Hi, I'm Dr. Tracey Marks, a psychiatrist,
and I make mental health education videos.
Today I'm talking about hoarding.
Hoarding used to be a subtype
of obsessive compulsive disorder.
A person would have persistent thoughts of collecting
or acquiring things,
and then they'd have rituals of holding on to items.
But research using functional brain imaging
has shown that different areas of the brain are affected
with hoarding than they are with OCD.
So in 2013, the fifth edition of the diagnostic manual,
hoarding and OCD
were pulled out of the anxiety disorder section
and hoarding became its own disorder
under the compulsive disorders section along with OCD,
body picking, hair pulling, and body dysmorphia.
Here's how it's defined.
It's a persistent difficulty
discarding or parting with possessions,
regardless of their actual value.
It's difficult to part with the items
because you feel you have to save them
and you become very distressed
with the idea of getting rid of them.
You become very attached to the items
and feel the need to save them from being destroyed.
In fact, some people can reach a delusional level
of treating the items like living beings.
Throwing away a newspaper from 1982
causes the same upset as having your dog taken away.
Another criteria is the difficulty
discarding the possessions
results in the accumulation of possessions
that congest and clutter active living areas
and substantially compromises their intended use.
If living areas are uncluttered,
it's only because of the interventions of third parties
such as family members, cleaners, or authorities.
Notice it says active living areas.
This is to distinguish this
from having a cluttered basement or a cluttered attic.
Having a lot of things in those areas
doesn't necessarily interfere with your functioning.
But having a lot of clutter in the active areas
means you can't cook in your kitchen,
or you can't take a shower, or sleep in your bed.
The last criteria is the hoarding causes
clinically significant distress or impairment
in social, occupational, or important areas of functioning,
including maintaining a safe environment
for yourself and others.
Most people with hoarding disorder
excessively acquire things.
So it's not that they simply just can't get rid of things,
but they actively acquire new things.
The most common method is buying,
which often causes financial problems
like getting into debt.
The next method is collecting free items
like pamphlets and flyers.
You can get in trouble because you go to an event
and take all of the programs.
And then smaller percentage of people will steal items
as part of the acquisition process.
Being held back from acquiring things
can cause a lot of distress
in the form of anxiety and depression.
What's the difference between hoarding and collecting?
With collecting, people acquire related things of value,
like figurines or race cars,
and it's not clutter.
One definition of clutter
is a large group of unrelated or marginally related objects
piled together in a disorganized fashion
in spaces designed for other purposes.
Collectors index and organize their possessions.
They're not just strewn about in piles.
Does this mean
that people who keep a cluttered home are hoarders?
No, because with hoarding,
you have the acquisition of new items of low value
and the clutter interferes with the active living spaces.
Some people are just more junky.
But chances are, if you go to their home,
there's still adequate space to walk around and sit down.
Now, just to give you some perspective
on what this can look like,
here's an example of an uncluttered space.
And this is an example of some clutter,
and then severe clutter.
These images are part of a clutter image rating scale
developed by the International OCD Foundation.
People who hoard can have other issues
like being indecisive, being perfectionistic,
procrastinating, and trouble planning and organizing tasks.
Animal hoarding is an unofficial subtype of hoarding
where you accumulate a large number of animals,
but fail to provide minimum standards of nutrition
and sanitation for the animals.
So it's more than just having a lot of pets
because you love animals.
You acquire the animals, but you don't take care of them.
And as you can imagine,
this increases the level of health hazards in your home
when you have diseased animals living there.
Hoarding disorder starts early, between ages 11 and 15,
but we don't often see it around 11 and 12
because you've got parents cleaning up
and getting rid of the clutter.
But as the years go on, it tends to get worse
if there's nothing done about it.
How do we treat it?
Therapy is the best approach,
usually cognitive behavior therapy,
to address the thoughts around acquiring
and holding onto the items.
Because of the need to acquire and accumulate,
it's not helpful to send the person off on a weekend getaway
while you get rid of their stuff.
That will only send them into a downward spiral of distress
over the loss of their items
and it won't keep them from accumulating more things.
Where do you find a therapist?
Check out this video I did on finding a therapist.
Another approach is using medications like antidepressants.
These can help,
especially if you're also depressed or anxious.
Also, sometimes a small dose of an antipsychotic medication
like aripiprazole may be helpful.
We don't have medication
specifically to treat hoarding disorder.
And in my experience, the medicines help a little,
but you still need therapy
to address the compulsive behavior.
Another resource is a site called helpforhoarding.org.
They have a buried treasure workshop
and a self-help book by the same title.
Check out these other videos on the compulsive disorders:
body repetitive behaviors and body dysmorphic disorder.
See you next time.