1. Hoarding and the inclusion of hoarding in the DSM-V By Candice L. Narrin December 8, 2010 1 A literature review

2. Discarding Excessive acquiring Clutter Distress 2 The are four common characteristics of a hoarder

3. A hoarder can not get rid of items (Cohen, n.d.; Gilliam & Tolin, 2010; Grisham & Barlow, 2005; Preston, Muroff, & Wengrovitz, 2009) Hoarders consider their possessions as part of themselves, according to Grisham & Barlow (2005). Grisham and Barlow (2005) also stated that people who hoard form emotional attachments to objects as opposed to people. Grisham, Steketee, & Frost, (2008) discredited this part of theory by doing emotional testing on people who hoard. However, this second study by Grisham et al., (2008) lacked a non control group for comparison. 3 Discarding

4. A second study by An et al., (2008) showed hoarders 50 pictures of high anxiety objects (rats, snakes, pics. Of body parts), 50 objects hoarders are believed to hoard, and 50 neutral objects. They were then asked to rate their anxiety when they pictured themselves discarding the 50 items related to hoarding. The hoarders rated the anxiety felt when picturing themselves discarding objects as anxiety provoking as the rats, snakes, body parts, etc. 4 Discarding

5. This study by An et al. (2008) included a control group of 50 participants who did not hoard objects for comparison of the two groups ratings for levels of anxiety. 5 Discarding

6. People who hoard acquire a lot of things because they get a high, or a positive emotional reinforcement, when they acquire a new item, which we have already learned they cannot discard (Gilliam & Tolin, 2010; Grisham & Barlow, 2005). The study by Gilliam & Tolin (2010) did not compare how non hoarders feel when they acquire a new object for comparison. The study by Grisham & Barlow (2005) claims to have up to date research but is five years old so it is now out of date. 6 Excessive acquiring

7. There is a difference between “normal” clutter and the clutter accumulated by a hoarder (Gilliam & Tolin, 2010; Grisham & Barlow, 2005, Maycroft, 2009). Maycroft (2009) goes on to explain the difference. With normal clutter, objects are disorganized but located in an appropriate spot, and with clutter from hoarding, objects are not put in logical places (Maycroft, 2009). For example, kitchen items may be stored in the living room because there is no more room in the kitchen. 7 Clutter

8. 8 Pictures of “normal” clutter and clutter accumulated by a hoarder Picture 2 Picture 1

11. The newest version of the DSM, the DSM-V (fifth edition), is due out in 2013 and currently, there is an argument over weather or not to include hoarding in it under a sub-condition of Obsessive compulsive disorder (OCD) or give it its own separate entry. Some researchers believe that a separate listing would increase public awareness of the issue, improve the identification of hoarding, ensure a proper diagnosis is made, and stimulate research and developments of effective treatment (Matiax-Cohls et al., 2010). Although this article discusses the need for a separate entry, it does not go on to explain the differences between hoarding and OCD that would make hoarding eligible for one. 11 Hoarding and the DSM-V

12. Those that argue that hoarding should be included as a sub-condition of OCD, do so based on the following: Like OCD, hoarding involves debilitating indecisiveness (An et al., 2008; IOCDF, 201; When keeping things gets out of hand; 2006). They both exhibit A lack of control over impulses (IOCDF, 201; When keeping things gets out of hand, 2006). They both have A desire for perfectionism (IOCDF, 201; When keeping things gets out of hand, 2006). They both have obsessive fears (IOCDF, 201; When keeping things gets out of hand, 2006). 12 Shared characteristics between hoarding and OCD

13. Emotional reasons thought to be responsible for hoarding are inconsistent with OCD (IOCDF, 2010). Few hoarders report negative, unwanted, intrusive thoughts regarding hoarding and these type of thoughts are the defining characteristic of OCD (IOCDF, 2010). Hoarders exhibit pleasurable feelings and emotions when acquiring an item which is never present with OCD (Gilliam & Tolin, 2010; Grisham & Barlow, 2005; IOCDF, 2010). 13 Differences between hoarding and OCD

14. The most common method of treatment is Cognitive behavior therapy (CBT) which attempts to change the thought process and cognitions associated with hoarding (Grisham & Barlow, 2005; Gilliam & Tolin, 2010). In some cases, this method has shown to be unsuccessful (Jefferys & Moore, 2008). Another method used that was more successful was group cognitive behavior therapy or GCBT (Muroff, Skeketee, Rasmussen, Gibson, Bratiotis, & Serrentino, 2009). It was thought that this method was more successful because it addressed the social exclusion some people who hoard describe (Muroff et al., 2009). 14 Current treatment options

