If you've seen the TV shows Hoarders or Hoarding: Buried Alive, you've undoubtedly had this thought: "These poor people could definitely use some professional help." Or maybe you've seen something on the evening news about public health officials being called to someone's house because it's become a health hazard, packed with so much trash and junk (or worse) that normal living is all but impossible.
And while hoarding is already recognized as a mental health disorder, it will now become official with its inclusion in the upcoming publication of the Diagnostic and Statistical Manual of Mental Disorders (often called the “DSM” for short), an important reference used by mental health professionals and insurance companies, among others.
The new edition of the DSM—called DSM-5—will be released in May by the American Psychiatric Association. It reflects a decade-long process to update and improve the recognition and treatment of mental illness.
The inclusion of hoarding in the DSM comes from the huge amount of research done on the condition over the past decade. Hoarding was considered a mental health problem before but it was classified as a sub-type of obsessive-compulsive disorder (OCD). But studies show people who are hoarders often don't have any other OCD symptoms.
"I think the DSM has caught up to where the field is," Jeff Szymanski, executive director of the International OCD Foundation, told TakePart. "Typically, hoarding had been thought of as a subtype of OCD. Anxiety is the prominent experience with someone with OCD. With people with hoarding disorder, the disorder is not generated by anxiety...So the treatments for OCD didn't apply."
Hoarding is the inability to discard possessions regardless of their value. Hoarders often stack books, boxes, toys, clothes, and other items from floor to ceiling, leaving only tiny pathways from which to maneuver around their homes. Hoarders are often procrastinators and have great trouble making decisions—including what to keep and what to throw out. "Hoarders get very excited about things, and they are not good at categorizing things in a linear way," Syzmanski says. "They don't like to put things away. They like to have everything out so they can find it. They get sentimentally attached to objects." They can't get rid of objects because they feel guilty or like they're doing something wrong, he adds.
The condition isn't rare. About five percent of Americans have the disorder, according to studies. Most people with the condition aren't aware that what they're doing is unusual or problematic.
But it is a problem. "The definition of any mental disorder includes some significant impairment," he says. "You aren't able to get to work or maintain relationships or care for yourself. There are people who are pack rats or who collect things or people who like trinkets and tchotchkes. But when you can no longer move around your house, or your house has become unsafe or a fire hazard, you're no longer talking about an eccentricity."
The separate listing of "hoarding disorder" in DSM-5 should lead to better identification of people with the disorder and more appropriate treatment, he says. "When you pull hoarding out from under the OCD diagnosis, it's more accurate," Syzmanski explains. Insurers are more likely to cover treatment and more research funding is likely to be devoted to the illness.
As part of an effort to address hoarding disorder, more cities around the country are establishing hoarding task forces and programs to identify the problem and deal with it appropriately, he adds. The International OCD Foundation has a website, Help for Hoarding, that contains a database of hoarding task forces.
What do you think causes hoarding? Do you know anyone who suffers from hoarding disorder?
Shari Roan is an award-winning health writer based in Southern California. She is the author of three books on health and science subjects.