Does Hoarding Warrant an Independent Psychological Diagnosis?

Hoarding (HD) has recently been added to the DSM-V as its own diagnosis. Previously thought to be associated with obsessive compulsion (OCD), HD is now considered an independent psychiatric condition that is characterized by a propensity to acquire items and a difficulty to discard things, even when they impair one’s living space, health, and quality of life. Most diagnoses of HD occur in adulthood, but recent research has suggested that HD often begins in adolescence. There is also a high rate of comorbidity thought to be present with HD, although evidence supporting this is inconsistent.

Therefore, Volen Z. Ivanov of the Department of Clinical Neuroscience at Karolinska Institutet in Sweden recently led a study assessing the prevalence of HD and symptoms of HD in a sample of 3,974 adolescent twin participants. Ivanov gathered self-reports on hoarding behavior and also evaluated parental reports of autism (ASD), attention deficit hyperactivity (ADHD), and OCD present in the twin sample.

The results revealed that 2% of the participants exhibited hoarding symptoms. The females were more represented in this rate, suggesting that during adolescence, hoarding symptoms and hoarding behaviors are more prominent in girls than in boys. Although clutter was not significant for any of the participants with HD, Ivanov believes that clutter increases when children reach adulthood and acquire their own living space and have their own financial means. Acquiring items was also lower in this sample than in adults with HD. While only 30-40% of these children reported excessive acquisition, this behavior is present in nearly 85% of adults with HD. Again, Ivanov believes that this changes when children have their own income and their own living space.

With respect to comorbidity, the findings of this study did not show a higher level of comorbidity among the HD participants when compared to those without HD. Overall, 2.9% of the participants with HD had OCD and another 2.9% had comorbid ASD while 10% had ADHD and HD. In sum, these findings suggest that although there is comorbidity with HD, conditions that co-occur with HD are no more prevalent than in the general population and therefore, it is not directly linked with OCD, ASD or ADHD. Ivanov added, “Hoarding was rarely associated with other common neurodevelopmental [issues], supporting its DSM-5 status as an independent diagnosis.”

Ivanov, V.Z., Mataix-Cols, D., Serlachius, E., Lichtenstein, P., Anckarsäter, H., et al. (2013). Prevalence, comorbidity and heritability of hoarding symptoms in adolescence: A population based twin study in 15-year olds. PLoS ONE 8(7): e69140. doi:10.1371/journal.pone.0069140

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  • Hannah

    July 18th, 2013 at 10:26 AM

    Funny how my first thought immediately went to the idea that no, this should be classified as a type of OCD disgnosis. But I guess if there is this much difference in how it presents and mainfests then it makes the most sense to be its own separate diagnosis.

  • BC

    July 18th, 2013 at 11:32 PM

    Always thought hoarding was just a bad habit of a few people. That this is classified as a separate disorder is news for me. I don’t know but I just feel like every little habit that is ‘away’ from normal is being labelled as a disorder these days! Am I the only one who thinks so?

  • Nellie

    July 19th, 2013 at 4:23 AM

    I work in the medical field and there is very much a movement to not lump things together, to go for more specificity with each diagnosis, and this really is very helpful to most professionals in the field. Whether or not hoarding needs its own diagnosis I am in no way any kind of expert on that so I wouldn’t know. But what I do know is that I see better treatment coming from this movement toward greater specifics, greater understanding of diseases and the ways that they impact lives, and hopefully a stronger medical and educational community as a result. I think the more that we individualize and see how illnesses are specific and differ from person to person, the greater the chance is that one will receive proper treatment and care, care that meets his own individual needs and not just what we think that it should be given what helped someone else.

  • Janet Singer (ocdtalk)

    July 19th, 2013 at 5:01 AM

    Interesting article. Hoarding never seemed to “fit in” as an OCD spectrum disorder to me, so I’m glad it is separate. I also always thought of it appearing later in life than adolescence, so that is eye-opening also. Thanks for the information!

  • nelson

    July 20th, 2013 at 2:03 AM

    kids do all kinds of weird things.hoarding things is something I have observed in over half the children I do we differentiate a habit from a disorder of this kind?because children will cry and throw a fit if parents do decide to throw away things they want to do parents know it is the child in them and not a disorder that is doing this??

  • jane

    July 20th, 2013 at 6:11 AM

    anything that gets a patient more thorough and complete care is a winner to me

  • yoav p

    August 28th, 2013 at 4:06 AM

    Agree with what that BC says. In recent years, anything related to slightly different behavior in children and adults is classified as OCD. For me, it starts to look like a more rewarding profession that people take the ride for a living.

  • S Jones

    October 6th, 2013 at 12:41 PM

    When is this just chronic laziness, ie. inability to get off your butt and clean or put anything away, vs. a disease.

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