Hoarding Disorder
-By Timothy Lyons
The fifth edition of the Diagnostic and Statistical manual of mental disorders (DSM-5) has now categorized Hoarding disorder as its own separate category (American Psychiatric Association, 2013). Earlier versions placed hoarding disorder as a symptom of Obsessive Compulsive Disorder. This new manner of categorization which includes a continuum approach more closely reflects the differences between obsessive compulsive disorder and hoarding disorder.
With obsessive compulsive disorder the sufferer understands that the obsession is not sensible whereas with hoarding disorder the subject can easily justify the intrusive thought by telling themselves that the acquisition of or inability to discard the object makes sense since it is thrifty or may be necessary. With obsessive compulsive disorder the thoughts can come up repeatedly without provocation but in the hoarding disorder sufferer the thoughts surface in direct relation to the objects of possession (Jacofsky, Santos, Khemlani-Patel, & Neziroglu, 2014).
The most interesting aspect of these differences is that the treatments for obsessive compulsive disorder seem to be effective in the area of hoarding disorder. The use of pharmacology for treatment as well as Cognitive Behavioral therapy appear to be the most effective means of treatment (Kress, Stargell, Zoldan, & Paylo, 2016).
As for the pharmacology, the first line treatment contains the use of SSRI and serotonin and norepinephrine reuptake inhibitors such as Effexor or venlafaxine. The SSRI Paxil has also been shown to ameliorate hoarding disorder symptoms while also dealing with possible comorbidity for depression and anxiety (Kress, Stargell, Zoldan, & Paylo, 2016).
The use of cognitive behavior therapy specifically deals with the hoarding behaviors in relation to emotional distress and information processing issues. The design of cognitive behavior therapy programs target hoarding symptoms of disorganization, difficulty with discarding items and the excess of collection. The actual mechanisms that are used are skills training, which assists with problem solving and decisions. Exposure techniques reduce distress from the main types of hoarding issues which are the urge to acquire, the inability to discard and the knowledge that the thoughts or not rational. In addition, the use of cognitive restructuring or reframing is used to target the thinking patterns associated with hoarding (Kress, Stargell, Zoldan, & Paylo, 2016; Jacofsky, Santos, Khemlani-Patel, & Neziroglu, 2014).
There is not much information in the area of scientific studies with the combination of these two treatments dealing with hoarding. They can and have been combined with good outcomes. The main impediment to successful treatment is compliance and follow up.
References
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5 ed.). Arlington, VA: American Psychiatric Publishing.
Jacofsky, M., Santos, M., Khemlani-Patel, S., & Neziroglu, F. (2014, January 2). (2014, January 2). Similarities and Differences Between Hoarding Disorder and obsessive compulsive disorder. Retrieved From Https://www.mentalhelp.net/articles/similarities-And-Differences-Between-Hoarding-Disorder-And-Ocd/. Retrieved November 27, 2016, from https://www.mentalhelp.net/articles/similarities-And-Differences-Between-Hoarding-Disorder-And-Ocd/
Kress, V. E., Stargell, N. A., Zoldan, C. A., & Paylo, M. J. (2016). Hoarding Disorder: Diagnosis and Assessment. Journal of Counseling & Development, 94, 83-94. doi:10.1002/jcad.12064