Spring, 2013 - Hartford Hospital!

Hoarding
is now
recognized
as a
Disorder
Researchers estimate that two million
Americans are hoarders, but the actual number
may be much higher. Hoarding is more than a
secret shame—it’s a psychiatric disorder.
Clutter results from an overwhelming desire to acquire
things, coupled with an inability to throw things
away. Hoarders often feel a sense of emotional attachment
toward their possessions and become upset about making
decisions to discard things. Often they hoard things they
don’t want or need.
“Family members and friends often don’t understand,”
said David F. Tolin, Ph.D., director of the Anxiety Disorders
Center and the Center for Cognitive Behavioral Therapy
at The Institute of Living. “They ask, ‘Why don’t you just
clean up?”
Hoarding disorder now has its own category in the upcoming
edition of the American Psychiatric Association’s
“bible” of diagnostic criteria, the Diagnostic and Statistical
Manual of Mental Disorders (DSM-V), scheduled for publication
in May. Hoarding was previously considered to be a
type of obsessive-compulsive disorder (OCD).
“Hoarding disorder bears very little resemblance to
OCD,” said Dr. Tolin. “What we see happening in the brain
is very different. People with hoarding disorder have
cognitive impairments that cause problems with decisionmaking
and attachment to possessions. They say, ‘I don’t
have a clutter problem. Who are you to
tell me I don’t need these things?’ Many
are resistant to treatment because they
don’t realize the severity of their pathological
need to save things.”
Thanks to a sophisticated brain imaging
technique called functional magnetic
resonance imaging (fMRI), Dr. Tolin and
a team of researchers at the Institute
of Living (IOL) are exploring the neural
(brain) mechanisms of the disorder. With
noninvasive tools like fMRI, scientists
not only visualize the brain, but also
measure activity in the cerebral cortex,
the site of many cognitive functions.
In people with hoarding disorder, the
brain shows abnormal activity in regions
called the anterior cingulate cortex and
insula. During the fMRI test, participants
were asked whether to keep or discard
various items. Brain regions in those
with hoarding disorder lit up when they
were asked to decide about throwing
away their possessions.
“Brain scans of hoarders making
decisions about discarding things show
activity in the part of the brain that activates
when someone is making a mistake,“ said Dr. Tolin.
“Their brains are telling them not to throw things away.
It’s usually not a pleasure response—they’re not getting a
thrill like a compulsive shopper.”
Hoarding seems to be related to impulse control
disorders, depression, social anxiety, bipolar disorder or
certain personality traits, although it sometimes follows
a stroke or dementia. People with the disorder are
chronically disorganized. Their houses are so cluttered
that they can’t sleep in the bed or cook on the stove. The
living space is filled with unwashed dishes and tattered
newspapers.
“Hoarders are prisoners in their own homes,” eplained
Dr. Tolin. “Although we don’t have a ‘cure’ for hoarding,
we help people manage the disorder with cognitive
behavioral therapy (CBT), a form of counseling that goes
beyond talking. The therapist and a professional organizer
visit the home to help the person regain control and
learn how to make decisions about what to throw away.”
For more information, visit www.harthosp.org/InstituteOf
LivingAnxietyDisordersCenter/CompulsiveHoarding.
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