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Old 11-26-2006, 04:55 PM #1
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Arrow Hoarding & Clutter - is it OCD? If so, it's definitely a very different kind

(this thread courtesy of firemonkey who found the article presented further down)

Hoarding and Clutter
the Obsessive-Compulsive Disorder



. . . when does enough become too much?
And why is it so hard for compulsive savers to know the difference?

Hoarding involves the accumulation and inability to throw away unneeded possessions, to the point that a home may become so filled with stuff that furniture and rooms can no longer be used for their intended purposes.

Dr. Randy Frost, a pioneer researcher in the study of clinical hoarding and Dr. Sanjaya Saxena, a neurobiologist who is pinpointing where in the brain the problem seems to originate contribute. Author Denise Linn, addresses non-clinical forms of hoarding with tips on how to recognize -- and get rid of -- clutter.

Dr. Fred Goodwin begins with an essay about his own recent experience in coming to terms with getting rid of clutter. While his story is not an example of clinical hoarding, he notes that it bears a resemblance to some of the stories we'll hear later in the program. He needed someone else's help in assessing and getting rid of what he didn't need -- old magazines, out of date text books, etc -- and he had to overcome thoughts of how the material really might be useful someday ("What if I might someday want to write a history of psychiatry? etc."). For awhile, he compromised by stashing the clutter in his garage, but when his township's yearly "take it away free" day rolled around, he finally threw it out for good. Looking around the now empty garage he felt a sense of accomplishment and relief. "Now the car could fit!"

While clinical hoarding falls in the more severe end of the spectrum of "saving" behavior, Dr. Goodwin notes that studying this condition throws light on more common patterns too.


Next, someone who's experienced problems with compulsive saving and cluttering since she was a child.

Speaking on the understanding that she would be identified only by her first name, Frances, age 70, says her clutter provides her with a feeling of security and abundance, contrasting with the great anxiety she feels when she thinks about throwing something out. Only recently did she recognize it as a possible symptom of obsessive-compulsive disorder, which led her to get help. Frances says friends and family can help by not criticizing someone with this problem, or taking matters into their own hands. She's found that an internet list-serve for compulsive hoarders and clutterers has been very helpful to her, giving her much needed understanding and help in dealing with her problem.

Resources and support for hoarders and clutterers include

For more information about hoarding as a symptom of Obsessive-Compulsive Disorder, or to inquire about support groups in your area or visit the Obsessive Compulsive Foundation of Boston or write to Obsessive-Compulsive Foundation, 676 State Street, New Haven, CT 06511; phone: 203-401-2070 and email: info@ocfoundation.org



Dr. Randy Frost is a leading researcher in the field of hoarding. Together with Dr. Gail Steketee, Dr. Frost contributed a chapter to a recent text book about Obsessive-Compulsive Disorder on hoarding and how to treat it ("Chapter 23") that many compulsive savers regard as their "bible." Dr. Frost is professor of psychology at Smith College in Northampton, Massachusetts.

Dr. Frost defines hoarding as the acquisition and saving of unneeded items to the point that it causes significant distress, and says that sometimes hoarding can even preclude the use of furniture and spaces. For instance, a bed will be so filled up with things there's no room for someone to sleep on it. Or the hoarder will be unable to use the kitchen because the stove is covered with things and even the oven is full of things being saved.

Hoarding is most often associated with Obsessive-Compulsive Disorder, which is an anxiety disorder. The anxiety is kept at bay as long as the compulsive saver avoids even thinking about throwing things out. Hoarding behavior is on a continuum, with symptoms ranging from mild to severe.


Getting in the way of being able to organize and throw things out are these neurological features -----
  • problems in sustaining attention
  • problems in categorizing possessions
  • a needed reliance on visual cues to trigger memory ("out of sight, out of mind")
  • difficulties in making decisions

Interestingly, Dr. Frost says that the anxiety people experience in discarding items is often short-lived, citing one woman who wept about a book but was fully recovered from her grief about five minutes later. Treatment, he says, can help a hoarder learn to tolerate this kind of anxiety.



Genetic?
A woman who has this problem is concerned that she may pass it on to her daughter, and Dr. Frost says that people who hoard often have a close relative who also has saving problems, but it's unclear whether this is the result of genetics of modeling.

Dr. Frost notes support groups can be effective in helping their members overcome this problem, and says that groups that move from house to house seem to be among the most effective.

Regarding behavioral therapy for hoarding.
Dr. Frost recommends that helpers or "coaches" do NOT take it on themselves to throw things out.


