, which also do not have a clear connection to the traumatic situations and other similar experiences (Frost & Steketee, 2014).
Doctors still find it difficult to explain the causes of this disease (Frost & Steketee, 2014). Some believe that its causes come from the obsessional neurosis or depression; others are looking for its roots in attention deficit hyperactivity disorder (ADHD) (Mataix-Cols et al., 2014). Some psychologists argue that individuals must constantly get confirmation of their importance for the society around them (Frost & Steketee, 2014). They see the beginning of hoarding disorder in children’s behavior, when the child does not feel that adults and especially parents understand him/her (Green, 2015). Growing up, the child will compensate for the alienation, beginning to create his\her own world of things that do not run and hide from him/her. The collection is always there, always at hand.
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Population Affected and Risk Factors
The disorder is most likely to appear in the age above 55. Elderly people are the most affected due to strong emotional connection to all memory-making items. However, the disease progresses slowly throughout life. If having a collection in 20-30 years will seem simply weird, then after 40-50 years it can take catastrophic proportions. On average 2% of the population is affected by the disorder, however this figure depends on where one lives. Among the population aged over 65 years, about 3% suffer from the disease. About half of the hoarders suffer also from concomitant mental illness, such as schizophrenia, depression, different types of dementia and alcoholism (Frost & Steketee, 2014).
Therefore, risk factors include:
- Age. Hoarding first often occurs in 13-15 years, without treatment tends to deteriorate with age. It can arise even in young children who are beginning to collect pencil stub, old calendars, and broken toys. However, the most prevalent age for the problem to become acute is above 55 and the victims are the lonely retirees.
- Family history. There is a very strong link between the presence of family members of patients and the risk of compulsive hoarding in the patient.
- Stressful experiences. In some cases hoarding develops after severe stress, such as the death of a loved one, loss of savings, fire, divorce, accident or experienced violence.
- Alcohol abuse. Researchers say that about half of the collectors had problems with alcohol in the past.
- Social isolation. People suffering from hoarding, are often rejected by society and are isolated. In many cases, the hoarding itself causes isolation (Frost & Steketee, 2014).
In addition, the risky category includes people with certain personality traits. In fact, they are more frugal by nature, closed, tend to buy things for the future, rather niggardly. If the youth expresses these characteristics not very vividly, with the age the manifestation will become more dynamic, taking ugly forms. Sometimes, this disorder can appear along with the emotional reactions to injury or bereavement (Mataix-Cols et al., 2014).
Interventions and Treatment
Apparently, due to the lack of clear scientific explanation of this phenomenon, there are also no official recommendations for the therapeutic treatment of this disease (Frost & Steketee, 2014). Some experts are inclined to believe that every interested person should seek their own strategies, which are based on the individual characteristics of a specific person, to address the hoarding disorder (Mataix-Cols et al., 2014). Often in this case, experts recommend paying attention to the characteristic deviation in behavior.
However, there are several frequent interventions used to treat the disorder (Frost & Steketee, 2014). First, it is necessary to exclude the presence of endogenous psychoses. These are the loss of criticism of the condition, decreased emotional condition, and volitional development disorders (apathy, abulia). Also, as in the case with other forms of dependency (alcohol, drug, games, etc.), treatment may be complicated by the fact that the sick person does not see any problem and does not realize his/her condition (Frost & Steketee, 2014).
Hoarders do not seek help from a specialist, and those who do, are not willing to change their way of life and say goodbye to the material possessions that are dear to their hearts (Mataix-Cols et al., 2014). Considering this aspect of the disease, the primary step in helping a person is to reduce the harm to their life and health. In these terms, the steps to be taken are the decontamination of space (persecution of insects and other pests) to the maximum possible extent, and the provision of free access to the fire escape. The idea of harm reduction is based on the understanding that healing does not happen instantaneously, but if so, it is necessary to develop a plan, which will decrease life and health risks of the patient (Pato et al.2015).
Therapist support is also necessary to fight hoarding (noting that cognitive-behavioral therapy works well with this disorder). Drug therapy for compulsive hoarding includes taking antidepressants from the group of selective (polling) serotonin reuptake inhibitors (SSRI, or SSRIs) such as paroxetine (Paxil). However, not every patient responds to such therapy (Frost & Steketee, 2014).
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This disease was chosen for the current research, since hoarding problem is beginning to affect more and more people. Thanks to media and television that often depict people sick with hoarding disorder, many people started to pay attention to the amount of things in their apartments and houses of their elder relatives, including me personally. This research assignment helped me to actualize my personal knowledge about the problem and to find out general risk factors, with which I was not familiar. Additionally, the research gave me an opportunity to learn about possible interventions and coping strategies, as well as the importance of the immediate intervention with the problem.
People suffering from compulsive hoarding quite rationally explain their strange tradition to eat on the edge of the chair, while all the rooms, corridors, and the kitchen are cluttered with useless things to which its owner cannot and does not want to say goodbye. People, who suffer from this disorder, often do not see this as a problem, what complicates their treatment. To combat hoarding modern medicine offers a large number of psychotherapeutic and pharmacological treatments. Despite the fact that compulsive hoarding is not yet listed in the international directory of diseases, experts discuss this obvious omission. Additionally, the range of treatment techniques is already created, since hoarding is starting to be a very acute problem among elders.