Since the dawn of hunting and gathering, some people have always gathered
more than others and just couldn't bear to part with
When such behavior crosses the line from the eccentric into the
DSM-IV realm, it becomes a symptom—hoarding—the
compulsion to acquire objects coupled with an unwillingness to discard
Hoarding may occur in connection with a number of psychiatric disorders,
but it is most commonly associated with obsessive-compulsive disorder (OCD).
Perhaps 30 percent to 40 percent of people with OCD have hoarding symptoms.
Specialists argue over the relationship between OCD and hoarding. Is the
latter merely a symptom of the former, or should the two be considered
"There's a real discussion in the field about where hoarding
goes," said Jack Samuels, Ph.D., a psychiatric epidemiologist and an
assistant professor of psychiatry at Johns Hopkins, in an interview with
Psychiatric News. "People with OCD and hoarding have more
severe symptoms, show more symmetry or ordering obsessions, and respond less
well to treatment than those who hoard but do not have OCD."
Recent studies have sought answers from several directions.
In the March 2007 American Journal of Psychiatry, Samuels and
colleagues from five other sites published a genetic study of 219 families
with OCD-affected sibling pairs and their first- and second-degree relatives.
They found a significant linkage on chromosome 14 to compulsive hoarding
behavior when they compared families with at least two hoarding relatives with
families with only one or no hoarders. Other researchers have found linkages
on chromosome 9 and chromosome 3.
Neuroimaging shows varying results too. "Obsessive-compulsive
hoarding may be a neurobiologically distinct subgroup or variant of OCD whose
symptoms and poor response to antiobsessional treatment are mediated by lower
activity in the cingulate cortex," wrote Sanjaya Saxena, M.D., and
colleagues in the June 2004 American Journal of Psychiatry.
A more recent study, in the January 8 Molecular Psychiatry, by
David Mataix-Cols, M.D., and colleagues found that when challenged, OCD
patients with prominent hoarding symptoms showed greater activation in the
bilateral anterior ventromedial prefrontal cortex than did patients without
hoarding symptoms and healthy controls.
Now a group of researchers from Spain and the United Kingdom reports on a
study of 163 individuals who exhibited hoarding behavior with and without OCD,
OCD without hoarding, plus control subjects with anxiety but without either
hoarding or OCD and healthy controls. An initial group of severe hoarders was
divided into two groups, those with and those without OCD.
Patients who had "OCD plus hoarding," "hoarding minus
OCD," or "OCD minus hoarding" were more likely to have
relatives with OCD than were the anxiety and healthy control groups, wrote
Alberto Pertusa, M.D., of the Division of Psychological Medicine at King's
College London, Institute of Psychiatry, and colleagues (including
Mataix-Cols) in the May 15 AJP in Advance. It is scheduled to appear
in the print edition of the American Journal of Psychiatry in
Hoarding seemed to run in families, wrote Pertusa. "More than half of
the participants in each of the two hoarding groups reported having at least
one relative with significant hoarding behavior."
Hoarders with OCD were more likely to collect "bizarre" items,
like feces, urine, hair, or rotten food than were hoarders without OCD.
Between 70 percent and 74 percent of both groups reported that clutter
filled most living spaces in their homes. The two groups said they started
hoarding at about age 20, often after some traumatic event.
Hoarders without OCD said they collected items because they were valuable,
might come in handy later, or had sentimental value. However, 28 percent of
hoarders with OCD said they feared that something catastrophic would happen to
them if they discarded an item.
Social phobia was more common in the two hoarding groups than in the"
OCD minus hoarding" group, and the two OCD groups had more
generalized anxiety disorder than did hoarders without OCD.
"In most cases, compulsive hoarding appears to be a separate syndrome
from OCD, which is associated with substantial levels of disability and social
isolation," concluded Pertusa. "[Our findings] support the idea of
compulsive hoarding being a distinct clinical syndrome, which is highly
comorbid with OCD as well as with other forms of psychopathology, like social
As preparations get under way for DSM-V, due to be published by
APA in 2012, researchers in the field hope to define the boundaries between
OCD and hoarding to better diagnose patients with either or both sets of
"Now is the time to revisit diagnoses that are uncertain," said
Samuels. "These studies all have implications not only for clarifying
diagnosis but eventually for treatment as well."
"Compulsive Hoarding: A Symptom of OCD, a Distinct Clinical
Syndrome, or Both?" can be accessed at AJP in Advance at<http://ajp.psychiatryonline.org/pap.dtl>."
To Discard or Not to Discard: The Neural Basis of Hoarding Symptoms in
Obsessive-Compulsive Disorder" is posted at<www.nature.com/mp/journal/vaop/ncurrent/abs/4002129a.html>.▪