Dr. Frost also recommends that in a de-cluttering or "excavation" session, one should target a particular area and/or type of possession, for instance "books on the kitchen chairs." Assign the things to a very limited number of categories, for instance "books to throw away, books to sell, and books to put on the shelves."

Coaches can help to sort and categorize, but the person with the hoarding problem should themselves make the decisions to discard.

You can reach Dr. Frost through his web site, e-mail him at rfrost@smith.edu

The Infinite Mind's Devorah Klahr visits the home of Jeff, a creative director at a major advertising firm. He's had problems with compulsive saving all his life, he says, and his parents also had problems throwing things out.

Recently Jeff came across a "to-do" list from 1980. At the top of the list "Get rid of half my possession by the end of the year." More than 20 years later, Jeff is ready to tackle the task -- with a little help from a friend. He asks his friend Jane to help him tackle his apartment. While he's at work, she rolls up her sleeves and gets to work, throwing out dusty magazines, paperwork from jobs he finished decades ago, etc. and consigning other possessions to boxes for charity or for Jeff to review.

When he comes home, Jeff says he is fighting a war between two parts of himself. There's the part that want to keep it -- "all of it!" -- as a reminder of past triumphs he wants to enjoy. And then there's the part that wants to let go and move on. Looking around his de-cluttered apartment, he says it will take an adjustment, but he'll get used to it. "It's like a hair cut," says Jeff. His friend adds "Except we don't want it to grow back!"

Dr. Sanjaya Saxena, Director of the Obsessive-Compulsive Disorder Research Program at the University of California at Los Angeles, points out that hoarding behavior is found in people with anorexia which is a disordered characterized by problems with a need to control. It also is found in some cases of schizophrenia, Alzheimer's disease and dementia, and among some people with mental retardation, but still, that it is most often associated with Obsessive-Compulsive Disorder.


OCD has several different 'clusters' of symptoms, each of which seem to have different genetic components, different responses to drugs, and that demand individual treatment protocols. Dr. Saxena is conducting a study that is using neuro-imagery to understand the structural and functional characteristics of the obsessive-compulsive brain.

The study is still underway, but preliminary data suggests that people with OCD who hoard are more likely to have mild atrophy or an unusual shape to their frontal lobes, which is the part of the brain associated with executive functions and decision-making.



Hoarding's Uniqueness Within the OCD Diagnosis


In hoarding, the same
medications that are used to treat other manifestations of OCD are found to be far less effective or not effective at all in treating hoarding.

Pharmacologically, Dr. Saxena says that for hoarding behavior, he often uses a COMBINATION of
1) a stimulant (such as Ritalin or Adderall
) to sharpen attention
2)
an anti-depressant - an SSRI like Zoloft or Prozac


In conclusion, Dr. Saxena points out that the public needs to understand that hoarding is a common problem, and is treatable, through a combination of medication and therapy. Dr. Saxena can be contacted through his web page at UCLA, or visit the Neuropsychiatric Institute on the UCLA web site.

While clinical hoarding represents one end of a spectrum of saving behaviors, most people have to deal -- sometimes more often than they might like -- with garden-variety, everyday cluttering.

Author and feng shui expert Denise Linn, who has helped thousands of readers and clients to clear up their homes -- and their lives. Denise Linn is the author of Feng Shui for the Soul and Sacred Space. Linn has more than 20 years experience in helping people to optimize the flow of positive energy through their homes and businesses using the Chinese art of feng shui. According to contemporary adaptations of this ancient art, clutter can very much impede the flow of positive energy and get in the way of almost every area of our lives. If you're having problems with your finances, for instance, Ms. Linn suggests going through all your financial paperwork and getting rid of what's out of date and un-needed.

She recommends as an exercise that anyone can do, to put on some music, relax, and close your eyes. Then mentally walk through your home and think about each object.
  • Imagine picking up an object in your home, and note your reactions
  • If your energy goes up, then keep it.
  • If your energy goes down, think about throwing it away
  • or put it in another spot and see if you have a better reaction
  • Now imagine picking up another object, and again note your reactions
  • Continue

The Infinite Mind public radio show features interview excerpts about many mental health disorders and illnesses. A directory to all the earlier interviews can be found on the website. This is only an excerpt from a much longer interview as heard originally on the radio show.
The Infinite Mind
Where to hear The Infinite Mind on the air
http://www.lcmedia.com/

Reason for posting excerpt: Recordings (www.LCMedia.com/mindprgm.htm) are very pricey. Wanted to show that the excerpts alone are very valuable - so go FREE !


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Old 11-26-2006, 05:16 PM #2
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I'm not sure what you mean by "is it OCD? If so, it's definitely a very different kind". Just wondering what you mean?

