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Hoarding and the inclusion of hoarding in the DSM-V By Candice L. NarrinDecember 8, 2010

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A literature review1Discarding Excessive acquiringClutterDistress2The are four common characteristics of a hoarder

Here are three different examples of what it might look like inside a hoarders house2A hoarder can not get rid of items (Cohen, n.d.; Gilliam & Tolin, 2010; Grisham & Barlow, 2005; Preston, Muroff, & Wengrovitz, 2009)

Hoarders consider their possessions as part of themselves, according to Grisham & Barlow (2005).

Grisham and Barlow (2005) also stated that people who hoard form emotional attachments to objects as opposed to people.

Grisham, Steketee, & Frost, (2008) discredited this part of theory by doing emotional testing on people who hoard.

However, this second study by Grisham et al., (2008) lacked a non control group for comparison.3Discarding3A second study by An et al., (2008) showed hoarders 50 pictures of high anxiety objects (rats, snakes, pics. Of body parts), 50 objects hoarders are believed to hoard, and 50 neutral objects. They were then asked to rate their anxiety when they pictured themselves discarding the 50 items related to hoarding. The hoarders rated the anxiety felt when picturing themselves discarding objects as anxiety provoking as the rats, snakes, body parts, etc.4Discarding

The pictures of the toilet paper roll, grocery sacks, and magazines are pictures of objects that hoarders keep. The pictures of the snakes and rat may be like the high anxiety provoking pictures that hoarders in the study were shown.4This study by An et al. (2008) included a control group of 50 participants who did not hoard objects for comparison of the two groups ratings for levels of anxiety.5DiscardingPeople who hoard acquire a lot of things because they get a high, or a positive emotional reinforcement, when they acquire a new item, which we have already learned they cannot discard (Gilliam & Tolin, 2010; Grisham & Barlow, 2005).

The study by Gilliam & Tolin (2010) did not compare how non hoarders feel when they acquire a new object for comparison.

The study by Grisham & Barlow (2005) claims to have up to date research but is five years old so it is now out of date.6Excessive acquiringExcessive cluttering leads to the next characteristic of a hoarder which is clutter.6There is a difference between normal clutter and the clutter accumulated by a hoarder (Gilliam & Tolin, 2010; Grisham & Barlow, 2005, Maycroft, 2009).

Maycroft (2009) goes on to explain the difference.

With normal clutter, objects are disorganized but located in an appropriate spot, and with clutter from hoarding, objects are not put in logical places (Maycroft, 2009). For example, kitchen items may be stored in the living room because there is no more room in the kitchen.

7Clutter

8Pictures of normal clutter and clutter accumulated by a hoarder

Picture 1Picture 2Picture 1 is mostly computer related objects kept by the computer. In picture 2, one arrow points to a refrigerator which signifies the room is a kitchen, and the other arrow points to a printer in the kitchen. If someone looks closely at the background in picture 2, they can also see a laundry basket being stored there.8

9Distress

Distress affects hoarders in two ways.

First of all, hoarders experience social distress (Gilliam & Tolin, 2010; Grisham & Barlow (2005). Family members know that the hoarders situation is not normal and they attempt to intervene or they avoid the hoarder in an attempt to avoid the negative feelings they experience in the hoarders environment.

Also, in regards to social distress, the hoarder experiences distress because they are embarrassed about their living environment and often go to extreme measures to not let anyone in it (Gilliam & Tolin, 2010; Grisham & Barlow (2005).

The second way that distress affects a hoarder is explained in the previously mentioned study by An et al. (2009) which demonstrated the high level of anxiety and/or distress hoarders experience when they try to make the decision to keep something or throw it away.

An et al. (2009) also theorized that this distress may be the reason a hoarder avoids attempting to make the decision in the first place.10Distress As mentioned earlier, the study by An et al. (2009) lacked a control group of non hoarders to compare how they feel when they are attempting to discard personal (remember hoarders may consider all objects, even worthless ones such as toilet paper rolls, personal) items.10The newest version of the DSM, the DSM-V (fifth edition), is due out in 2013 and currently, there is an argument over weather or not to include hoarding in it under a sub-condition of Obsessive compulsive disorder (OCD) or give it its own separate entry.

