Hoarding Disorder & OCD

Course excerpt from Obsessive-Compulsive Disorder (OCD)

Hoarding DisorderHoarding is the saving, keeping, and accumulation of items that are considered to have some kind of value, even though they might be considered useless, unimportant, and trash to others. Strong emotional attachment, sentimental value, potential usefulness, and fear of running out of supplies (e.g. buying multiples of toilet paper because it’s on sale) are some of the rationalizations for the behavior.

The DSM-5 has classified hoarding as its own diagnosis and is no longer considered an OCD subtype. It is categorized in the Obsessive Compulsive and Related Disorders category of the DSM-5 (American Psychiatric Association, 2013).

Hoarding has received much recent media attention, as evidenced by the TV series Hoarders on the A&E cable channel, PBS documentaries, and memes found on the internet. Parents who have problems with hoarding have been implicated in child neglect and abuse cases, as well as public health task forces being organized due to the impact of hoarding on the home environment. Children on hoarders are usually unable to have play dates at their houses due to the shame and embarrassment of the chaotic household environment.

Hoarding appears to be “hard wired” and ego-syntonic, which makes it a very difficult problem to treat. It typically involves the acquisition of excessive amounts of material goods that may appear valueless or useless. As a result of the hoarding and associated challenges with making decisions about what to keep and what to throw away, the individual often has difficulty with organization. Hoarders have been considered creative due to their ability to think of clever or creative ways of using discarded or useless items, even though they hardly ever do.

Some people have hoarding behaviors not because they want to save items, but because they have problems with disorganization and making decisions about what is important to save or throw away. Junk mail, magazines, and newspaper are common items that pile up and are neglected.

Common dysfunctional thoughts of hoarders are that items with sentimental value should be saved, fear of getting rid of something that he or she might “need” later, belief that almost everything has purpose or value, making decisions about what to save so difficult, that even common items are irreplaceable, not having important or useful information for “later,” and mistakenly discarding important things along with unimportant items.

Commonly hoarded items are newspapers, articles, magazines, books, CDs, clothes, pictures, receipts, mail, emails, post-it notes and slips of paper to read “later,” and collections or sets of favorite things.

Behaviors may include sorting through garbage, saving items to recycle or reuse, taking multiples of freebies (e.g., brochures, samples), and “churning” (moving items around from one pile to the next when trying to organize or sort through items). Extreme distress and a sense of loss of control are experienced if family members attempt to throw things away, and sometimes even when others touch the items.

Some serious negative effects of hoarding can be:

  • Mold/squalor leading to health problems
  • Fires caused by piles of papers kept near the stove
  • Lack of functional living space
  • Injuries sustained when piles of items topple on to someone
  • Public health concerns requiring community intervention
  • Involvement of child services

Current environmental concerns can cause “green guilt” that reinforce hoarding. Reusing and recycling make it difficult for hoarders to throw things away. They may even pick up trash they see while out in public and take it home. Hoarders also do not like to waste and keep things until its last shred of utility.

Cognitive-behavioral therapy is considered the most effective psychotherapy for treating the dysfunctional beliefs and patterns of functioning that contribute to hoarding. Motivational interviewing strategies are also effective in helping to improve insight, which is typically limited in this disorder. Competence, informed consent to treatment, and risk of harm must be considered within the context of any observed neurocognitive deficits.

The prevalence rate of hoarding is between 1.5 and 5% of the general population. The prevalence of co-occurring OCD was 2.9% in a study by Ivanov and colleagues. Another study reported that 96 of 396 hoarders met criteria for OCD.

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Obsessive-Compulsive Disorder (OCD)Obsessive-Compulsive Disorder (OCD) is a 3-hour online continuing education (CE/CEU) course that reviews the diagnosis, assessment and treatment strategies for OCD. Obsessive-Compulsive Disorder (OCD) is characterized by intrusive, unwanted, and anxiety-provoking thoughts, images, impulses and rituals that are performed to alleviate the accompanying distress. Because OCD is a heterogeneous disorder with several subtypes, assessing, diagnosing, and treating it can be challenging. Further, the presentation of varying symptoms may be considered to be OC Related Disorders. Being able to make differential diagnoses and treatment recommendations are essential in clinical work with the many patients that present with the spectrum of OC problems. Specific behavioral strategies have been developed and validated in the literature that target the various manifestations of OCD and related disorders. The first part of the course offers information on the neurobiology, diagnosis and assessment tools, including the various subtypes, and highlights important topics to be taken into consideration during the process. Emotional and cognitive factors are outlined that seem to play important roles in the diagnosis and the course of episodes. The next section is dedicated to describing the clinical factors of and differential aspects of the OC Related Disorders and their prevalence. A case study follows that outlines the precipitating events, assessment, and behavioral treatment of a college student who is struggling to maintain and overcome her OCD. The final section describes effective treatment and coping strategies and augmentations that help to maintain treatment gains. Course #30-95 | 2017 | 60 pages | 20 posttest questions

This online course provides instant access to the course materials (PDF download) and CE test. After enrolling, click on My Account and scroll down to My Active Courses. From here you’ll see links to download/print the course materials and take the CE test (you can print the test to mark your answers on it while reading the course document). Successful completion of the online CE test (80% required to pass, 3 chances to take) and course evaluation are required to earn a certificate of completion.

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