by guest blogger Michael A. Thompkins, Ph.D.

Over the years, most clinicians and researchers have diagnosed people with a compulsive hoarding problem as having obsessive-compulsive disorder (OCD), in part, because many people with OCD report some hoarding behaviors. However, a growing body of evidence suggests that it may not be accurate to classify compulsive hoarding as OCD for a number of reasons.

First, although it is true that many people with OCD exhibit some hoarding behavior, the majority of those with OCD do not. Hoarding behavior appears in a variety of medical or mental health problems or conditions, such as dementia, bipolar disorder, attention deficit/hyperactivity disorder, and social phobia, to name a few. In fact, hoarding behavior accompanies so many other psychiatric conditions that it is perhaps more accurate to think of it the way clinicians think of depression. Depression is both its own disorder and a feature of any number of other problems or disorders. For example, people who have social phobia or dementia are often depressed too.

Second, in spite of the fact that most people who hoard report some OCD traits, such as indecisiveness, perfectionism, check, and doubting, researchers have consistently identified hoarding as a separate and distinct class of OCD symptoms, along with symmetry/ordering, contamination/cleaning, and obsessions/checking. This suggests that hoarding does not overlap much with other obsessive-compulsive symptoms, thereby strengthening the argument that hoarding is not quite the same as OCD.

Third, hoarding symptoms do not respond as well to the treatments we have that are typically effective for OCD, specifically medication (selective serotonin reuptake inhibitors) and cognitive-behavior therapy. Furthermore, people with OCD who have significant hoarding symptoms typically drop out of these treatments earlier than people with OCD who do not have significant hoarding symptoms. Researchers believe that people who hoard do not respond well to typical OCD treatments because they do not adequately target the underlying neuropsychological underpinnings of hoarding. Neuroimaging studies further support this hypothesis and reveal different patterns of brain metabolism in people with hoarding symptoms versus people with non-hoarding OCD symptoms.

In conclusion, hoarding symptoms are present in a wide variety of psychological and medical syndromes, including OCD. However, in spite of this overlap with OCD, a growing body of evidence suggests that hoarding is not the same as OCD. Research that clearly identifies what hoarding is and what it is not are essential if we hope to develop effective treatments for this devastating problem.

Michael A. Thompkins, Ph.D. is the author (with Tamara L Hart, Ph.D.) of Digging Out: Helping Your Loved One Manage Clutter, Hoarding, and Compulsive Acquiring.

Resources:

• Mataix-Cols, D., Pertusa, A., & Leckman, J. F. (2007). Issues for DSM-V: How should obsessive-compulsive and related disorders be classified? American Journal of Psychiatry, 164, 1313-1314.
• Frost, R. O., Steketee, G., Tolin, D. F., & Brown, T. A. (2006). Comorbidity and diagnostic issues in compulsive hoarding. Annual Meeting of the Anxiety Disorders Association of America. Atlanta, GA.
• Abramowitz, J. S., Wheaton, M. G., & Storch, E. A. (2008). The status of hoarding as a symptom of obsessive-compulsive disorder. Behaviour Research and Therapy, 46, 1026–1033. Calamari, J. E., Wiegartz, P. S., & Janeck, A. S. (1999). Obsessive-compulsive disorder subgroups: A symptom clustering approach. Behaviour Research and Therapy, 37, 113-125.
• Mataix-Cols, D., Rosario-Campos, M. C., & Leckman, J. F. (2005). A multidimensional model of obsessive-compulsive disorder. American Journal of Psychiatry, 162, 228-238.
• Mataix-Cols, D., Rauch, S. L., Manzo, P. A., Jenike, M. A., Baer, L. (1999). Use of factor-analyzed symptom dimensions to predict outcome with serotonin reuptake inhibitors and placebo in the treatment of obsessive-compulsive disorder. American Journal of Psychiatry, 156, 1409-1416.
• Saxena et al., 2004. Cerebral glucose metabolism in obsessive-compulsive hoarding. American Journal of Psychiatry, 161, 1038-1048.
• Rachman, S., Elliott, C.M., Shafran, R., & Radomsky, A.S. (2009). Separating hoarding from OCD. Behaviour Research and Therapy, 47, 520-522.