Hoarding and Obsessive Compulsive Disorder (OCD)
Obsessive Compulsive Disorders (OCD) are a spectrum of psychological conditions which affect one out of every forty Americans. According to the National Institute of Mental Health, approximately 1% of the worldwide adult population suffers from OCD; 50% of those cases are classified as “severe.”
OCD is characterized by recurrent obsessions (intrusive thoughts, images, or urges) that cause anxiety or distress, and compulsions (repetitive mental or behavioral acts) that the individual feels driven to perform in relation to an obsession or according to rules that he or she has created. While the term “OCD” is now a common descriptor in everyday interactions to facetiously label repetitive behaviors or a need for order and cleanliness, the actual disorder leads to far more disruption than people typically imagine.
Obsessions are persistent, uncontrollable thoughts, impulses, or mental images that are invasive, unwanted and disturbing. They can cause marked anxiety or distress. Examples include a fear of contamination, fear of causing harm to oneself or another (for example, one’s child), fear of embarrassment, uncomfortable sexual impulses, or fear of disorder. Compulsions are repetitive behaviors or mental acts, such as counting, praying, or hand washing that are performed to control or suppress the obsessive thoughts.
Another characteristic of OCD is Thought-Action Fusion (TAF). With TAF, certain individuals confuse their thoughts with actions; for example, a person may worry that a loved one will get into a car accident, believing their thoughts may actually cause the car accident to happen.
The OCD spectrum has a wide variety of presentations. OCD centering around bodily preoccupation may manifest as Body Dysmorphic Disorder, Hypochondriasis, Trichotillomania (hair pulling), or certain eating disorders.
The OCD spectrum can also include symptoms of hoarding disorder or Disposophobia, although some psychologists believe there is a distinction between “pure hoarding” behavior and hoarding that stems from OCD.
Hoarding, portrayed in detail in the TV series “Hoarders,” is a chronic condition that requires lifelong management to control. It is defined as a psychological disorder in which individuals collect unusually large amounts of material items with the inability to voluntarily discard them regardless of whether the items have any practical use. The hoarding of items can be so overwhelming it interferes with daily functioning; sanitary problems can ensue as well, causing risk to health from mold, bacteria and animal feces.
Hoarding can affect every aspect of a person’s life, including overall well-being, hygiene, and social interactions. When an individual suffers from severe hoarding, their homes can be filled to the brim with miscellaneous “junk”, sometimes to the point that moving around within the home is nearly impossible.
It is common for hoarders to isolate themselves within their homes, experiencing anxiety at the thought of others seeing their living conditions, and therefore their social lives suffer greatly. They begin to detach from their family and friends, and dating becomes difficult as well. This isolation can also result in depression, which is a common condition that is comorbid with hoarding disorder.
For hoarders suffering from OCD, psychologists believe that the compulsive need to keep “stuff” can be a way of managing upsetting and intrusive thoughts, like concerns over cleanliness, health, or other obsessions. Keeping excess possessions becomes a way to temporarily manage these intrusive thoughts.
People that suffer from hoarding disorder but don’t necessarily show symptoms of OCD may be reluctant to let go of things in their household for other reasons, such as the belief that one day their possessions might be useful or because getting rid of things causes them distress or makes them depressed. In some cases, hoarders may not even realize that their behavior is harmful to themselves and others.
Treatment for hoarding disorder requires professional care. Because hoarding often falls under the category of OCD, the best clinically-proven way to address hoarding is with Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP). CBT helps clients to understand the errors in thought that lead to hoarding behaviors. ERP involves gradually exposing individuals to anxiety-provoking conditions and then working with the individual to avoid the compulsions.
For example, a person with hoarding disorder can be made to discard an item from their home (exposure); the coach or therapist then works with them to avoid a compulsion (bringing in more items) and helps them lower their anxiety levels. This needs to be done in a controlled environment, so as to only trigger manageable amounts of anxiety, allowing the individual to slowly increase their threshold of distress tolerance.
Depending on the degree of hoarding, this therapy can take anywhere from weeks to months, but can ultimately allow the individual to return to a functional life, now able to manage their hoarding behaviors.
Learn more about OCD and hoarding and how PCH Treatment Centers addresses these behaviors.
Obsessive compulsive disorder among adults. National Institute of Mental Health. 12 September 2017.https://www.nimh.nih.gov/health/statistics/prevalence/obsessive-compulsive-disorder-among-adults.shtml
Clinical definition of OCD. Beyond OCD Bettering Recruitment & Referrals. 12 September 2017. https://beyondocd.org/ocd-facts/clinical-definition-of-ocd