15. This study by Muroff et al. (2009), did not include any control for non group related effects that could have influenced the participants in the group. Some research is also being done into developing programs specifically designed for hoarders (When keeping stuff gets out of hand, 2006). 15 Current treatment options Picture 2 Picture 1

16. Some research indicates that there is a possible link between brain malfunctions and hoarding symptoms (An et al., 2009; Grisham & Barlow, 2005; When keeping things gets out of hand, 2006). one study conducted brain images of hoarders and non hoarders when they pictured themselves discarding personal items and found that there were areas of the brain that were significantly more active in the hoarder during the process (An et al., 2009). 16 Could hoarding be caused by physiological problems that are treatable with medicine?

17. The study by An et al. (2009) has both a positive and a negative aspect. The positive side is that it uses sophisticated equipment to take images of brain activity. The negative aspect is that the study did not take into account any psychological illnesses that might have altered the brain activity, such as depression. 17 Could hoarding be caused by physiological problems that are treatable with medicine?

18. This research is important because it provides the possibility that hoarding is linked to physiology and that perhaps it is treatable with medications used to treat disorders responsible for altering brain activity such as diabetes, ADHD, depression, eating disorders, head and brain injuries, and schizophrenia. 18 Importance of study

19. Hoarding has four characteristics. They are discarding issues, acquiring, excessive clutter, and distress. The current argument related to hoarding is whether to include it with OCD in the DSM-V or to give it its own separate entry. Currently the treatment options are CBT and GCBT. Some studies link hoarding with physiological illnesses that cause brain disturbances which can be treated with medicine. 19 In conclusion

20. An, S., Mataix- cols, D., Lawrence, N., Wooderson, S., Giampietro, V., Speckens, A., Brammer, M., & Phillips, M. (2009). To discard or not to discard: the neural basis of hoarding symptoms in obsessive-compulsive disorder. Molecular Psychiatry, 14(3), 318-31. Retrieved November 7, 2010, from ProQuest Psychology Journals. (Document ID: 1648470121). Cohen, J. (n.d.). The danger of hoarding. USA Today, Retrieved from Academic Search Elite database Gilliam, C., & Tolin, D. (2010). Compulsive hoarding. Bulletin of the Menninger Clinic, 74(2), 93-121. Retrieved from Psychology and Behavioral Sciences Collection database. Grisham, J., & Barlow, D. (2005). Compulsive hoarding: Current research and theory. Journal of Psychopathology and Behavioral Assessment, 27(1), 45-52. Retrieved November 7, 2010, from Criminal Justice Periodicals. (Document ID: 2157329011). Grisham, J., Steketee, G., & Frost, R. (2008). Interpersonal problems and emotional intelligence in compulsive hoarding. Depression & Anxiety (1091-4269), 25(9), E63-E71. doi:10.1002/da.20327. 20 References

21. 21 International OCD Foundation-hoarding. (2010). From Dante to DSM-V: A short history of hoarding. Retrieved November 7, 2009, fromhttp://www.ocfoundation.org/hoarding/dante_to_dsm-v.aspx Jefferys, D., & Moore, K.. (2008). Pathological hoarding. Australian Family Physician, 37(4), 237-41. Retrieved November 7, 2010, from ProQuest Health and Medical Complete. (Document ID: 1590810551). Mataix-Cols, D., Frost, R., Pertusa, A., Clark, L., Saxena, S., Leckman, J., et al. (2010). Hoarding disorder: a new diagnosis for DSM-V?. Depression & Anxiety (1091-4269), 27(6), 556-572. doi:10.1002/da.20693. Maycroft, N. (2009). Not moving things along: hoarding, clutter and other ambiguous matter. Journal of Consumer Behaviour, 8(6), 354-364. doi:10.1002/cb.298. Muroff, J., Steketee, G., Rasmussen, J., Gibson, A., Bratiotis, C., & Sorrentino, C. (2009). Group cognitive and behavioral treatment for compulsive hoarding: a preliminary trial. Depression & Anxiety (1091-4269), 26(7), 634-640. doi:10.1002/da.20591. Preston, S., Muroff, J., & Wengrovitz, S. (2009). Investigating the mechanisms of hoarding from an experimental perspective. Depression & Anxiety (1091-4269), 26(5), 425-437. doi:10.1002/da.20417. (2006). When keeping stuff gets out of hand. Harvard Women's Health Watch, 13(7), 4-5. Retrieved from Academic Search Elite database.