There are many different diagnoses that are difficult in terms of formulating and assessment. These include disorders of mental health, which are characterized by abnormal human behavior resulting in discomfort. Such behavior is considered a disease when it poses a threat to the patient’s life or surrounding people or when it interferes with normal social activities. One of these diseases is hoarding disorder, which is formulated by the pathological accumulation of garbage or unnecessary things. The aim is to analyze this disorder in terms of formulating the DSM 5, and to frame possible treatments.
Hoarding, or the pathological accumulation of unnecessary things and rubbish, is a complex mental disorder that can manifest itself in various degrees. Psychological concepts are expressed by obsessive behavior, neurosis, and dyspophobia, which, with the development of the disease, can develop into compulsions (Steketee & Bratiotis, 2020). At the same time, the patient does not notice signs of the strangeness of one’s behavior and believes that the actions do not go beyond normal activity (Gorenstein & Corner, 2014). The main symptoms are nervousness and anxiety if there is a necessity to dispose of unnecessary things, in addition, the quantity of rubbish in the apartment interferes with normal life. Among the things that the patient cherishes, as a rule, there are thoughtless objects, such as packages, newspapers, empty boxes, and others.
The description of the disease in DSM 5 is similar to the symptoms indicated above. Thus, the disorder is described as the extreme clutter of the territory of residence with unnecessary things, which interferes with normal eating, visiting the bathroom, sleeping, or other activities (National Library of Medicine, 2022). Cluttering of the territory of residence may be absent only with the intervention of third parties, such as family, relatives, or friends (National Library of Medicine, 2022). Among the potential disorders are attention-deficit/hyperactivity disorder (ADHD), anxiety disorders, and depression (National Library of Medicine, 2022). Thereby, the current disease has a wide range of symptoms and may result in several conditions.
Based on the patient’s symptoms, one may conclude that it is a hoarding disorder. The criteria listed for the disease in the DSM-5 diagnostic manual include several fundamental points. These involve the patient having difficulty not only with parting with unnecessary things but also with an excessive acquisition of objects for which there is no place (National Library of Medicine, 2022). A person can understand with good or moderate awareness that hoarding of things is an issue, or the person may be convinced that it is not problematic (National Library of Medicine, 2022). Finally, the individual may fully reject all the threats related to the accumulation of rubbish.
The patient meets the criteria for this disorder indicated in DSM 5 because there is an increased reaction to the need to part with rubbish, manifested in anxiety and nervousness. Additionally, the individual denies that such behavior is problematic, that is, there is absent insight/delusional beliefs. The validity of the chosen DSM 5 manual is characterized by pieces of evidence and amendments from medical researchers and doctors. Among the limitations is label providing, which may lead to stigmatizing and oversimplifying patients’ behavior. Moreover, in some cases, there is a risk of over-diagnosis or misdiagnosis.
The disorder is worth considering from the cognitive, behavioral, and psychoanalytic perspectives since such an approach is helpful in deeply analyzing the disease. Besides, one summarized the overall information about the hoarding, but not about the particular case. Talking about the cognitive aspect of the disease, the reason is formulated by emotional triggers, information processing processes, and invalid beliefs related to possession (Moghadam, 2021). The theoretical behavioral orientation of the diagnosis may be articulated by the genetics and some activities done by parents or relatives to the person, which launched the trigger in the patient’s mind (Moghadam, 2021). The psychoanalytic reasons include environmental factors, genetics, altered levels of serotonin, and stress.
Further, it is worth noting that the disease can take place with concomitant disorders. It is due to the nature of mental illness being characterized by a wide range of damaging aspects of the psychological health of the individual. The most common comorbidity in hoarding is depression, which can often present in an acute form. In some cases, it may cause suicidal thoughts and psychosis. In addition, comorbidity disorders are anxiety, social phobia, attention-deficit disorder, and impulse control disorder. Finally, generalized anxiety disorder is the common comorbid condition of hoarding.