Our experience has been that OC symtoms vary enormously from individual to individual. I do know someone though who is a compulsive hoarder but doesn't have OCD as such, they actually have an Obsessive Compulsive Personality Disorder. It's more about control for them than anxiety...

More here:

The Obsessive-Compulsive Foundation:
http://www.ocfoundation.org/hoarding/

The Anxiety Disorders Center at the Institute of Living:
Hartford Hospital
http://www.instituteofliving.org/ADC...e_hoarding.htm

Association for the Advancement of Behavior Therapy:
http://www.aabt.org/

From Anxiety Disorders Association of America.
http://www.adaa.org/GettingHelp/Anxi...orders/OCD.asp

__________________________________

p.s. this is from a Canadian site that I use a lot. This describes the person I know to a tee. I'm not really into labels as such, but there is a huge difference between OCD and OCPD.

http://www.mentalhealth.com/dis1/p21-pe10.html


Obsessive-Compulsive Personality Disorder
American Description
Diagnostic Criteria

A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

1. is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost
2. shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met)
3. is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity)
4. is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification)
5. is unable to discard worn-out or worthless objects even when they have no sentimental value
6. is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things
7. adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes
8. shows rigidity and stubbornness

Last edited by Lara; 11-26-2006 at 05:26 PM.
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Old 11-26-2006, 07:35 PM #3
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Lightbulb Hoarding - Where Does It Belong in Terms of Diagnostic Categories?

Hi Lara - understand because this is new to me, too...

Excerpts from a paper on the OC Foundation Organization website
http://www.OCFoundation.org/hoarding/about-hoarding/hoarding-where-does-it-belong.php


Hoarding: Where Does It Belong?
By James Claiborn, Ph.D.
Northeast Occupational Exchange
Portland, Maine


Dr. Claiborn did review of the literature and saw patterns of research findings:

Hoarding is typically thought of as a symptom of OCD. However, there are several ways in which it is distinct.
  • For instance, in hoarding it is difficult to identify an intrusive thought that is typical of other obsessive symptoms.
  • Also, hoarding does not respond as well to treatments that are effective for other OCD symptoms (see Steketee & Frost, 2003).
  • Furthermore, recently researchers have attempted to identify subtypes of OCD based on the types of obsessions and compulsions experienced. This research has consistently found hoarding to fall into a separate cluster (Calamari, Wiegartz & Janeck, 1999; Summerfeldt, Richter, Antony & Swinson, 1999).
  • Hoarding and tics also show up more commonly in the families of people who hoard than those of other OCD patients.
  • This might suggest a separate genotype (inborn differences in our genes - OMT) (Samuels et al., 2002; Stein et al., 1999).
  • If this is true, it could be that OCD hoarding represents a separate disorder that might explain the poor response to treatments (Saxena et al., 2002).
  • Another possibility is that hoarding is one of a spectrum of disorders related to OCD - but somehow distinct (Stein, Seedat, & Potocknk, 1999).
  • Investigators have suggested a wide range of disorders as part of this spectrum including hypochondriasis, eating disorders, and many more.

Is hoarding an impulse control disorder rather than OCD?

Among the spectrum of disorders thought to be related to OCD are the impulse control disorders. These disorders are characterized by the failure to control the impulse to engage in harmful behavior, for example "compulsive gambling," kleptomania, etc.

The excessive acquisition of new possessions that characterizes compulsive hoarding fits this characterization. This behavior mimics what is usually called "compulsive shopping."

Although not officially recognized as a disorder in DSM-IV, compulsive shopping is often considered an Impulse Control Disorder ....
and resembles (or is co-morbid with) other OCD spectrum disorders (Koran, 1999).

Hoarding individuals may purchase excessively, or may acquire excessive amounts of free items, or may pick from others' trash.

Compulsive hoarding (generally) has enough in common with other forms of OCD to be classified as a variation of this disorder with some features of impulse control disorders.

This particular variety of OCD is common and can be severe and quite difficult to treat.

Ultimately, research may clarify questions about differences in neurobiology or genetics of varieties of OCD and tell us where hoarding best fits.

(boldface & emphasis added by me - click on link above to see full article)

Last edited by OneMoreTime; 11-26-2006 at 07:44 PM.
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Old 11-26-2006, 07:54 PM #4
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Lightbulb More about other research results

Lara - also, the full article also talks a lot about how compulsive hoarding (to the point of clutter that significantly disrupts normal functioning, such as the inability to cook meals and no place to sleep on the bed, no places to sit because all the chairs are stacked high, only narrow paths to walk thu the home, etc):

- CAN often be found in conjunction with various behavior addictions like Gambling... or pet hoarding.
- CAN be found in conjunction with OCPD rather than OCD itself....

