Compulsive hoarding syndrome: symptoms, causes and treatment.

A disorder linked to the accumulation of possessions, similar to Diogenes syndrome.

Compulsive hoarding syndrome, also known as hoarding disorder (in the Diagnostic Manual of Mental Disorders, DSM-5), is a new disorder in the latest edition of the manual, although not a new disorder in clinical practice.

It is related to the classically known "Diogenes Syndrome", although it has important differences. Throughout this article we will use the name compulsive hoarding syndrome to refer to DSM-5 hoarding disorder (they will be interchangeable).

What is hoarding syndrome?

Hoarding syndrome is a psychological disorder linked to the accumulation of objects and possessions of all kinds, from furniture, writings and instruments to plants and other living things. of all kinds, from furniture, writings and instruments to plants and other living beings. Being a disorder, it generates significant discomfort for the person who manifests it, or for the people around him/her.

Differences with Diogenes syndrome

The compulsive hoarding syndrome or hoarding disorder is classified within the Obsessive-Compulsive Disorders, and it differs from the classic "Diogenes Syndrome" in that Diogenes Syndrome typically appears in patients with some form of dementia or frontal lesion, as well as in patients with schizophrenia and/or other brain impairments. and/or with other significant brain impairments.

In contrast, in compulsive hoarding syndrome there is no other mental disorder that better explains the symptoms, nor is it attributable to another medical condition such as brain damage, cerebrovascular disease or Prader-Willy syndrome.

Furthermore, Diogenes Syndrome does not exist as an official diagnosis in any reference manual (neither in the ICD-10 nor in the DSM); it is more of a "popular" or social nomenclature.

Symptoms of compulsive hoarding syndrome

The symptoms of compulsive hoarding syndrome include the following phenomena.

1. Difficulty in disposing of possessions

The patient shows great difficulty in getting rid of possessions, and does not consider the value of the possessions.and does not consider their real value (whether they have it or not).

2. Discomfort in discarding

The difficulty in discarding things or objects is due to a need perceived by the person to keep the objects; that is, "he/she needs to keep them". This need This need brings with it a significant discomfort associated with getting rid of the objects..

3. Accumulation of possessions

The previous symptoms provoke a large accumulation of various objects and possessionswhether it be furniture, old newspapers, broken toys, books, boxes, magazines, bags, etc. This accumulation congests and clutters the living areas of the house (e.g. the bathroom, kitchen, living room...), and significantly compromises their use.

Moreover, if the areas are tidy, it is thanks to the intervention of third parties (family members, authorities, cleaning staff...), never thanks to the patient suffering from compulsive hoarding syndrome himself.

4. Significant discomfort

The accumulation of objects leads to a significant psychological discomfort for the patient, and/or a deterioration of his daily functioning in all (or almost all) areas of his life (personal, social, work...).

In addition, the patient's environment can be dangerous for the patient and/or and/or for others, being the areas of the home accumulated with objects, susceptible to fire, for example.

Specifics

In compulsive hoarding syndrome, it should be specified in its diagnosis if an excessive acquisition is also included. This means, if the person also buys, acquires (or asks for) objects that are not necessary or for which there is not enough space or for which there is not enough space in the home.

Other specifications included in the DSM-5 for compulsive hoarding syndrome are:

• With good or adjusted illness awareness.
• With poor illness awareness.
• With absent awareness of illness / delusional.

Characteristics

It is estimated that between 2-6% of the American population suffers from it. Regarding its prevalence, in the general population (without mental disorder), it is more prevalent in men than in women. However, in the clinical population (with some other mental disorder), there are more women than men with compulsive hoarding syndrome.

It occurs more frequently in older people (especially between 55 and 94 years), versus young people (between 34 and 44 years). In addition, the first symptoms usually appear at 11 and 15 years of age.

Comorbidity with other disorders

It is considered a chronic disorder, although it can be treated or improved.. As for its comorbidity with other disorders, it is usually associated with major depressive disorders, social phobias, GAD (Generalized Anxiety Disorder) and OCD (Obsessive Compulsive Disorder).

Specifically, 75% of patients with compulsive hoarding syndrome also have a mood or anxiety pathology. On the other hand, 20% of cases with the syndrome also have symptoms that meet OCD criteria. However, we must remember that none of the associated disorders fully explains the symptoms of compulsive hoarding syndrome.

• You may be interested in "Obsessive-compulsive disorder (OCD): what is it and how does it manifest itself?"

Causes

As for its etiology, although the causes are not entirely clear, there are some risk factors for developing a compulsive hoarding syndromerelated to the person's temperament, environment (surroundings) and genetics.

1. Temperament

An indecisive or perfectionist temperament is typical in these patients.

2. Family history

The fact of having a family member with compulsive hoarding syndrome is typical in these patients. also increases the likelihood of suffering from it oneself.

Stressful events

Going through a particularly stressful period, as well as the occurrence of certain stressful life events, is associated with the onset of hoarding disorder. These events include the death of a loved one, losing possessions in a fire, an eviction or a divorce, for example.

4. Age

Risk factors are also related to a specific age of onset, as we have already seen; 11 and 15 years of age. Over time, symptoms worsen. Older people are also more prone to develop it.

Treatment

Psychological treatment may include cognitive-behavioral therapy, as well as exposure techniques with response prevention. (e.g. exposing the patient to get rid of the objects without recovering them again) and an important emotional support, especially to alleviate the symptoms that usually go with it, such as anxiety or depression.

At the psychopharmacological level, antidepressants or anxiolytics can be administered to treat the symptomatology comorbid to compulsive hoarding syndrome.

Bibliographic references:

• American Psychiatric Association -APA- (2014). DSM-5. Diagnostic and statistical manual of mental disorders. Madrid: Panamericana.
• Belloch, A.; Sandín, B.y Ramos, F. (2010). Manual de Psicopatología. Volume I and II. Madrid: McGraw-Hill.
• Becerra, J.A., Robles, M.J. (2010). Characteristics of hoarding disorder: A new clinical syndrome? Biological Psychiatry, 17(3): 111 - 113.