What is Hoarding?

Hoarding Disorder: What it is, and what it is not.

By Dr David Mataix-Cols, Ph.D.

Like most human behaviors, saving and collecting possessions can range from being totally normal to excessive or pathological. Most children have collections at some point and approximately 30% of British adults define themselves as collectors. Hoarding and Compulsive Hoarding are some of the more commonly used terms to refer to an excessive and problematic form of 'collectionism'.

Hoarding is highly prevalent (approximately 2-5% of the population – that is potentially over 1.2 million people in the UK alone) and when severe, is associated with substantial functional disability and represents a great burden for the sufferers, their families and society.

Hoarding has often been considered a symptom of obsessive-compulsive disorder (OCD). It is clear that in some cases, hoarding can be a symptom of OCD, for example, when hoarding accompanies a fear of contaminating/harming others if "contaminated" possessions are discarded, or superstitious thoughts such as the unreasonable belief that throwing something away will result in a catastrophe of some kind. However, recent research has shown that in most cases, hoarding appears to be independent from other neurological and psychiatric disorders, including OCD. These individuals do not experience intrusive thoughts, images, or impulses (that is, obsessions) or repetitive behaviors (that is, compulsions) as defined in the current classification systems and required for a diagnosis of OCD. This means that a large proportion of sufferers may remain undiagnosed and thus not receive adequate treatment.

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the book that contains all officially recognised mental disorders, is due to be published in 2013. The work group I advise is proposing the creation of a new diagnosis in DSM-5 named "Hoarding Disorder." This proposed diagnosis would apply to hoarding that occurs in the absence of, or independently from, other organic or mental disorders. The World Health Organisation (WHO) is also likely to follow suit and include the disorder in its next edition (due in 2015).

World Health Organisation (WHO) finally announced recognition in 2018 World Health Organisation Hoarding Disorder Definition June 2018 On June 18, 2018, The World Health Organisation (WHO) released its new International Classification of Diseases (ICD-11)25. ICD-11 will be presented at the World Health Assembly in May 2019 for adoption by Member States to come into effect on January 01, 2022 Definition: “Is characterised by accumulation of possessions due to excessive acquisition of or difficulty discarding possessions, regardless of their actual value". It adds: "Accumulation of possessions results in living spaces becoming cluttered to the point that their use or safety is compromised. "The symptoms result in significant distress or significant impairment in personal, family, social, educational, occupational or other important areas of functioning.“

It is worth noting that whilst some hoarders have good insight into the problems caused by their behaviour, others are completely convinced that their situation is not problematic, despite evidence to the contrary. These sufferers are often reluctant to seek help for their problems, causing great distress to family members. Sometimes, when possessions and clutter spill over to communal areas, e.g. front and back gardens, neighbours may be affected too and councils may be forced to intervene.

Dr David Mataix-Cols, PH.D, now lectures at the Karolinska Institute in Sweden.