When thinking about obsessive-compulsive disorder (OCD), hoarding might be the last thing that comes to mind. OCD and hoarding disorder may seem like complete opposites. OCD often conjures up images of immaculately clean and neat spaces while hoarding disorder most likely brings about images of rooms overrun with dirt and clutter. However seemingly different these disorders might appear on the surface, they actually both fall under the obsessive compulsive and related disorders category in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Additionally, while not always the case, hoarding behaviors can be indicative of a possible OCD diagnosis. Given how closely related hoarding disorder and certain presentations of OCD can be, it is important to understand what exactly hoarding disorder is, how it can be distinguished from OCD, and when hoarding behavior may point to an OCD diagnosis.
Similar to OCD, hoarding is an often misconstrued disorder and one which is frequently thrown about in conversation to describe friends who are messy or have cluttered homes. For many, their conception of what an individual with hoarding disorder may look like or act like comes from reality television. While the accumulation of clutter in different living areas in one’s home is almost always a feature of hoarding disorder, this alone is not sufficient for a diagnosis. For the accumulation of clutter to be a potential red flag for hoarding disorder, the clutter must reach a point of causing living spaces to lose some capacity to fully serve the rooms intended purpose. In other words, hoarding disorder may lead to a living room that cannot be lived in, a bedroom that cannot be slept in, or a kitchen that cannot be cooked in.
Not every individual with hoarding disorder lives in spaces overrun with clutter such as those described above. However, it is often the case that if an individual with hoarding disorder has managed to declutter their spaces, it was likely a result of intervention from family, friends, or professional services. This is important to note because these individuals are not “cured” nor are they struggling with the effects of hoarding disorder any less than an individual whose spaces have not been decluttered.
For individuals with hoarding disorder, there are two main causes for the accumulation of clutter: difficulty parting with possessions and excessive acquisition of items. Parting with possessions poses a challenge for individuals with hoarding disorder as the sense that these possessions must be held onto for one reason or another is often quite strong. Difficulty discarding any item, despite its value, is a key feature of this disorder. While there are many different reasons why individuals with hoarding disorder become so attached to possessions, a few of the main reasons include the perceived utility, aesthetic value, or sentimental attachment to the items. To those without hoarding disorder some of the commonly saved items, such as newspapers, bags, old mail or paperwork, may seem useless. However, because of the perceived value of these items, getting rid of them, or even thinking about getting rid of them, is often accompanied by intense feelings of distress for those with hoarding disorder.
In addition to the difficulty parting with possessions, it is also extremely common for individuals with hoarding disorder to engage in the excessive acquisition of items. According to the DSM-5, around 80% to 90% of individuals with this disorder also display behaviors of excessive acquisition in the form of continuous purchasing or holding onto items they received for free. In some instances, individuals with hoarding disorder may also engage in stealing items although this is far less common than excessive purchasing or collecting free items.
Based on the description above, hoarding disorder may not seem at all related to OCD. OCD is marked by intrusive thoughts, followed by compulsive acts aimed at easing the distress related to those thoughts. The presence of intrusive thoughts and compulsions are not typical for an individual with hoarding disorder. Rather, the distress associated with hoarding disorder stems from the difficulty associated with discarding possessions along with the ongoing acquisition of items. So how are these disorders linked?
Hoarding behavior, which is fundamental in hoarding disorder, may also be present for an individual with OCD. What distinguishes the two disorders are why the individual is engaging in hoarding behaviors. Individuals with hoarding disorder accumulate items because of their perceived value while OCD related hoarding is generally an unwanted response to an obsessive feeling or thought. While individuals with hoarding disorder experience distress as a result of having to discard items, individuals with OCD experience distress as a result of the compulsive accumulation of items.
While OCD hoarding behaviors can manifest in many ways, the most common is hoarding due to feelings of incompleteness. In other words, an individual with OCD may fear losing part of their identity or sense of self if they do not document all life experiences. This can result in the accumulation of any and all items the individual feels are related to their life such as toys, paperwork, birthday cards, etcetera. Hoarding related OCD can also be caused by fear of contamination which is an extremely common fear for individuals with OCD. An individual may avoid throwing items out because doing so would require touching items they perceive to be contaminated. Fear of contamination may also result in excessive acquisition similar to that in hoarding disorder. The individual may believe that everything they touch becomes contaminated and they therefore must purchase everything that they come into contact with in order to prevent others from contamination.
In addition to the similarities between hoarding disorder and OCD, it is also common for individuals with hoarding disorder to experience symptoms of non-hoarding related OCD. According to the DSM-5, around 20% of those with hoarding disorder also meet the criteria for an OCD diagnosis. In fact, individuals with hoarding disorder may not view their hoarding behaviors as problematic and therefore may not report symptoms. Because of this, hoarding disorder is frequently not diagnosed until the individual seeks evaluation for OCD.
While all forms of OCD offer unique challenges, treatment remains constant across all subtypes of the disorder. Exposure and response prevention therapy (ERP therapy) is a form of cognitive behavioral therapy (CBT) that is regarded as the gold standard for treating OCD. ERP is also viewed as a successful treatment option for hoarding disorder. ERP treatment, which relies on the principle of habituation, involves the individual slowly exposing themselves to their intrusive thoughts and obsessions while refraining from engaging in their normal compulsive behaviors to alleviate their distress. Over time and through repeated exposure habituation occurs, meaning that the previously feared thoughts begin to lose their power and the anxiety and distress related to those thoughts begins to weaken.
If you or someone you know is struggling with hoarding related OCD, or OCD of any kind, help is available. You can get started now by scheduling a free 15-minute phone call with an NOCD specialist. All NOCD therapists are clinically trained to provide ERP therapy. NOCD also offers video therapy for those who need it and is available in all 50 states.