The Relationship between Compulsive Hoarding Disorder and Obsessive-Compulsive Disorder

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Compulsive hoarding is a controversial and life-debilitating disorder that has recently gained popularity due to the horror stories of people afflicted. About two or three weeks ago, I was watching television and saw a commercial for a show called “Hoarders”. The commercial proceeded to show the house of a woman suffering from compulsive hoarding disorder. At first I could not believe my eyes; this woman’s house was so chaotic and messy that she could barely walk. Many questions immediately popped into my mind. How does this woman, or any hoarder, live a home that is so cluttered? Why would a person subject themselves to such living conditions? What causes a person to hoard in the first place? Once I delved into the research and knowledge about compulsive hoarding, I discovered a relationship between compulsive hoarding disorder and obsessive-compulsive disorder (OCD). At first this relationship seemed quite strange to me and, therefore, sparked my interest. In this paper, I would like to discuss the relationship compulsive hoarding and OCD in more depth and discuss some of the current research being done about this topic. 

So what is compulsive hoarding disorder? Compulsive hoarding disorder, also known as compulsive hoarding syndrome, “is the excessive collection of items, along with the inability to discard them.” (5). Compulsive hoarding frequently creates such overcrowded living conditions that a hoarder’s home may be almost completely filled with clutter. Some hoarders also collect animals and keep them in extremely unsanitary conditions. Compulsive hoarding affects emotions, thoughts and behavior. People who engage in compulsive hoarding typically collect items because they believe these items will be important in the future. A person also may hoard items that he or she feels have important emotional significance (3). At the moment, it's not apparent what causes compulsive hoarding. Genetics and upbringing are probably among the triggering factors of compulsive hoarding due to the fact that the condition is more likely to affect people with a family history of compulsive hoarding. Compulsive hoarding is currently considered a subtype of OCD, but this classification is currently under debate.  It is not clear whether compulsive hoarding is an isolated disorder, or rather a symptom of OCD. Current research is aimed at understanding the biological and environmental factors that seem to play a role in compulsive hoarding. The findings from these studies may lead to the classification of compulsive hoarding as a new and distinct mental health disorder from OCD (5).

Obsessive-compulsive disorder is a potentially debilitating anxiety disorder that forces people into nonstop cycles of repetitive thoughts and behaviors. People with OCD are plagued by recurring and distressing thoughts, fears, or images that they cannot control. The anxiety produced by these thoughts leads to an immediate need to perform certain rituals or routines, also known as compulsions. The compulsive rituals are performed in an effort to avoid the obsessive thoughts or make them stop. Although the ritual may make the anxiety go away momentarily, the person must perform the ritual again when the obsessive thoughts return. This OCD cycle can advance to the point of taking up a significant amount of time during the person's day and greatly interfering with normal activities. People with OCD may be aware that their obsessions and compulsions are pointless or impractical, but they cannot stop their behavior (1).

So why are compulsive hoarding and obsessive-compulsive disorder related? At first this relationship was very confusing to me. Aren’t people who suffer from OCD obsessively neat and people who suffer from compulsive-hoarding excessively messy? How can these disorders on two opposite ends of the spectrum, at least in my mind, be related? It turns out, compulsive hoarding can be a symptom of OCD and it is officially listed as one of the eight symptoms of OCD. But many people who hoard don't have other OCD-related symptoms, and researchers are working to better understand compulsive hoarding as a distinct mental health problem. Many mental health researchers argue that, while some people with OCD have compulsive hoarding behavior, compulsive hoarding is not specific to OCD (4).

In one study done at the University of Iowa, compulsive hoarding was shown not to share a specific relation with OCD. It was found that even though the classic OCD symptoms of rituals, routines, and other compulsions intercorrelated consistently strongly with one another, compulsive hoarding only related somewhat to both these OCD symptoms and to depression. It was also found that OCD patients who suffered from classic OCD symptoms did not also suffer from compulsive hoarding. Also OCD symptoms showed consistent relations with Negative Affect, whereas compulsive hoarding largely was uncorrelated to the Negative Affect. These results do not support a specific OCD-compulsive hoarding relation but rather challenge the tendency to consider compulsive hoarding a specific symptom of OCD (6).

