Dr. Grossi's Blog


Dr. Philip Grossi
Thursday, 31 May 2012

Hoarding has become a disorder in the spotlight, a subject of intense interest by the general public. From a psychiatrist's point of view it was entirely off the radar until the mid 1990s when a number of articles studying the phenomena began to appear. Literary references have been present for many hundreds of years with one of the earliest in Dante Alighieri's Divine Comedy written in the 14th century. Other literary references include Krook in Charles Dickens Bleak House and Sherlock Holmes, the detective created by Sir Arthur Conan Doyle. Intermittently there are articles in the newspapers about specific examples of hoarding as there were in New York papers about the Collyer brothers who died amid their junk about eighty years ago or a man who lived and died in San Francisco and who was described and pictured in the San Francisco Chronicle in the early 1970s. His apartment was piled from floor to ceiling with papers and one needed to move about in the apartment in what appeared to be tunnels between the stacks. The popular television series has greatly expanded interest in this topic.

Buttressing this attention is the new knowledge that hoarding is a significant public health problem. Timpano and colleagues have conducted epidemiological investigations and found a current population estimate of 5.8%, which is startling in that it exceeds the prevalence of autism, schizophrenia, OCD, and panic disorder. Other epidemiological studies have produces estimates of 5.3% and 4.6%, which still exceed the prevalence of the above-mentioned disorders. It is more common in men and increases with age. It does tend to run in families with between 12% to 25% of first degree relatives being hoarders or pack rats. Hoarders are also more likely to have impaired family and work domains as well as increased rates of chronic medical disease and increased usage of psychiatric services.

Frost and Gross published the first systematic definition of hoarding. They defined hoarding as "the acquisition of, and failure to discard, possessions which appear to be of useless or of limited value". Hoarding was associated with perfectionism and indecisiveness in their study. This study also confirmed the large number of first degree relatives with the disorder and disconfirmed the notion that the problem arose out of material deprivation earlier in life. It has been thought in the past that hoarding is a symptom dimension of obsessive compulsive disorder (OCD); however, recently that thinking has changed for many reasons and the DSM-V which is in preparation will likely list hoarding as a separate disorder.

illustration to Hoarding blogIn summary, hoarding represents the connection of three problems. First collecting too many things. Second, having great difficulty disposing of the items which seems to be driven by fear of losing important information or emotional attachment or just behaving wastefully. Third, hoarders manifest tremendous disorganization and attention problems.  These people tend to shop too much, collect free things, keep packing materials or even shoplift ot steal things.  The hallmark feature is the inability to dispose of things, especially clothes, newspapers, and books.  Finally, there is a manifest inability to organize their possessions which probably stems from an information processing problem and problems with attention, categorization, and decision making.  Often valuable items are mixed with worthless ones and often these individuals move possessions from one place to another without any effective result.