Mother reported that her daughter was an only child who was shy and withdrawn. She was a "good student" until she reached middle school, when she began to refuse to attend and was socially isolated. There was no indication of brain trauma, viral syndromes or disorders such as Prader-Willi, schizophrenia, intellectual disabilities (formerly called mental retardation), cardiac conditions or major depressive disorder that may have hoarding as part of symptoms associated with the condition. Mother described her daughter as having Obsessive-Compulsive Disorder, but could not confirm a diagnosis.
When I asked about the possibility of autism, mother appeared to hesitate. If "compulsive collecting" is part of the autistic syndrome, then the person cannot be diagnosed with hoarding. Hoarding can be seen just before the onset of Alzheimer's Disease.
- Hoarding falls under the category of Obsessive-Compulsive Disorders + Related Disorders.
- Hoarding has been observed across all cultures, not just "consumer-oriented" cultures such as ours.
- It is seen in 2-6% of the population and while some studies indicate that males may experience it more than females, it is the female sufferers who seek help. The male hoarder is more "invisible".
- Annually, self-storage is a $38 BILLION industry. Americans spent $1.2 TRILLION on things we don't need. Having too much "stuff is our cultural norm". There may be more hoarding going on than we ever even thought about!
- Hoarding begins, typically, between 11 and 15 years and starts causing life problems in the mid-20's and becomes crippling by the mid-30's. With each decade, the severity increases.
- With hoarding, there are no periods of "waxing and waning", the symptoms keep escalating as time moves along.
- Hoarding behavior is tough to see in kids because they don't have control over their environments. Parents are in charge of purging extra and outdated/worn items.
- Hoarding is not to be confused with collecting. People who enjoy certain items collect them, but value and care for them.
- Those with Obsessive-Compulsive Disorder (OCD) collect bizarre things such as diapers, rotten food, feces as well as items such as discarded receipts or pamphlets which they get for free. Their obsession with, for example, cleanliness or fear of contamination or harm, causes them to behave compulsively by collecting things that may make them feel complete. Their behaviors are unwanted and distressing and they don't usually buy things to add to their "pile".
- Those with OCD experience an excessive signal that comes from the emotional part of the brain that checks the environment for danger and finds evidence for fear when there is no evidence. This signal causes a cascade of responses from other parts of the brain such as a sense of panic with heart racing and trembling. It's very distressing because abnormal messages sent in one part of the brain can cause unpredictable reactions in other parts of the brain.
- Those with hoarding do not find their behaviors to be distressing and they are prone to buying items to add to their possessions.
- 80-90% of hoarders demonstrate "excessive acquisition" whereby they make purchases.
- 50% of those who hoard have a hoarder in the family, so there's a familial component. They have family members who are seriously indecisive and cannot make up their minds about whether or not to discard an item.
- A traumatic event or stressor can cause the onset of hoarding behavior.
- 75% of hoarders have a mood or anxiety disorder; 50% are depressed or have social anxiety and 20% have OCD.
- Functional impairments include not being able to access their bed to sleep, use the sink or stove and their refrigerators are used to store items. They are at serious risk of falling, being trapped under their possessions, or causing a fire. Their utilities are frequently disconnected and their appliances are broken. They have been evicted or neighbors complain to the authorities about the condition of their properties including noxious odors.
The level of insight they have about their situation is a major factor in determining the outcome. If they have "good insight" and recognize their behavior is problematic, they are more likely to change than those with "poor" insight where they do not believe their behavior is a problem despite evidence to the contrary. Those whose insight is "absent" have delusional beliefs and are completely convinced their behavior is not problematic despite having severe functional impairments.
Recovering from hoarding is a long and arduous process of progress and decline, progress and decline and the healthiest outcome is when family and therapists collaborate.
As for the woman whose mother called The Dr. Claudia Show, I encouraged her to get information by working with a therapist who can help mother understand how to approach her daughter. It appears that anxiety and possibly, a social interaction disorder such as autism may be responsible for the current situation. Regardless, if mother is experiencing distress over her daughter, she need to develop a plan to reduce her own anxiety while helping her daughter. It's a win-win.
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