Defining Hoarding

You might have heard that hoarding is being added to the Diagnostic and Statistical Manual for Mental Disorders (DSM) and hoarding has been approved as a separate listing in it (due to be released May 2013). I will refrain from a commentary on the issues with the DSM in general and simply point out that from a scientific perspective, they designate a series of criteria in order to prevent the definition from being applied too broadly. The very thing many people seem tempted to do with all the media attention hoarding has been getting in recent years.

In the case of a hoarding disorder, these are the proposed criteria:

A. Persistent difficulty discarding or parting with personal possessions, even those of apparently useless or limited value, due to strong urges to save items, distress, and/or indecision associated with discarding.

B. The symptoms result in the accumulation of a large number of possessions that fill up and clutter the active living areas of the home, workplace, or other personal surroundings (e.g., office, vehicle, yard) and prevent normal use of the space. If all living areas are uncluttered, it is only because of others’ efforts (e.g., family members, authorities) to keep these areas free of possessions.

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others).

D. The hoarding symptoms are not due to a general medical condition (e.g., brain injury, cerebrovascular disease).

E. The hoarding symptoms are not restricted to the symptoms of another mental disorder (e.g., hoarding due to obsessions in Obsessive-Compulsive Disorder, lack of motivation in Major Depressive Disorder, delusions in Schizophrenia or another Psychotic Disorder, cognitive deficits in Dementia, restricted interests in Autistic Disorder, food storing in Prader-Willi Syndrome).

Specify if:
With Excessive Acquisition: If symptoms are accompanied by excessive collecting or buying or stealing of items that are not needed or for which there is no available space.

Specify whether hoarding beliefs and behaviors are currently characterized by:
Good or fair insight: Recognizes that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are problematic.

Poor insight: Mostly convinced that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are not problematic despite evidence to the contrary.

Delusional: Completely convinced that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are not problematic despite evidence to the contrary.
http://www.ocfoundation.org/hoarding/diagnosing.aspx

Since these are simply the proposed criteria, it remains to be seen what the specific wording will be. This also doesn’t clarify how many of the lettered criteria need to be met for someone to qualify as having a hoarding disorder. With all DSM diagnoses, a person has to meet specific criteria. The purpose is to limit the subjective diagnoses – the possibility of someone to judge someone else based on their own viewpoints.

This is critical in my opinion as I see too much of someone (often a family member) deciding that this person is a “hoarder.” It’s not simply about having a lot of stuff around – even having severely cluttered living spaces – is not enough to qualify a person for having a hoarding disorder, that’s only one piece of several that need to be met.

One of the shocking and disturbing aspects of the hoarding television shows is the amount of trash that surrounds them and than how excruciating the thought, let alone the action, of throwing those things away is for them. This is one of the defining characteristics as defined by a number of presentations I have attended in the past years from psychologists. It’s more than struggling with making the decisions, there’s a terror about having those things removed. Although we might focus on the “obvious” trash that cannot be removed, someone who struggles with hoarding saves virtually everything, and it’s painful to consider getting rid of any of it.

I’ve briefly touched on the idea that hoarding is more complex than the media conveys. In a future post I plan on getting into more details as it applies to the general public. In the meantime, I hope this helps to clarify that hoarding is a true disorder that is often simplified by television.