There was simply so much research, so many correlations, that I chose only a relatively limited amount to feature above.

It also talks a lot about the anxiety patterns -- of just how the anxiety manifests in relationship to the behaviors. It talks about its association with Social Anxiety and Avoidance disorders.

It is, they say, sometimes called a Successful Compulsion. Those who have the most anxiety are renters who MUST admit landlords and maintenance personnel. Otherwise, virtually no one is ever admitted.

OneMoreTime - Teri
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Old 11-26-2006, 08:06 PM #5
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Thanks for that. It's one area that's still confusing to me after all these years. That's an excellent OC Foundation link you posted. There's so much OC overlap in so many different conditions that affect us here.

I guess in the long run though it doesn't matter what it's called, hey, just if it's so bad that it's disrupting our lives then we need to figure out how to treat it the right way.

There's actually been quite a lot of work done on researching hoarding in people with Tourette Syndrome which also has overlap with OC behaviours. An example of that research below. A lot of people with TS, for example, might experience compulsions without the obsessive thoughts... that is, without any anxiety. Same with Autism when I think about it. Simon Baron-Cohen wrote a extensive papers regarding the different behaviours between OCD in people with and without Autism. Ref: Folk Physics.

Then again, some people can have more than one condition at the same time, so that's where the water gets muddy and difficult to sort out. To outside onlookers, some of that hoarding type behaviour that is often seen in people with autism could look like OCD, but it's different.

Quote:
Depress Anxiety. 2002;16(2):59-63.
Obsessive-compulsive disorder with and without tics in a clinical sample of children and adolescents.
Hanna GL, Piacentini J, Cantwell DP, Fischer DJ, Himle JA, Van Etten M.

Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of Michigan Health System, University of Michigan, Ann Arbor, Michigan 48109-0390, USA.

The purpose of this study was to discriminate subtypes of obsessive-compulsive disorder (OCD) in a clinical sample of children and adolescents. Sixty OCD patients were assessed in two outpatient psychiatric clinics; 15 patients had a lifetime history of tics and 45 patients had no tic history. Interviews were conducted with the patients and their parents by a child psychiatrist using the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). The symptom checklist of the CY-BOCS was used to categorize obsessions and compulsions. Discriminant function analysis was used to compare the two groups in their symptomatology. There was no difference between the two groups in seven obsession categories. However, there was a significant difference between the two groups in seven compulsion categories. Ordering, hoarding, and washing compulsions were more common in those with no tic history. The results indicate that tic-related OCD may be differentiated from non-tic-related OCD early in life by the presence or absence of certain compulsive symptoms. Copyright 2002 Wiley-Liss, Inc.

PMID: 12219336 [PubMed - indexed for MEDLINE]
I find this an interesting subject and thanks for posting about it.

Last edited by Lara; 11-26-2006 at 08:18 PM. Reason: adding "Folk Physics"
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Old 11-27-2006, 08:02 AM #6
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as we had two threads with duplicated info I have removed the previous one that firemonkey started.
I had received a request to make that thread sticky, but as the discussion is now taking place on this thread, I have left a redirect to this thread on the "useful websites" sticky above
This will avoid any confusion that could arise with duplicated threads etc
Sorry for any confusion and let me know if any further action is needed.

Very interesting discussion btw
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Last edited by Chemar; 11-27-2006 at 08:12 AM. Reason: clarity
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Old 02-28-2007, 04:19 PM #7
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Am J Psychiatry 164:380-384, March 2007

http://ajp.psychiatryonline.org/cgi/...full/164/3/380

Editorial

Is Compulsive Hoarding a Genetically and Neurobiologically Discrete Syndrome? Implications for Diagnostic Classification

Sanjaya Saxena, M.D.
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Old 03-10-2007, 12:39 PM #8
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I spent my adult life working insurance claims. One of the more memorable claims involves a hoarder. I was called to a residential, fatal fire that killed the resident who was a hoarder. Every room in this two story, three bedroom house with a full basement was filled to the ceiling. The fire marshal said the fire started when the weight of contents in the kitchen, put excessive pressure on some matches at the bottom of the contents, and the matches ignited causing the fire. The resident was sleeping upstair and panicked when she smelled smoke. In her attempt to exit the home, she inadvertently knocked over some of her possessions, blocking her path out of the room, and out of the home. Because of the amount of the contents in her home, she became trapped and died of smoke inhalation. In short, her hoarding caused her demise.
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