Talking about the symptoms within an appropriate theoretical orientation, namely the cognitive, one may distinguish several points. As already indicated, in the cognitive model of the disease, an incorrect assessment of possession is indicated. This factor is fully comparable with the patient’s specific symptoms, namely the accumulation of unnecessary things. There is an overestimation of the importance of certain subjects, resulting in the individual setting the wrong priorities. It leads to a painful reaction to the threat of parting with things as if they were essential objects for the patient. Besides, the cognitive orientation is formulated by the emotional trigger aspect. Considering that an emotional reaction accompanies this disorder, namely nervousness and anxiety, it is also comparable to the patient’s symptoms.
Speaking about the validity of the diagnosis, there are several views which are characterized by the features of the current disorder. Firstly, there are conclusions that hoarding may be properly considered a distinct disease from obsessive-compulsive disorder (Cooper, 2018). There are many studies which provide fundamental differences between these two mental health problems. The demographics of the hoarding are formulated by age features, namely, more significant occurrence in older adults aged over 50 years than in younger adults from 34 years (Cath et al., 2017). Besides, there were no pieces of evidence about the gender, socioeconomic status, sexual orientation, and ethnicity differences. The scientific merit of these sources is formulated by conducting the study and being publishing in peer-reviewed journals and publishers.
The group of biological risk factors for hoarding is not relevant since there is no evidence of the disorder being related to the biological causes. Psychological risk factors are formulated by dangerous psychological conditions or concomitant diseases. Dangerous psychological conditions include stress and childhood psychological trauma. Environmental risk factors are articulated by unfavourable living conditions that promote further stress. Finally, social risk factors include in-group and out-group ones. The in-group is characterized by the patient’s personal problems, such as bullying, dysfunctional family, and lack of career, work, or housing. The out-group includes problems related to the management and control of patients’ mental conditions. It is formulated by barriers to obtaining high-quality and timely assistance for some social strata of the population.
There are many different treatment or intervention options for people with hoarding. These include evidence-based practices and alternative non-evidence-based options. The most studied evidence-based intervention is cognitive behavioral therapy. It is constituted by reshaping the patient’s mind and aligning one to focus on normal behavioral patterns. The non-evidence-based option includes alternative medicine such as hypnosis and drug therapy. However, drug treatment of hoarding only contributes to temporary relief or temporary disappearance of symptoms. It does not solve the underlying cause of the disease, namely the psychological factor influencing the patient’s perception.
The degree of success of treatment depends on the individual characteristics of the patient and the degree of illness. As already indicated, an effective intervention is cognitive behavioral therapy. The success rate varies from 60-80% improvement and 30% complete resolution of symptoms. However, it is important to understand that many factors influence the success of treatment. To achieve the most effective result, it is necessary to analyze and evaluate the patient’s individual indicators.
To conclude, hoarding is a complex disorder characterized by the uncontrolled accumulation of unnecessary things. The extent of the disease depends on the actions of the patient, if the amount of debris interferes with a normal life, quick intervention is necessary. DSM 5 manual defines the disorder as cluttering up an apartment with meaningless things, and the absence of littering can only be with the intervention of a third party. As a rule, things do not carry any value for the individual, it can be bags, newspapers, boxes, and other garbage. The most effective evidence-based intervention is cognitive behavioral therapy, but there are treatments such as hypnosis and medications. The degree of success of the treatment depends on the patient’s individual characteristics and the development of the disease.
References
Cath, D. C., Nizar, K., Boomsma, D., & Mathews, C. A. (2017). Age-specific prevalence of hoarding and obsessive compulsive disorder: A population-based study. Am J Geriatr Psychiatry, 25(3), 245-255, Web.
Cooper, R. (2018). Diagnosing the diagnostic and statistical manual of mental disorders. (5th ed.).
Gorenstein, E., & Corner, R. J. (2014). Case studies in abnormal psychology. (2nd ed.). Worth Publishers.
Moghadam, M. A. (2021). Hoarding disorder: A practical guide to an interdisciplinary treatment. Springer Nature.
National Library of Medicine. (2022). DSM-5: Hoarding disorder.Web.
Steketee, G., & Bratiotis, C. (2020). Hoarding: What everyone needs to know. Oxford University Press.