Is Hoarding a Symptom or a Disorder?

Dr. Devi C.G¹, Mrs. Jasinder Pal Kaur², Mrs. SeemaAggarwal³

¹Principal, Hind College of Nursing, Mau, Atria, Sitapur, Uttar Pradesh.

²Associate Professor, Dasmesh College of Nursing, Faridkot, Punjab

³Assistant Professor, Dasmesh College of Nursing, Faridkot, Punjab.

*Corresponding Author E-mail: yaminiindia2001@yahoo.in

ABSTRACT:

Hoarding is a condition that is caused by both biological and psychological factor usually begins slowly but build over time. In childhood items are collected for leisure or enrichment, in adulthood it is often for monetary reasons and in old age the collection of items may be reasons of sentimentality or security. An individual with extreme collection and acquisition behavior lead to distress, dysfunction and is undertaken secretly. The compulsive hoarding behavior is associated with health risk, impairment functioning economic burden and adverse effects on friends and family members. Education and increase social support play an important role in early identification of hoarding disorder.

KEY WORDS: Hoarding, biological, acquisition, dysfunction, behavior.

INTRODUCTION:

Hoarders- the mess begins in the brain

Many of them hang on to treasures and memorabilia from the past but homes are not so overwhelmed with clutter that it becomes detrimental to health and safety but now, possession and owing of plenty of material regarded as good sign of fortune and prosperity but excessive accumulation of material can be troubleshoot and destructive ,even be a obstacles and challenge everyday life. Hoarding usually begins slowly but builds over time, which includes certain behavior pattern of compulsive purchasing, searching and saving of items which has no value, these behavior has deleterious effect on physical, emotional, social, financial and even legal for family members and hoarders. Hoarding is a serious problem for both individual and family ,it doesn’t discriminate according the age, gender, race, socioeconomic status, religion, or any other differentiator. hoarding is greater in older than in younger age group, more in men than women¹

What is Hoarding disorder?

Hoarding disorder includes three things

1. A person collects and keeps a lot of items ,even things that appear useless or of little value to most people and

2. These items clutter the living spaces and keep the person from using their rooms as they were intended and

3. These items cause distress or problem in day to day activities²

Causes of Hoarding Disorder

· Family and medical history. Someone who has a family member with hoarding disorder is more likely to develop hoarding disorder. Many people with hoarding disorder also have a history of depression, anxiety disorders, or alcoholism.³Hoarding behavior is familial, with about 50% of individuals who hoard reporting having a relative who also hoards. Twin studies indicate that approximately 50% of the variability in hoarding is attributable to achieve genetic factors. ⁴

· Stressful life events. Some people develop hoarding disorder after a stressful life event. Examples include the death of a loved one, divorce, or losing possessions in a fire.

· Social isolation. Although some people become socially isolated as a result of hoarding disorder, others develop hoarding disorder as a coping mechanism for their loneliness.

· Personality traits; indecisiveness, perfectionism, disorganization, distractibility, procrastination, impulsivity, intense emotional attachment with object.

· Belief:

v Possession (Value, emotional comfort, negative impact of loss)

v Vulnerability (Ability to cope , face loss, grief without certain items)

v Responsibility (Rewaste, protection, preparation, opportunity)

v Memory (Extrinsic reminders to prevent mistake

· Specific brain anomalies are associated with higher incidence of abnormal hoarding behavior. damage to frontal lobe of brain may lead to abnormal hoarding behavior (Sk A Mataixcols et al)⁵

Types of Hoarding Disorder:

· Animal Hoarding

· Bibliomania / Information Hoarding (hoarding of Books)

· Syllogomania (Hoarding of trash/ garbage)

· Larder Hoarding (Hoarding of Food)⁶

Psychodynamics

According to Sigmund Freud - Psycho sexual stage:- (Age 1-3)⁷

Toilet training start the child learn first lesson of discipline, when Strict toilet training is there leads to Anal aggressive personality. Too much importance on anal activity leads to Anal retentive personality with extreme orderliness, hoarding, stubbornness and stinginess.

Conceptual model of compulsive Hoarding (Steketer and Frost 2007)⁸

Clinical manifestation:

1. Persistent difficulty in discarding or parting with possession regardless of their actual value .

Things mostly hoarded- clothes, containers, books, newspaper ,junk mail, craft items, garbage.

2. Difficulty arises is due to perceived need to save the items and distress associated with discarding them

Hoarders rationale their behavior for saving items as :

§ Increased sense of comfort and safety

§ Sentimental item

§ Future need

§ Memory aid

§ Contain certain important information.

3. Possession get accumulated resulting in congestion and cluster of living area and lead to compromises their intended uses and increased environmental safety risk ,fire hazards ,health risk.

