Hoarding is defined as the acquisition of, and inability to discard worthless items even that appear (to others) to have no value. Hoarding behaviors can occur in a variety of psychiatric disorders (such as dementia, eating disorders, psychosis) and in the normal population. However, Compulsive Hoarding has quite a unique presentation.
Compulsive hoarding is not just an enthusuiasts' passion for collecting stamps, dolls, or baseball cards. Neither is it someone who likes to 'tinker', and fix up old cars or broken furniture. People with Compulsive Hoarding Syndrome may have immense difficulty throwing anything away, from the oldest paper clip, to a used food container, to an out of date newspaper, for fear that they might need those items in the future. Their homes are often full of stuff that the rest of us would call ‘junk’. The most commonly saved items include newspapers, magazines, old clothing, bags, books, mail, notes, and lists.
Along with difficulties in throwing things away, compulsive hoarders have severe difficulties with making decisions, perfectionism, and avoiding tasks. People with Compulsive Hoarding Syndrome do not like to make mistakes. In order to prevent making a mistake, they will avoid or postpone making decisions. Even the smallest task, such as washing dishes or checking mail may take a long time because it has to be done 'right'. The net result of these high standards and the fear of making a mistake is that compulsive hoarders avoid doing many tasks, because everything becomes tedious and overwhelming.
To differentiate 'normal' collecting from compulsive hoarding, Dr. Randy Frost and his colleagues define the compulsive hoarding syndrome according to 3 criteria;
1. The acquisition of, and failure to discard, possessions that appear to be useless or of limited value.
Compulsive hoarders have an obsessive need to acquire and save many objects, and tremendous anxiety about discarding them, because of a perceived need for the objects for their apparent value or excessive emotional attachment to them. A compulsive hoarder will think, “This is too good to throw away,” “This is important information," “I will need this later on," “This should not be wasted." These thoughts are normal, but their frequency and the importance attached to them are clearly excessive in compulsive hoarders. If they have any doubt at all as to the value of an object – no matter how trivial, compulsive hoarders will keep it – just in case.
2. Living spaces sufficiently cluttered so as to preclude activities for which those spaces were originally designed.
Obviously, with lots of items coming into the home and very few going out, the clutter will accumulate. It does not take long for the clutter to start spreading onto the floors, counter tops, hallways, stairwells, garage, and cars. Beds become so cluttered that there is no room to sleep. Chairs become buried under clutter, so there is no where to sit. Kitchen counters become so cluttered that food cannot be prepared. For many hoarders, it gets to a point where there might be only a narrow pathway that connects each room, and the rest of the house is piled several feet high with clutter. It becomes impossible to use many areas of the house for their original purpose.
3. Significant distress or impairment in functioning is caused by the hoarding.
Because of their desires for perfection, compulsive hoarders frequently take a long time to do even small chores. An inordinate amount of time may be spent “churning” – moving items from one pile to another but never actually discarding any item nor establishing any consistent organizational system. Many compulsive hoarders have limited social interactions. The nature of their problem makes them socially isolated. They are frequently too embarrassed by their clutter to have people come to their home, sometimes for many years. Some compulsive hoarders are able to work, but they will often comment that they are not working in a job that fully utilizes their skills or potential. They always come in early and they leave late because they take much longer than other people to finish task. A survey of elderly hoarders found that hoarding constituted a physical health threat in 81% of identified cases, including threat of fire hazard, falling, unsanitary conditions, and inability to prepare food.
Given this profile, it appears that people with Compulsive Hoarding Syndrome have unique deficits in problem-solving and information-processing. Compulsive hoarders have a distinct behavioral profile and a characteristic pattern of symptoms and functional disability that requires a unique treatment approach.
Treatment for Compulsive Hoarding involves two ongoing and overlapping phases. First there is the Discarding Phase, where a person learns to make decisions about individual items, and ultimately becomes more able to make the decisions required to discard much of their clutter. As more and more items are discarded, a person can then start learning how to effectively organize the stuff that remains. They learn how to develop efficient and effective systems for organizing their belongings that doesn't rely on visual cues. This is the Organizing Phase of treatment. However, it's one thing to be ableto organize one's belongings, but the compulsive hoarder typically has to learn how to be more organized in their daily lives. So another aspect of treatment is to help the person with compulsive hoarding to function more efficiently on a day to day basis. Treatment for compulsive hoarding can be a lengthy and time consuming process, but it can be tremendously effective for those dedicated people who really want to address their problem with hoarding.
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