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Great difficulty categorizing or organizing possessions; Indecision about what to keep or where to put things

Severe anxiety when attempting to discard items

Inability to throw away possessions

Distress, such as feeling overwhelmed or embarrassed by possessions

Suspicion of other people touching items

Functional impairments, including loss of living space, social isolation, family or marital discord, financial difficulties, health hazards

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There is no required duration for the symptoms; proof that the patient has hoarding behaviors is sufficient.

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Hoarding Disorder Diagnostic Criteria 300.3 (F42)

A. Persistent difficulty discarding or parting with possessions, regardless of their actual value.

B. This difficulty is due to a perceived need to save the items and to distress associated with discarding them.

C. The difficulty discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use. If living areas are uncluttered, it is only because of the interventions of third parties (e.g., family members, cleaners, authorities).

D. The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others).

E. The hoarding is not attributable to another medical condition (e.g., brain injury, cerebrovascular disease, Prader-Willi syndrome).

F. The hoarding is not better explained by the symptoms of another mental disorder (e.g., obsessions in obsessive-compulsive disorder, decreased energy in major depressive disorder, delusions in schizophrenia or another psychotic disorder, cognitive deficits in major neurocognitive disorder, restricted interests in autism spectrum disorder).

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Antidepressants (usually SSRIs) - help people with OCD but have limited success in treating compulsive hoarding.

Cognitive behavioral therapy (CBT) - Involves recognizing and changing maladaptive thoughts, emotions and behaviors. CBT has gotten very effective since the 1990s. Here are some tolerance-building exercises:

Tolerance-building exercises:

Patients simply drive by a store they would like to visit without stopping to go inside.

They learn to walk right past the store. In the final stage they enter the store, pick up an item that they really want to buy, put it down and leave.

Asking patients to write a list of pragmatic questions that they might ask themselves when deciding whether to buy something. Whenever they get the urge to buy or otherwise acquire something, patients are supposed to bring out the list and answer the questions in order to make smarter decisions. Some questions are:

Can I afford this?

Do I have the space for this object?

Do I really need it?

Similar exercises teach hoarders to discard items they already have and do not need. It is better for a hoarder to throw their own things away; if a cleaning company throws away their belongings, the hoarder would go into depression and will replace the lost objects.

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Link: https://www.scientificamerican.com/article/real-world-hoarding/

Brief summary (2-3 sentences):
Lee Shuer's hoarding helped him overcome his social anxiety. After CBT therapy, Shuer now catches himself in the act of acquiring something he does not have space for, and gradually gets rid of things without mourning their loss.

Misconceptions:

- Hoarding is no longer regarded as a subset of OCD, primarily because most hoarders do not perceive thoughts about hoarding as intrusive or unpleasant; OCD patients regard obsessions as unwelcoming interruptions against their will. Also, while Hoarding tends to get worse, OCD fluctuate over time.

- Many hoarders live relatively typical lives, hold steady jobs and maintain ties to friends and family, even if their habits create tension. A few widely publicized cases, such as that of the Collyer brothers—two reclusive Americans who were found dead in their New York city apartment surrounded by more than 100 tons of stuff—affirmed a misconception of hoarders as eccentric and socially isolated people.

- Hoarding behaviors can be seen in children; they will become furious or miserable when faced with losing a particular object, even one that their families did not realize was important to them.

- Hoarders do not collect only junk. The article lists a wide variety: "Clothes—old and brand new, bits of glass or pottery, antiques, figurines, magazines, letters, greeting cards, pens, receipts, bills and expired medication. Sometimes hoarders mix incredibly valuable items—such as jewelry or the deed to the house—with piles of genuine junk. Almost anything can become the object of a hoarder's interest and affection. Some collect bits of their own body: fingernails, strands of hair, urine. Others hoard animals."

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https://www.psychiatry.org/patients-families/hoarding-disorder/what-is-hoarding-disorder

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https://docs.google.com/document/d/1Rvqd6XydSDV26boghfEh0aA2VoUXe9koSHZJNpaVjmE/edit

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3c. Is there a local program that treats this specific disorder? What does this person/facility do?

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3c. Is there a local program that treats this specific disorder? What does this person/facility do?

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Gerrus Maintenance performs heavy duty, health hazard cleanups, with care and understanding, for those affected by compulsive hoarding & cluttering syndromes. They specialize heavy duty sanitizing, odor removal and health hazard remediation. They serve all of New Jersey, Staten Island, NY, and Northeastern Pennsylvania.

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31:35 - 33:55

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Hoarding: Buried Alive - Season 1 Episode 4 ''Life on Fire''

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Wanda, of Radford, Virginia, and Ray, of Menlo Park, California are extreme hoarders destined to lose their homes and live in isolation if they don't stop surrounding themselves with stuff. Making the change will be emotional and filled with anguish but they know that time is running out.

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0:00 - 1:50

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Gourmet Kitchen | Hoarding: Buried Alive

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1e. Are there environmental causes or triggers?

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1e. Are there environmental causes or triggers?

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Hoarding can be related to compulsive buying, the compulsive acquisition of free items, and the search for perfect or unique items.

Some develop hoarding tendencies after stressful life events they have difficulty coping with: death of loved one, eviction, losing possessions in a fire, etc.

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Again, the exact causes of hoarding are unknown.

Neuroimaging studies and case reports have revealed divergent patterns of brain activity and various cognitive peculiarities common to many hoarders: The very act of deciding what to keep and what to throw away causes them great anxiety, for instance, and they form unusually strong emotional attachments to inanimate objects.

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The key features - difficulties discarding, excessive amount of clutter - are generally the same in both genders. Females, however, tend to display more excessive acquisition (buying) than males.

Hoarding affects both males and females, but some epidemiological studies have reported a significantly greater prevalence among males. This contrasts with clinical samples, which are predominantly female.

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1b. What is the age of onset for Hoarding?

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1b. What is the age of onset for Hoarding?

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Hoarding symptoms may first emerge around ages 11-15, start interfering with the individual's everyday functioning by the mid-20s, and cause clinically significant impairment by the mid-30s. The severity of hoarding increases with each decade of life.

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1a. What are some known causes of Hoarding?

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1a. What are some known causes of Hoarding?

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While the exact causes of hoarding are unknown, other disorders (like OCD, anxiety disorders, personality disorders, depression addiction, and post-traumatic stress disorder, pica) are associated with hoarding behaviors.

Hoarding can be related to compulsive buying, the compulsive acquisition of free items, and the search for perfect or unique items.