ORLANDO – Compulsive hoarding traditionally has been considered virtually synonymous with obsessive-compulsive disorder, but its reach actually extends far beyond.
Indeed, hoarding turns out to be is highly prevalent across a broad span of psychiatric disorders, including bipolar disorder.
In a random sample of 165 psychiatric inpatients with a variety of diagnoses who were screened using the Hoarding Rating Scale, 70 (42%) showed evidence of clinically significant compulsive hoarding, Dr. Nidhi Goel reported at the annual meeting of the American Association for Geriatric Psychiatry.
Clinically significant hoarding as defined by a score of 14 or more was present in half of patients hospitalized with bipolar disorder, 41% of those with substance use disorders, close to 40% of those diagnosed with schizophrenia or schizoaffective disorder, more than one-third of patients hospitalized for major depression, and 28% with other psychotic spectrum disorders, noted Dr. Goel, director of inpatient psychiatric services at Maimonides Medical Center in Brooklyn, N.Y.
The clinical implication is clear, she added: Hoarding disorder – newly upgraded to a full-blown diagnostic category in the DSM-5 – needs to be brought up onto more psychiatrists’ radars.
"Patients come in with depression, substance use problems, and all sorts of Axis I diagnoses where we just forget to assess the hoarding problem. Then when they’re ready to be discharged, a family member mentions, ‘We cannot even get into their apartment because of all the stuff that has piled up.’ This disorder negatively [affects] our patients’ quality of life quite a lot," Dr. Goel continued.
"My thinking is that if hoarding is so common in all of these disorders, could treating hoarding prevent some of these other disorders? We don’t know. It hasn’t been studied," Dr. Goel said in an interview.
In the DSM-5, hoarding disorder is for the first time categorized as a distinct entity. It is listed under the chapter heading Obsessive-Compulsive and Related Disorders. Before the DSM-5, there was no "hoarding disorder." Rather, hoarding was merely considered a symptom of OCD. And OCD was included in the chapter on anxiety disorders. Now OCD and Related Disorders have their own chapter and are no longer considered anxiety disorders.
The DSM-5 fact sheet on hoarding disorder states, "Creating a unique diagnosis in DSM-5 will increase public awareness, improve identification of cases, and stimulate both research and the development of specific treatments for hoarding disorder. This is particularly important, as studies show that the prevalence of hoarding disorder is estimated at approximately 2%-5% of the population. These behaviors can often be quite severe and even threatening."
Hoarding disorder and its attendant clutter also create a significant public health problem, according to Dr. Goel, who noted that hoarding-related complaints to urban public health departments occur at a rate of 26/100,000 population per 5 years.
One of the features of the DSM-5 diagnostic category of hoarding disorder Dr. Goel considers a big step forward is the inclusion of specifiers regarding insight and delusional beliefs. Patients with hoarding disorder can be categorized as having good or fair insight, poor insight, or absent insight with delusional beliefs.
"Let’s say, for example, that a patient comes in who has been diagnosed with schizophrenia just because there is some delusional component attached. I’m now thinking maybe this patient may not have schizophrenia. Maybe it’s just hoarding disorder with delusions, or delusional disorder [not otherwise specified]," she said.
The Hoarding Rating Scale assesses difficulty in using living spaces because of clutter, the inability to get rid of possessions, the excessive acquisition of objects, and hoarding behavior–related functional impairment and emotional distress.
Dr. Goel reported having no financial conflicts with regard to this study.