Obsessive Compulsive Disorder (OCD) and Compulsive Hoarding (CH) are intertwined. CH is a form of OCD and not all people that have CH can be classified as OCD. So it gets confusing to say the least.
According to Karron Maidment RN, M.A. "Those people who report compulsive hoarding as their primary type of OCD, experience significant distress or functional impairment from their hoarding. They have symptoms of indecisiveness, procrastination, and avoidance, are classified as having compulsive hoarding syndrome."
CH can be discribed as unorganized to the extreme because they are afraid of throwing anything away for fear that they might need those things in the future. The sad fact is even if that were the case and they do need it someday, they wouldn't be able to find it under all the newspapers, magazines, old clothing, bags, books, mail, notes and lists.
Along with the fear of throwing things away they maybe a perfectionist also and everything they do must be done perfectly. This leads to procrastination and avoiding doing tasks even the smallest will be a challenge because everything must 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” states Maidment.
The difference between normal collecting and hoarding according to Dr. Randy Frost, he defines the compulsive hoarding syndrome according to three criteria:
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. Sometimes an excessive emotional attachment to them develops. 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 generally 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.
Living spaces sufficiently cluttered so as to preclude activities for which those spaces were originally designed. Obviously, with many items coming into the home and very few going out, the clutter will accumulate. It does not take long for the clutter to spread 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 nowhere 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.
Significant distress or impairment in functioning is caused by the hoarding. Because of their desire 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 leave late because they take much longer than other people to finish tasks. A survey of elderly hoarders found that hoarding constituted a physical health threat in 81% of identified cases. These included threat of fire hazard, falling, unsanitary conditions, and inability to prepare food.
According to Maidment “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. This requires a different treatment approach from that used for other types of OCD. Compulsive hoarding syndrome may represent a subgroup or variant of OCD that is caused by different genetic and familial factors than non-hoarding OCD.”
The compulsive hoarder views themselves as being efficient or thorough, even conscientious and responsible. By avoiding discarding, hoarders avoid experiencing obsessive fears about losing necessary or wanted items. They don't do any overt behaviors like washing, checking or repeating. In fact their problem is that they don't do anything. They don't throw things away, and they don't make decisions. So, they have a hard time thinking of not doing something as a compulsion.
Drs. Frost, Steketee, and colleagues have been at the forefront of the development of a cognitive behavioral model for treatment specifically for compulsive hoarding. Their model conceptualizes compulsive hoarding as involving four main problem areas:
information-processing deficits: including deficits in decision making, deficits in organizational skills, and difficulties with memory functions;
problems in forming emotional attachments: compulsive hoarders believe that their belongings are a part of them, so discarding an item is like discarding a part of themselves;
behavioral avoidance: the net result of poor decision-making skills and the need for perfection. Compulsive hoarders avoid not only the decision to discard an object, but also what to do with the object once they have it; and,
erroneous beliefs about the nature of possessions: such as beliefs about the necessity of maintaining control over possessions, beliefs about responsibility for possessions, and beliefs about the necessity of perfection.
But there is hope! The treatment and how it should work will be the subject of the next post.
