Compulsive Hoarding Syndrome was always considered a form of OCD obsessive compulsive disorders. In 2013 the DSMV reclassified Hoarding Disorder or Hoarding Syndrome as sui generis or a disease unto itself, in its own category apart from OCD. Persons suffering with compulsive hoarding syndrome usually have multiple obsessional thoughts that result in the compulsive behaviors that cause a temporary emotional relief from the obsessions. Compulsive hoarding syndrome results in a snowball effect where the person is having more and more obsessional thoughts leading to more compulsive behaviors. One common obsessional thought is the concern over being contaminated to the point that the person can only relieve the thought by repetitively washing their hands. This of course perpetuates the anxiety to the worry that others might think the person is “crazy” because the person is washing their hands too much. Compulsive hoarding syndrome can be very impairing since it can take up so many hours of one’s day doing the compulsive behaviors. The person and their family members, friends, and maybe community all suffer from this illness. As with the ritual hand-washing, hoarding seems to mollify certain anxieties as well.
If I may digress for a moment, all of science really boils down to taxonomy or the naming or classification of the reality that we experience. When we reclassify and narrow our definitions of events, diseases and other things in life what we are doing is finding a better understanding of what something is and its causes. So as we reclassify hoarding disorder we are discovering more information about this disease, renaming it and then looking for its causes so we may better treat it. Often the social sciences, psychology and psychiatry take a bigger “leap” in the use of taxonomy in order to treat a particular illness. Unlike internal medicine where we can look at germs and viruses and clearly delineate between them; psychiatry is a bit fuzzier and sometimes less precise. So the reclassification of hoarding disorder may or may not be appropriate and we will not know this until we move down this road and new discoveries are made; therefore, some of us may continue to treat it as a form of OCD while the researchers are looking at this illness through a new paradigm with the hopes of finding better treatments and maybe even a cure someday. So for the time being hoarding disorder is now its own disease.
Compulsive Hoarding Syndrome Was Reclassified Apart From OCD
New studies have suggested the need to reclassify hoarding disorders from a sub-type of OCD to a separate disease. One of the reasons is that many hoarders don’t always meet the criteria for OCD. For now we will still continue to treat this disorder as being subsumed under OCD obsessive compulsive disorder. One of the benefits of reclassifying compulsive hoarding syndrome is that it might lead to a positive mind shift in research. Hoarding behavior can be very distressing and most people, even though they are aware of the disease, the feel enslaved to their compulsions and can’t break away. They are stuck in this bondage and therefore, don’t have much of a social life. They are isolated because they forego inviting people over for the embarrassment that this would cause. The hoarding disorder can be one of the most challenging disorders to treat. Nevertheless we now have many effective treatments for this if the person is able to acknowledge that there is a problem and go for help.
Generally hoarding disorder is treated with a multimodal approach. We have some medications that are now FDA approved to treat it. Fluoxetine (also called Prozac) and Fluvoxamine (also called Luvox), and Clomipramine (trade name Anafranil) can be quite helpful to the patients and seems to ease their desire or need to hoard. The other form of treatment that can be extremely beneficial is psychotherapy, specifically called cognitive behavioral therapy (CBT) and a more specific subtype of this is exposure response prevention (ERP) therapy. This therapy is accomplished when a person is exposed to the noxious stimuli or contaminant, and then not allowed to wash his or her hands during the therapy session with the therapist). I have seen this be very effective with the person becoming more and more comfortable with the exposure. The person is then able to translate that in his or her life. The therapist might bring some of the “junk” into the session and have the patient throw away the items in front of the therapist. This gives the patient not only a sense of accomplishment; but also the sense that they can really do this. Then the therapist will give the person homework to do at home starting with five things a day to throw away and sort ten things progressing with each session to eventually throwing twenty things away while sorting through twenty-five items. By this time the patient is well on his or her way to getting the life back that they had only dreamed of before the treatment.
Compulsive Hoarding Can and Often Affects The Family and Community
In more severe cases of compulsive hoarding syndrome, when the person’s home becomes so bad that it could be almost or positively condemned due to the living conditions, therapists and or home organizers sometimes will go out to the person’s home (usually at the behest of their family members) and work on the huge endeavor of cleaning it out and getting it organized, so that, one can live in it. I have seen homes where the homes were actually so cluttered with things that you could not go up even a stairwell. Other places have gotten so dirty that it is unhealthy to live in the home. Compulsive hoarding syndrome is a serious condition! Many times people only have a small path to go through in their homes because of all the clutter about with the hoarding behavior. Family members send me pictures of the patient’s home with only a small path to walk through with mountains of things three to six feet high on either side. This can be very disabling. Hoarding syndrome can often be minimized as sloppy or untidy habits.
I would always recommend that a person start on medication so that their minds allow them more readily to let go of these things that they have accumulated. Otherwise to rip these things away from people can be quite traumatic, especially since they have many times developed sentimental attachments to these things. You can realize that this is quite painful for these folks when you see them being brought to tears when these things are stripped away from them. This is why I think that a combination of medication, psychotherapy, and organizational help is the best approach to treat this condition in patients.
In the most OCD refractory cases of hoarding disorder, there is a neurosurgery used to treat this as well; but this is of course reserved for the most treatment resistant patients as a last resort. This surgery that is performed by neurosurgeons involves severing some connections between the left and right hemispheres of the brain. This has been proven effective, and therefore it is done in the most extreme cases. I have never actually witnessed this being done in any patient, but it is a very complicated procedure and not to be confused with a Hollywood depiction of a lobotomy. This is very invasive; therefore, we try to use medication and psychotherapy. Many times the biggest hurdle is finding patients that are cognizant of the problem and readily motivated to change. With a patient who is willing, there is a prognosis for relief from compulsive hoarding syndrome. There are many ways to deal with minor cases of OCD and to an extent we all seem to have an occasional quirk or tic. When these wry behaviors start to interfere with your daily functions, then it is time to seek help for compulsive hoarding syndrome or whatever manifestation of OCD you may be suffering from.