Hoarding

Disorder
What is Hoarding Disorder?
A. Persistent difficulty discarding
or parting with possessions,
regardless of their actual value
B. Difficulty is due to a perceived
need to save the items and
distress associated with
discarding them
C. Results in accumulation of
possessions that congest and
clutter living areas and
substantially compromises their
intended use.
Specify if: with excessive acquisition
insight is good/fair, poor, absent/delusional
D. Clinically significant
distress/impairment in social,
occupational or other important
area of functioning (including
maintaining a safe environment
for self/others)
E. Not attributable to another
medical condition
F. Not better explained by another
mental disorder
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DSM-5 Development:
Obsessive-Compulsive and
Related Disorders
o F 00 Obsessive-Compulsive Disorder
o F 01 Body Dysmorphic Disorder
o F 02 Hoarding Disorder
o F 03 Hair-Pulling Disorder
(Trichotillomania)
o F 04 Skin Picking Disorder
o F 05-06 Substance-Induced Obsessive-
Compulsive or Related Disorders
o F 07 Obsessive-Compulsive or Related
Disorder Attributable to Another Medical
Condition
o F 08 Obsessive-Compulsive or Related
Disorder Not Elsewhere Classified

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Characteristics of Hoarding
 Community prevalence  Course of illness: typically
2.3-6% chronic
✗ Prevalence in  Average age at treatment
OCD: 30% = 50
✗ Rate increases  Education ranges widely
with age: 2.3%  Tend to be single, live
aged 34-44, 6.2% alone
among age 55 and  Low marriage rate, high
above divorce rate
 Mean age of onset of
hoarding symptoms: 13
✗ 60% report onset
by age 12
✗ identified in 2-3.7%
of 15 year olds!

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Manifestations of
Hoarding
1. Compulsive Acquiring
✗ Compulsive buying
o Retail/discount
o Ebay, web shopping
o Home shopping network
✗ Compulsive acquiring of
free things
o Advertising flyers/handouts
o Give-aways
o Trash picking, dumpster diving

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2. Saving
✗ Reasons for saving
o Sentimental “this helps me
remember. This represents my
life. It’s part of me.
o Instrumental “I might need this.
I could fix this. Somebody could
use this. Think of the potential!”
o Intrinsic “Isn’t this beautiful”
✗ Hoarders apply these reasons to
more things

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3. Disorganization
✗ Condition of the home
o Clutter
o Mixture of important and
unimportant items
✗ Behaviour
o Fear of putting things out of sight
o Indecisiveness – churning
o Categorization problems

May be slow at completing tasks, frequently

late, use circumstantial/over-inclusive
language

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9
Assessing
Potential
Hoarders
HOARDING ASSESSMENT
SCALES
✗ UCLA Hoarding Severity Scale
(Saxena et al, 2007)
✗ Saving Inventory-revised (Frost
et al, 2004)
✗ Hoarding Rating Scale-Interview
(Tolin et al, 2010)

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Questions to ask someone who acknowledges “clutter”:
 Are your belongings in piles along the sides of
some/most rooms? How high?
 Are you limited to pathways in some rooms?
 Or are you walking on “goat paths” over piles?
 Are any rooms so cluttered that they’re difficult
to use/unusable? i.e. no longer sleeping in
bed, kitchen too full to use, no access to
bathtub?
 Do you feel your clutter is a problem?
 Are you willing to work on getting rid of things?

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MANAGEMENT
OPTION

✗ Cognitive-behavioral therapy
(CBT)
✗ Medication

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✗ During CBT, individuals gradually learn to
discard unnecessary possessions with less
distress, diminishing their exaggerated perceived
need or desire to save for these possessions.
✗ They also learn to improve skills such as
organization, decision-making, and relaxation.
✗ For many people, certain anti-depressant
medications may be helpful and may produce
more rapid improvement

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Summary
✗ Hoarding likely ✗ Poor insight,
common, unwillingness to
chronic, frequently accept help may
severe limit outcome in
✗ Hoarding becoming community
viewed as ✗ Etiology is poorly
an independent understood,
disorder which is multifactorial
sometimes
associated with
OCD
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Summary
✗ Treatment may help ✗ Long-term treatment
✗ Drug treatment often necessary
✗ CBT ✗ Consider long-term
✗ Combined care/non-drug
approaches alternatives in very
✗ Establish realistic refractory cases
treatment goals:
improvement, not
remission

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In two or three columns
Yellow Blue Red
Is the color of gold, Is the colour of the clear Is the color of blood, and
butter and ripe lemons. sky and the deep sea. It because of this it has
In the spectrum of visible is located between violet historically been
light, yellow is found and green on the optical associated with sacrifice,
between green and spectrum. danger and courage.
orange.

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Charts explain your ideas

Gray

White Black

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And tables compare data

A B C

Yellow 10 20 7

Blue 30 15 10

Orange 5 24 16

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Let’s review some concepts
Yellow
Is the color of gold, butter and
ripe lemons. In the spectrum of
visible light, yellow is found
between green and orange.
Yellow
Is the color of gold, butter and
ripe lemons. In the spectrum of
visible light, yellow is found
between green and orange.
Blue
Is the colour of the clear sky and
the deep sea. It is located
between violet and green on the
optical spectrum.
Blue
Is the colour of the clear sky and
the deep sea. It is located
between violet and green on the
optical spectrum.
Red
Is the color of blood, and
because of this it has historically
been associated with sacrifice,
danger and courage.
Red
Is the color of blood, and
because of this it has historically
been associated with sacrifice,
danger and courage.
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