4. Significant distress and impairment in social, occupational and daily living.³

Characteristic of Hoarding Disorder.³

Assessment and Diagnostic criteria - hoarding disorder:

Assessment-

1. hoarding interview

2. Measures of hoarding severity

· Hoarding rating scale

· Save inventory

· Clutter image rating⁹

According to DSM V Report that 2-6 % of the population have hoarding disorder,20 percentage of people with hoarding disorder also have OCD.¹⁰

v Criteria A --- persistent difficulty or parting with possession ,regardless of their actual value

v Criteria B--- The difficulty is due to a perceived need to save the items and to distress associated with discarding them .

v Criteria C--- The difficulty discarding possessions result in accumulation of the possession that congest and clutter active living area and substantially compromises their intended use.

v Criteria D —The hoarding causes clinically significant distress or impairment in social occupational or other important areas of functioning including maintaining a safe environment for self and others.

v Criteria E--- The hoarding is not attributable to another medical condition, brain injury, Cerebrovascular diseases, pracerwillis syndrome.

v Criteria F--- The hoarding is not better explain, the symptoms of other mental disorder.

Specify if ---- with excessive acquisition

Good or fair insight

Poor insight

Absent insight

Treatment:

· Medication- selective serotonin reuptake inhibitors (fluvoxamine, sertraline), serotonin/nor epinephrine reuptake (venlafaxamine)are used to treat hoarding disorder ¹¹

· Cognitive behavioural therapy (CBT) Session weekly (20—26 weeks)¹²

CBT protocol focuses on four specific element.

1.Information processing

2.Emotional attachment to possessions

3.Beliefs about possessions

4.Behavioural Avoidance.

Information processing:

People who hoard have trouble making decisions regarding whether to keep possession or not and with organization and categorization. As such treatment focuses on skill is sorting, organizing and decision making.

Emotional attachment to possession:

It is not uncommon for people to hoard to report an intense sentimental attachment to objects. This attachment, can make it difficult to discard object that otherwise have little to no value. Therapy using this technique such as cognitive restructuring and exposure are use to challenger beliefs around these objects and explores the true consequences of discarding such objects.

Belief about possession:

Hoarding often involves an intense belief that control must be maintained over possession and that there is a responsibility to ensure the possession.

Behavioural Avoidance

· Behavioural exposure and response prevention therapy

· Motivational interviewing

· Skill training

· Family therapy

Complications of Hoarding disorder :

Hoarding disorder can cause a variety of complication including:

· Increased risk of falls

· Injury or being trapped by shifting or falling items

· Family conflicts

· Loneliness and social isolation

· Unsanitary conditions that pose a risk to health

· A fire hazard

· Poor work performance

· Legal issues like eviction

Strategies to treat hoarding include:

· Challenging the hoarder’s thoughts and beliefs about the need to keep items and about collecting new things

· Going out without buying or picking up new items

· Getting rid of and recycling clutter. First, by practicing the removal of clutter with the help of a clinician or coach and then independently removing clutter

· Finding and joining a support group or teaming up with a coach to sort and reduce clutter

· Understanding that relapses can occur

· Developing a plan to prevent future clutter¹³.

REFERENCES:

1. General hoarding information http://www.ocfoundation.org

2. CBT therapy for hoarding abct-www.abct.org.<information >fa

3. Hoarding disorder-overview–mayoclinic .www.mayoclinic .org.ovc-20317407

4. Lervolino AC, Perroud N, Fullana MA et al (2009) ; prevalence and heritability of compulsive hoarding; a twin study ,Am J Psychiatry 166 (10);1156-1161

5. Sk. A.Mataixcols et al (2009) To discard or not to discard ,the neural basis of hoarding symptoms in obsessive compulsive disorder .molecular psychiatry,vol.14,pp 318-331.

6. www.hoarder.com> type of hoarder

7. A psychological perspectives on hoarding. WWW. bps.org.uk, system> files>a psy

8. Frost RO, Steketee, G (2014) The oxford handbook of hoarding and acquiring. Newyork; Oxford University Press

9. Treatment recommendation for hoarding disorder. Mental help. http//www.mentalhelp.net.>article>to

10. http/www.dsm5.org/documents/ocd

11. Hoarding disorder medication ;emedicine.medscape.com.>article.

12. http// www verywell.com>what is?.

13. Self-help strategies for hoarding disorder /Anxiety BC .https;//www.anxietybc.com> adults> self

Received on 16.08.2017 Modified on 20.08.2017

Int. J. Adv. Nur. Management. 2017; 5(3): 259-261.

DOI: 10.5958/2454-2652.2017.00056.7