Testing the DSM-V’s Diagnostic Criteria for Hoarding

Hoarding (HD) is a relatively recently recognized condition that has been added to the DSM-V. Its inclusion has raised concern, and debate still exists as some are suggesting that it be placed on the spectrum of obsessive compulsion (OCD), while others oppose that classification. Another question that has arisen with the inclusion of HD is the validity of measures used to diagnose it. The first ever field test was recently conducted by David Mataix-Cols of the Institute of Psychiatry at King’s College London, to determine if the criteria for HD are valid, effective, and clinically accurate for identifying people with HD and, more importantly, recognizing individuals who do not have HD but exhibit characteristics similar to those with HD.

In the study, Mataix-Cols interviewed 20 self-described collectors and 50 participants with hoarding tendencies. The participants were evaluated in their homes several times and independent raters assessed the results. According to the results, 58% of the hoarding participants met diagnostic criteria for HD. The raters reported excellent specificity and sensitivity of symptoms as well as reliability and validity. The specifiers, which included acquisition of items and clutter, were defined as acceptable tools, but Mataix-Cols believes that the wording of some of the specifiers might need some modification. The most promising finding was that none of the participants who called themselves collectors met the criteria for HD. This is a key finding and suggests that the design of the diagnostic measures used to classify someone with HD are extremely complex in nature and can adequately distinguish collecting behavior from hoarding behavior.

Mataix-Cols also discovered what could be some predictive factors. In this study, the hoarding participants were more likely to be single, have less education, and live in smaller homes than the collectors. This could indicate that higher levels of education and cohabitation or marriage may act as buffers against the onset of hoarding and could potentially keep collecting from escalating into hoarding. In sum, Mataix-Cols believes that these results provide evidence of the efficacy of the proposed diagnostic criteria for HD. He added, “Crucially, they seem to be sufficiently conservative and unlikely to over pathologize normative behavior.”

Mataix-Cols, D., et al. (2013). The London field trial for hoarding disorder. Psychological Medicine 43.4 (2013): 837-47. ProQuest.Web.

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  • harlowe

    March 29th, 2013 at 3:52 AM

    Now really do we need the diagnostic manual to tell us seriously who is a hoarder and who isn’t? All you have to do is to look at someone’s space or house and see the junk and know that they are a hoarder. I believe it is a sickness and so now does this entire community too- but there comes a time when you have to clean up. It is NASTY the way that these people live, and whatever void they are trying to fill in their lives, I just don’t know how they think that that will be fulfilled by collecting stuff or cats or whatever. I am not heartless, because I know that this is a paroblem for some people, but I can’t help but think about where the family is when they are seeing someone do this and they do nothing to stop it.

  • Regina Lark

    March 29th, 2013 at 12:49 PM

    A few comments… Friends and loved ones of people with HD spend years, sometimes decades, trying to help. At some point everyone is fed-up. As mental illness it makes sense that most people with the disorder are not consciously “trying to fill a void.” I don’t think the acquiring as conscious as that. Interesting result, re: ‘true’ collectors in the study don’t meet hoarding criteria. What I am waiting for is to see how insurance companies will/won’t work with the organizations who can help clean/clear the hoarded household.

  • flora

    March 29th, 2013 at 11:27 PM

    it may be somewhat weird but I dont see a difference between collecting and hoarding. Yes on a more upper level the two may seem different. But go down to the microscopic level and both have very similar actions on part of the person. It is the craving to hold onto or have something. Some call it collecting but for me its nothing more than a veiled hoarding in action.

  • Alana

    March 30th, 2013 at 5:53 AM

    I am kind of surprised that this would show up in the DSM only because I guess I have always thought of hoarding as being more like a symptom of something bigger, and not necessarily the disease. Does that make sense? You know, kind of like you are missing something (feeling depressed, whatever) and then trying to fill that up with stuff. Not really the healthiest of coping mechanisms, but still symptomatic of something else.

  • Arthur

    March 30th, 2013 at 11:58 PM

    “Mataix-Cols believes that the wording of some of the specifiers might need some modification.”

    Almost always a problem isnt it? Be it a diagnostic criteria or a law, interpretation can be so different from what was intended!

  • Travis

    March 31st, 2013 at 7:42 AM

    Would this have ever even come into society consciousness if not for that A&E show?
    I mean, I did not even realize that there were people who lived like that until that show started a few years ago.
    Or I guess maybe I knoew that there were a few people who did this but not that it was the bigger problem that it seems to be.

  • Hannah George

    April 1st, 2013 at 5:08 AM

    If there is an argumat to be amde to include this in the OCD spectrum, that seems reasonable to me. What is the agument about there?

  • Melissa

    April 7th, 2013 at 7:12 PM

    It is a relief that Hoarding has finally been acknowledged in DSM 5. Now, Governments will have to provide funding to provide specialised training and to educate the community.

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