Some researchers believe that a separate listing would increase public awareness of the issue, improve the identification of hoarding, ensure a proper diagnosis is made, and stimulate research and developments of effective treatment (Matiax-Cohls et al., 2010).

Although this article discusses the need for a separate entry, it does not go on to explain the differences between hoarding and OCD that would make hoarding eligible for one.11Hoarding and the DSM-V

DSM stands for Diagnostic and Statistical Manual of Mental Disorders. Shown here is the current edition, the fourth edition, text revised, or more commonly called the DSM-IV-TR.

11Those that argue that hoarding should be included as a sub-condition of OCD, do so based on the following:

Like OCD, hoarding involves debilitating indecisiveness (An et al., 2008; IOCDF, 201; When keeping things gets out of hand; 2006).

They both exhibit A lack of control over impulses (IOCDF, 201; When keeping things gets out of hand, 2006).

They both have A desire for perfectionism (IOCDF, 201; When keeping things gets out of hand, 2006).

They both have obsessive fears (IOCDF, 201; When keeping things gets out of hand, 2006).

12Shared characteristics between hoarding and OCDEmotional reasons thought to be responsible for hoarding are inconsistent with OCD (IOCDF, 2010).

Few hoarders report negative, unwanted, intrusive thoughts regarding hoarding and these type of thoughts are the defining characteristic of OCD (IOCDF, 2010).

Hoarders exhibit pleasurable feelings and emotions when acquiring an item which is never present with OCD (Gilliam & Tolin, 2010; Grisham & Barlow, 2005; IOCDF, 2010).13Differences between hoarding and OCDAlso, in support of how hoarding is different from OCD, only 25-30 percent of people with OCD displays symptoms of hoarding, and ad much of 80 percent of hoarders display symptoms of OCD.13The most common method of treatment is Cognitive behavior therapy (CBT) which attempts to change the thought process and cognitions associated with hoarding (Grisham & Barlow, 2005; Gilliam & Tolin, 2010).

In some cases, this method has shown to be unsuccessful (Jefferys & Moore, 2008).

Another method used that was more successful was group cognitive behavior therapy or GCBT (Muroff, Skeketee, Rasmussen, Gibson, Bratiotis, & Serrentino, 2009). It was thought that this method was more successful because it addressed the social exclusion some people who hoard describe (Muroff et al., 2009). 14Current treatment optionsThis study by Muroff et al. (2009), did not include any control for non group related effects that could have influenced the participants in the group.

Some research is also being done into developing programs specifically designed for hoarders (When keeping stuff gets out of hand, 2006).

15Current treatment options

Picture 1Picture 2Picture 1 is an example of what a group CBT therapy session might look like and picture 2 is an example of what an individual CBT therapy session might look like.15Some research indicates that there is a possible link between brain malfunctions and hoarding symptoms (An et al., 2009; Grisham & Barlow, 2005; When keeping things gets out of hand, 2006).

one study conducted brain images of hoarders and non hoarders when they pictured themselves discarding personal items and found that there were areas of the brain that were significantly more active in the hoarder during the process (An et al., 2009).

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Could hoarding be caused by physiological problems that are treatable with medicine?

The study by An et al. (2009) has both a positive and a negative aspect.

The positive side is that it uses sophisticated equipment to take images of brain activity.

The negative aspect is that the study did not take into account any psychological illnesses that might have altered the brain activity, such as depression.17Could hoarding be caused by physiological problems that are treatable with medicine?

This research is important because it provides the possibility that hoarding is linked to physiology and that perhaps it is treatable with medications used to treat disorders responsible for altering brain activity such as diabetes, ADHD, depression, eating disorders, head and brain injuries, and schizophrenia.18Importance of studyHoarding has four characteristics. They are discarding issues, acquiring, excessive clutter, and distress.

The current argument related to hoarding is whether to include it with OCD in the DSM-V or to give it its own separate entry.

Currently the treatment options are CBT and GCBT.

Some studies link hoarding with physiological illnesses that cause brain disturbances which can be treated with medicine.

19In conclusionAn,S.,Mataix- cols,D.,Lawrence,N.,Wooders

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