From reality shows about OCD to documentaries about drug use, modern television programming has no shortage of content concerning mental health. One syndrome in particular seems to be particularly popular on our TV screens: hoarding disorder. You’ll find Hoarding: Buried Alive on TLC, Hoarders on A&E, Britain’s Biggest Hoarders on BBC One, and Confessions: Animal Hoarding on Animal Planet. Through their dramatic portrayals of this condition, these televisions show all beg the question: What is hoarding disorder – and how do we treat it?
Until recently, hoarding has been considered a subset of Obsessive Compulsive Disorder (OCD). However, a growing body of evidence led the creators of the DSM-V to introduce hoarding disorder as a separate entity with its own distinct mechanisms. The differences between OCD and hoarding disorder are notable. They include “a relative lack of awareness regarding the condition’s real-world impact, a relative decline in overall mental function, and an increased likelihood of having co-occurring mental health conditions such as personality disorders, anxiety or depression… [as well as] certain genetic characteristics that clearly differentiate them from people with OCD.”
One study has been especially important in revealing these differences on a neurological level. The study was conducted by David Tolin et al at Yale University School of Medicine. They define the disorder as “the excessive acquisition of and inability to discard objects, resulting in debilitating clutter.”
In the study, they tested a group of participants with hoarding disorder, a group with OCD, and a group judged to be mentally healthy. They asked each of the subjects to bring a collection of miscellaneous papers, “such as newspaper and junk mail.” While fMRI brain scans were being conducted, they were presented with fifty pieces of their own items and fifty pieces of someone else’s (which were explicitly labeled as either their property or a stranger’s). For each item, they had to decide if they wanted to keep it or discard it, and it would immediately be shredded in front of them.
As expected, the hoarders chose to get rid of the least amount of their own items, and it took them longer to make a decision. Also interesting is the brain activity illustrated by the fMRI’s – in those with hoarding disorder, “Readings in both the anterior cingulate cortex, associated with detecting mistakes during uncertain conditions, and the mid- to anterior insula, linked to risk assessment, importance of stimuli and emotional decisions.” Another source explains, “The implicated brain areas are hubs of a salience network that weighs the emotional significance of things and regulates emotional responses and states. Hoarding patients’ severity of symptoms, self-ratings of indecisiveness, and feeling of things being ‘not just right’ were correlated with the degree of aberrant activity in these hubs.”
In addition, the hoarders showed different brain activity from the other groups when presented with someone else’s papers – “In this case, their brain activity was much lower than normal.” The researchers say this actually mimics brain activity in individuals who fall somewhere on the autism spectrum.
The issue of treating hoarding disorder is complicated, to say the least. SSRI antidepressants and CBT have been shown to be mildly effective. Another possibility is “transcranial magnetic stimulation (TMS)… a therapy that uses non-invasive electrical stimulation of the brain to treat depression.” Ultimately, hoarding disorder is largely understudied, and much more research must be conducted before we can find a solution.
If you or someone you know suffers from hoarding disorder, here are some helpful resources:
– By Betty Vine