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Is It OCD or …?

Is Compulsive Hoarding a Genetically and Neurobiologically Discrete Syndrome?
American Journal of Psychiatry
Sanjaya Saxena, M.D.

Cerebral Glucose Metabolism in Obsessive-Compulsive Hoarding
Sanjaya Saxena, M.D.
-The American Journal of Psychiatry, June 2004

Brain region identified that controls collecting behavior
“The UI team studied 86 people with focal brain lesions – very specific areas of brain damage – to see if damage to particular brain regions could account for abnormal collecting behavior.”
-Medical News Today, 12/04

Hoarding and Alzheimer’s Disease-One Daughter’s Story
Presented by Rosemary Bakker, Director of NYC Hoarding Task Force
on Hoarding and Older Adults

Compulsive Clutter-In Depth Doctor Interview
(Sanjaya Saxena, M.D., Psychiatrist)
Ivanhoe Broadcast News Interview
February 8, 2007

Hoarding Behavior and Self Neglect
September 22, 2004-American Red Cross of Northeastern NY
Symposium Minutes

Significant Linkage to Compulsive Hoarding on Chromosome 14
in Families With Obsessive-Compulsive Disorder,
Results From the OCD Collaborative Genetics Study:

American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM)

More information

Currently in the DSM IV:

This disorder is not listed in DSM-IV; therefore, DSM-IV criteria for this disorder do not exist.

In DSM-IV, ‘the inability to discard worn-out or worthless objects even when they have no sentimental value’ is one of the 8 criteria for Obsessive-Compulsive Personality Disorder (OCPD)

In the text accompanying the OCPD criteria, DSM-IV states:

“Despite the similarity in names, OCD is usually easily distinguished from OCPD by the presence of true obsessions and compulsions. A diagnosis of OCD should be considered especially when hoarding is extreme (e.g. accumulated stacks of worthless objects present a fire hazard and make it difficult for others to walk through the house). When criteria for both disorders are met, both diagnoses should be recorded” (p. 728)

Proposed Revision for DSM V
Hoarding Disorder

The work group is recommending that this be included in DSM-5 but is still examining the evidence as to whether inclusion is merited in the main manual or in an Appendix for Further Research.

A. Persistent difficulty discarding or parting with possessions, regardless of the value others may attribute to these possessions. *

B. This difficulty is due to strong urges to save items and/or distress associated with discarding

C. The symptoms result in the accumulation of a large number of possessions that fill up and clutter active living areas of the home or workplace to the extent that their intended use is no longer possible. If all living areas are uncluttered, it is only because of the interventions of third parties (e.g., family members, cleaners, authorities).

D. The symptoms cause 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 symptoms are not due to a general medical condition (e.g., brain injury, cerebrovascular disease).

F. The hoarding symptoms are not restricted to the symptoms of another mental disorder (e.g., hoarding due to obsessions in Obsessive-Compulsive Disorder, decreased energy in Major Depressive Disorder, delusions in Schizophrenia or another Psychotic Disorder, cognitive deficits in Dementia, restricted interests in Autism Spectrum Disorder, food storing in Prader-Willi Syndrome).

Specify if:

With Excessive Acquisition: If symptoms are accompanied by excessive collecting or buying or stealing of items that are not needed or for which there is no available space.

Specify whether hoarding beliefs and behaviors are currently characterized by:

Good or fair insight: Recognizes that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are problematic.

Poor insight: Mostly convinced that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are not problematic despite evidence to the contrary.

Absent insight: Completely convinced that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are not problematic despite evidence to the contrary.

* The Work Group is considering alternative wording: “Persistent difficulty discarding or parting with possessions, regardless of their actual value.”

  • Additional reading:

This article provides a focused review of the literature on compulsive hoarding and presents a number of options and preliminary recommendations to be considered for DSM-V. In DSM-IV-TR, hoarding is listed as one of the diagnostic criteria for obsessive–compulsive personality disorder (OCPD).

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