Academic journal article Journal of Counseling and Development : JCD

Hoarding Disorder: Diagnosis, Assessment, and Treatment

Academic journal article Journal of Counseling and Development : JCD

Hoarding Disorder: Diagnosis, Assessment, and Treatment

Article excerpt

Hoarding disorder (HD) is a newly added mental disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association [APA], 2013). In previous editions of the DSM, hoarding behaviors were formally recognized only as a symptom of obsessive-compulsive personality disorder (OCPD; Mataix-Cols et al., 2010). Maintaining its connection with obsessive-compulsive features but creating a unique identity, HD is currently categorized under the Obsessive-Compulsive and Related Disorders section of the DSM-5.

Characteristics of HD include the urge to acquire and save objects, a marked inability to discard objects that may have no apparent value to others, and restricted functioning as a result of excessive clutter in daily living spaces (APA, 2013). Those who have HD do not typically discriminate among the items collected and acquired, and more than half of all individuals with HD hoard both inanimate (e.g., newspapers) and animate (e.g., animals) objects (McGuire, Kaercher, Park, & Storch, 2013; Steketee et al., 2011). Although HD has only recently been formally recognized as a distinct disorder, compulsive hoarding behaviors have been formally acknowledged in the counseling literature for over 2 decades (Frost & Gross, 1993).

HD is estimated to be prevalent in approximately 2% to 6% of the general U.S. population (APA, 2013; Samuels et al., 2008). However, no national epidemiological studies have been conducted to confirm the true prevalence of this disorder. Factors such as embarrassment and a lack of insight related to the severity of the behaviors may confound prevalence estimates (Ale, Arnold, Whiteside, & Storch, 2014).

Individuals with HD are often resistant to change, and symptoms may continue throughout their lifetimes (Grisham, Frost, Steketee, Kim, & Hood, 2006; Wheaton, Cromer, LaSalle-Ricci, & Murphy, 2008). Left untreated, the severity of symptoms will likely increase with each decade that passes (Ayers, Saxena, Golshan, & Wetherell, 2010). HD is more prevalent in the older adult population (i.e., ages 55-94 years; APA, 2013), but some more recent studies have reported that the initial onset of the disorder often occurs in childhood and adolescence (APA, 2013; Ayers et al., 2010). Nevertheless, the average age of those seeking treatment for HD is 50 years old (Samuels et al., 2008). This is because symptoms typically become more clinically significant with age (APA, 2013), and the effects of the hoarding often escalate because of the acquisition of possessions, which occurs over time (Ayers et al., 2010).

* Diagnosis

As mentioned, the first formal set of diagnostic criteria for hoarding as a disorder was presented in the DSM-5 (APA, 2013). According to the DSM-5, the disorder is characterized by (a) persistent difficulty discarding items that may or may not have value, (b) the desire to save items in order for the individual to avoid negative feelings associated with discarding items, (c) significant accumulation of possessions that clutter active living areas, and (d) significant distress or impairment in areas of functioning. The DSM-5 states that HD symptoms must not be attributed to a medical condition (e.g., traumatic brain injury, dementia) or other mental disorders (e.g., schizophrenia, autism spectrum disorder).

As with other disorders within the Obsessive-Compulsive and Related Disorders category of the DSM-5 (APA, 2013), specifiers can be used to describe an individual's level of insight into his or her hoarding behaviors. These specifiers include with good or fair insight, with poor insight, and with absent insight/delusional beliefs. Individuals with HD typically have less insight into their behavior and its consequences than individuals diagnosed with obsessive-compulsive disorder (OCD; Tolin, Fitch, Frost, & Steketee, 2010); that is, individuals with HD have greater difficulty recognizing that their behaviors are problematic. …

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