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Compulsive hoarding in an apartment

Compulsive hoarding (or pathological hoarding) is extreme hoarding behaviour in humans. It involves the collection and/or failure to discard large numbers of objects even when their storage causes significant clutter and impairment to basic living activities such as moving around the house, cooking, cleaning, showering or sleeping. Hoarding rubbish may be referred to as syllogomania. A slang term for a compulsive hoarder is pack rat or packrat.

While there is no definition of compulsive hoarding in accepted diagnostic criteria (such as the current DSM), Frost and Hartl (1996) provide the following defining features:^[1]

• the acquisition of, and failure to discard, a large number of possessions that appear to be useless or of limited value
• living spaces sufficiently cluttered so as to preclude activities for which those spaces were designed
• significant distress or impairment in functioning caused by the hoarding

The following (edited) case study is taken from a published account of compulsive hoarding:^[2]

The client, D, lived with her two children, aged 11 and 14, and described her current hoarding behaviour as a 'small problem that mushroomed' many years ago, along with corresponding marital difficulties. D reported that her father was a hoarder and that she started saving when she was a child. In addition to hoarding, she reported several other obsessive-compulsive symptoms, such as fear of hurting others due to carelessness, an over-concern with dirt and germs, a need for symmetry and a need to know or remember things. D also suffered from a handwashing compulsion and engaged in lengthy cleaning rituals of household items. The volume of cluttered possessions took up approximately 70 percent of the living space in her house. With the exception of the bathroom, none of the rooms in the house could easily be used for their intended purpose. Both of the doors to the outside were blocked, so entry to the house was through the garage and the kitchen, where the table and chairs were covered with papers, newspapers, bills, books, half-consumed bags of chips and her children's school papers dating back ten years.

It is not clear whether compulsive hoarding is a condition in itself, or simply a symptom of other related conditions.^[3] Several studies have reported a correlation between hoarding and the presence and / or severity of obsessive-compulsive disorder (OCD). Hoarding behaviour is also related to obsessive-compulsive personality disorder (OCPD). There may be an overlap with a condition known as impulse control disorder (ICD), particularly when compulsive hoarding is linked to compulsive buying or acquisition behaviour. However, some people displaying compulsive hoarding behaviour show no other signs of what is usually considered to be OCD, OCPD or ICD. Those diagnosed with attention-deficit hyperactivity disorder (ADHD) often have hoarding tendencies.^[4]

People who exhibit compulsive hoarding tend to absorb glucose into the brain differently than people who do not exhibit this behavior. The difference in cerebral metabolism of glucose is greatest in the rear and central parts of the brain.^[5]

A 2004 University of Iowa study found that damage to the frontal lobes of the brain can lead to poor judgement and emotional disturbances, while damage to the right mesial prefrontal cortex of the brain tends to cause compulsive hoarding. ^[6]

OCD disorders are treated with various antidepressants: from the TCA family clomipramine (brand name Anafranil); and from the SSRI family paroxetine (Paxil), fluoxetine (Prozac), fluvoxamine (Luvox), sertraline (Zoloft), and citalopram (Celexa). With existing drug therapy OCD symptoms can be controlled, but not cured. Serveral of these compounds have been tested successfully in conjunction with OCD hoarding, but paroxetine in particular is indicated for treatment of compulsive hoarding.^[7] As always, care must be taken in the use of prescription medication. Antidepressant drugs have been linked with increased suicide rates. The U.S. FDA now requires a "black box" warning on many of these drugs. Paroxetine has also been associated with birth defects. Lawsuits have been filed against this drug. A 2006 study of this usage of the drug to treat compulsive hoarding was conducted by the University of California, San Diego.

OCD disorders are also treated with psychotherapy.

• Animal hoarding
• Bibliomania
• Collecting
• Diogenes syndrome
• Hoarding
• Impulse control disorder
• Obsessive-compulsive disorder
• Collyer brothers, notable hoarders
• Edmund Trebus, notable hoarder
• Plyushkin, fictional Russian hoarder
• Seven Dumpsters and a Corpse, film by Thomas Haemmerli, 2007

• Squalor Survivors - online resource concerning squalor and hoarding
• Children of Hoarders - online support group and information clearinghouse for children of compulsive hoarders