Hoarding Disorder

Hoarding Disorder is a mental disorder characterized by persistent difficulty discarding or parting with possessions (regardless of their actual value) due to a strong perceived need to save the items. There is also associated distress associated with discarding these items.

Epidemiology

There is a community prevalence of 2-6%.[1] Prevalence in the OCD population is about 30%. The rate of hoarding disorder increases with age. The mean age of emergence of hoarding symptoms is age 13, but the average age of treatment is at age 50.[2]

Prognosis

The course of illness is typically chronic. Individuals typically have a low marriage rate and high divorce rate.

Comorbidity
Risk Factors
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Specifiers

Specifiers

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Severity Specifier

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Hoarding vs. Collecting

Hoarding disorder differs from the normal collecting of items. In hoarding disorder, there is a large number of possessions that clutter active living areas to the point that the area is substantially compromised (and often poses a fire or safety risk).
  • Clutter Image Rating Scale
  • Savings Inventory-Revised
  • HOMES Scale

There is inconsistent evidence for the role of medications, particularly SSRIs in the treatment of hoarding.[3] In general, for people who do respond, the responses to SSRIs are poorer than those with OCD alone. The current approach is to attempt a trial of SSRIs or CBT, which can be helpful for hoarding.

SSRI's effectiveness is controversial, and poor outcomes have been shown with citalopram and escitalopram.

CBT has been found to be effective. Specialized CBT for hoarding includes: psychoeducation, skills training (organizing, decision-making, problem-solving), behavioural exposures (discarding, non-acquiring), and cognitive strategies.[4][5]

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Individuals with hoarding disorder are at very high risk for: fires in the home and falls. Clinicians should consider the individuals mobility, frailty, medical conditions, and visual or hearing impairment as part of safety planning. There is also high risk for infestations (bed bugs, lice, etc.). Other safety considerations include whether individuals have the ability to enter and exit the home, rooms, kitchen, bathrooms, and fire escapes. Hygiene, risk of infection, and air quality are also major issues. It is important to ensure individuals have available access to emergency services. A forced “clean out” is the last resort (i.e. - when there is a serious fire risk or health hazard). It is important to build rapport and consider risk management approach if possible, and gradually reduce these risks over time.[6]

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