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Hoarding and the DSM-V
The fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) will be released in 2013, but until then, the definition of hoarding is controversial. Hoarding and obsessive compulsive disorder (OCD) are arguably related, but is hoarding a subtype of OCD, or is it a completely distinct disorder? At this point, the jury is out, as the DSM work groups continue to review the research.
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Similarities Between Hoarding and OCD
Hoarding and obsessive compulsive disorder share many characteristics, which is why some people believe that hoarding is simply an OCD subtype. For example, a person with hoarding tendencies may be motivated by a fear of throwing out important information or objects with emotional significance. This seems similar to the obsessions that OCD people struggle with. The need for symmetry that characterizes some people with OCD produces distress when someone else touches their possessions, which is true for hoarders as well. In addition, some hoarders seem to display other OCD tendencies at a much higher proportion than the general public. Hoarding and OCD also both respond to cognitive behavioral therapy (CBT), although hoarding does not respond to the drugs often used to treat OCD.
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Differences Between Hoarding and OCD
At the same time, hoarding and OCD exhibit several differences as well. There are rarely any true "rituals" or compulsions associated with hoarding, since the difficulty throwing out objects is more the absence of an action, rather than the presence of one. Even the "obsessions" associated with hoarding are usually less intrusive than those that people with OCD experience, and they are less distressing and repetitive as well. Throwing out collected objects may cause a hoarder to feel grief or anger, as opposed to the anxiety that someone with OCD might feel in the same circumstances. In addition, people with OCD often feel how abnormal their actions are and wish they could "cure" them, whereas hoarders often enjoy the experience of hoarding and view it as normal and healthy.
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Are There Two Types of Hoarding?
One way to reconcile these seeming similarities and differences is to define two separate types of hoarding: OCD-based hoarding and hoarding disorders. OCD-based hoarding would include hoarders who;
- Obsess about superstitions regarding discarding or organizing objects
- Fear contamination of their objects
- Resist cleaning in order to avoid certain rituals that they feel compelled to do during the cleaning process.
Individuals with this type of hoarding may experience distress rather than pleasure due to these symptoms and attach little or no emotional value to their possessions.
People with a hoarding disorder, which is completely distinct from OCD, would not meet these specifications. The DSM-V, or the fifth edition of the DSM, will have to grapple with the connection between hoarding and obsessive compulsive disorder, deciding on whether they should be considered related but distinct conditions, whether one is a subtype of the other, or whether there are really two types of hoarding.
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How Are Hoarding and Obsessive Compulsive Disorder Connected?
Hoarding is one of the OCD symptoms that is hardest to treat, but there are treatment options available. This series includes articles on these treatment options, as well as articles about specific aspects that affect hoarders and those around them.