In one study done by Saxena et al, it was found that OCD patients with compulsive hoarding syndrome had a different pattern of cerebral glucose metabolism than nonhoarding OCD patients and comparison subjects. This study wanted to identify cerebral metabolic patterns specifically associated with the compulsive hoarding syndrome using positron emission tomography (PET).  PET scans were obtained for forty-five adult subjects who suffered from OCD, twelve of whom had compulsive hoarding as their most prominent OCD symptom factor, and seventeen normal control subjects. Regional cerebral glucose metabolism was compared between the groups. It was found that, in relation to the comparison subjects, the patients with compulsive hoarding syndrome had significantly lower glucose metabolism in the posterior cingulate gyrus and cuneus parts of the brain, whereas the nonhoarding OCD patients had significantly higher glucose metabolism in the bilateral thalamus and caudate parts of the brain. As compared to nonhoarding OCD patients, compulsive hoarders had significantly lower metabolism in the dorsal anterior cingulate gyrus part of the brain. Across all OCD patients, compulsive hoarding severity was negatively correlated with glucose metabolism in the dorsal anterior cingulate gyrus part of the brain. This study supports the idea that OCD patients with compulsive hoarding disorder had a different pattern of cerebral glucose metabolism than nonhoarding OCD patients and comparison control subjects. From these results it may also be speculated that compulsive hoarding may be a neurobiologically distinct subgroup or variant of OCD. (2).

So why is the research about the relationship between compulsive hoarding and OCD so important? The way that the scientific community currently understands compulsive-hoarding, as a subset of OCD, greatly influences the way that compulsive-hoarding is diagnosed and treated. If, as much research suggests, the relationship between compulsive-hoarding and OCD is deemed insignificant or at least not as significant as it is considered to be now, then the way that compulsive-hoarding is diagnosed and treated will change. As the scientific knowledge of compulsive-hoarding changes it may become clearer what exactly causes hoarding and in which ways it can be prevented. There is still relatively little known about compulsive-hoarding disorder. Although much of the current research leads us to believe that the relationship between compulsive-hoarding and OCD is insignificant, more research is needed.

Reference List

1.      "An Overview of Obsessive-Compulsive Disorder (OCD)." WebMD - Better Information. Better Health. Web. 06 Apr. 2010.        <http://www.webmd.com/anxiety-panic/guide/obsessive-compulsive-disorder>.

2.      "Cerebral Glucose Metabolism in Obsessive-Compulsive Hoarding -- Saxena Et Al. 161 (6): 1038 -- Am J Psychiatry." The American Journal of Psychiatry. Web. 05 Apr. 2010. <http://ajp.psychiatryonline.org/cgi/content/full/161/6/1038>.

3.      "Compulsive Hoarding." Wikipedia, the Free Encyclopedia. Web. 05 Apr. 2010. <http://en.wikipedia.org/wiki/Compulsive_hoarding>.

4.      Grisham, Jessica R., and David H. Barlow. "Compulsive Hoarding: Current Research and Theory." Journal of Psychopathology and Behavioral Assessment,, Mar.-Apr. 2005. Web. 4 Apr. 2010.                                                                                           <http://www.springerlink.com/content/hqu8828408686x55/fulltext.pdf>.

5.      "Hoarding - MayoClinic.com." Mayo Clinic Medical Information and Tools for Healthy Living - MayoClinic.com. Web. 05 Apr. 2010. <http://www.mayoclinic.com/health/hoarding/DS00966>.

6.      "ScienceDirect - Behaviour Research and Therapy : Hoarding and Its Relation to Obsessive–compulsive Disorder." ScienceDirect - Home. Web. 05 Apr. 2010. <http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6V5W-4D5JSC1-1&_user=400777&_coverDate=07%2F31%2F2005&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=1272973573&_rerunOrigin=google&_acct=C000018819&_version=1&_urlVersion=0&_userid=400777&md5=021cf72c07d494b994e199e828ac98a0>.