Hoarders: Mental Disorder Profiles

Hoarding is under increased scrutiny in both the public presence and clinical neuroscience research.  Some of this can be attributed to the television show Hoarders.  This show profiles a series of individuals with hoarding behaviors and the attempts made by professionals trying to help them.

If you have seen any of the shows you quickly realize that this problem is easy to assess but difficult to treat.   The effect on family members of hoarders is often extreme.  Family members commonly are driven from the hoarder's home due to increased clutter and concerns about sanitation.

Hoarding is being proposes as a new diagnosis under the fifth edition of the Diagnostic and Statistical Manual.  Clinicians who treat patients with obesessive compulsive disorder (OCD) are aware of hoarding phenomenology (symptoms) as some individuals with OCD will have hoarding behaviors.

Understanding hoarders requires assessment of co-occuring or comorbid mental disorders.  Frost et al have conducted a study of a comorbid disorders in a large series of over 200 individual hoarders and compared them to a group with OCD without problems with hoarding.

Obsessive compulsive disorder is a reasonable mental disorder to compare with hoarding.  Since some individuals (but not all) with OCD will have hoarding, it is helpful to use OCD as a psychiatric control group.  Such a strategy can aid with determining the boundaries (or discriminant validity) between similar conditions.

The authors used a rating scale that I have not heard of before--the Hoarding Rating Scale that rates three key components of hoarding:

• Clutter in the living environment
• Problems with discarding items
• Excessive acquistion of physical objects

As expected the hoarder group had higher rates on all components of the Hoarding Rating Scale.  The two groups had some interesting differences in lifetime prevalence rates for mood, anxiety and ADHD diagnoses as summarized in the chart below:

Hoarders had higher rates of major depression and generalized anxiety disorder than those with OCD.  Additionally they demonstrated significant increase in rates of attention deficit hyperactivity disorder.  

When the two groups were compared on a variety of types of impulse control behaviors, hoarders were much more likely to endorse compulsive buying, a pathological drive to obtain free items and kleptomania.  They were not different than those with OCD in rates of pathological gambling or trichotillomania (a impulse to constant pull out ones own hair).

This study does lend some support for considering hoarding as a distinct disorder separate from OCD.   The high rates of ADHD in this hoarding sample support clinical consideration of this condition in hoarders.  I was surprised by the relatively low rate of substance abuse.

You will likely hear more about research examining those who have hoarding behaviors.  Family, twin and other genetic studies would helpful to tease out where this type of behavior differs for OCD and other mental disorders. Below is a three minute educational video on hoarding from the University of Michigan.



Chart is an original chart from the author adapted from data presented in the Frost et al manuscript listed below. 

Frost RO, Steketee G, & Tolin DF (2011). Comorbidity in Hoarding Disorder. Depression and anxiety PMID: 21770000