Tuesday, November 27, 2007

compulsive hoarding

When she shops for food, she feels a compulsion to buy far more than she needs as a single woman in Norman. She buys enough fruits and vegetables for a small army and has filled a pantry with enough boxed and canned goods to survive a nuclear winter.

For Williams, just finding room for all the items she buys is a challenge. Her refrigerator is packed with homemade soups, cartons of yogurt, leftover Chinese take-out, jars of pickles and other perishable items. Her toaster oven is buried under a huge basket of produce, and her emerald green Formica countertops are covered with boxes of pasta and cocoa, herbs and spices, baskets of bread, utensils, bags of sugar and flour and assorted kitchen appliances. Her cabinets are filled with similar things. Oddly, her sink is bare except for two coffee cups and a spoon.

Williams lives in a lovely neighborhood, with tidy lawns and children riding bikes on the sidewalks. From the outside, her idyllic brick ranch-style home looks like any other home on her street. But when she raises her garage door, you get a glimpse of what lies within. The garage is stacked with boxes of weathered books, many of which Williams will never read but can't bear to get rid of.

Her living room tells of an intelligent woman who loves history. Collectible G.I. Joe and Civil War dolls mingle with porcelain-faced baby dolls. A high-powered telescope aims out a front window toward the sky. Military and history books fill seven tall bookcases, and holiday decorations are placed here and there among the clutter. Assorted other containers hold sewing patterns, cat toys, knickknacks, clothes, blankets, etc.

Williams knows her mess is beyond clutter. She admits she is a hoarder. And she is ready for a change.

"I want to get everything shoved into the back rooms, and I want to decorate for Christmas," she said, glaring at the task before her. She recently cleared out her dining room, dusted her late father's antiques and vacuumed the beige carpet. But the stuff she moved is still stacked 4 feet high around the perimeter of the room, effectively walling it off.

As far back as she can remember, Williams has had the urge to save things. She recalls that when she was a young girl living in the mountains near Colorado Springs, Colo., her family would stock up on groceries and necessities since stores were inconvenient and there was a possibility of being snowed in. But it was as she grew older, she said, that her compulsion to hoard worsened.

"I knew that I was having trouble just getting between the boxes I've stacked up everywhere, but I just thought that I was amassing stuff because I don't have anyone in my life that I'm really close to. I thought I had things instead of people. You know, like some kind of a safety net," she said.

Williams has no family nearby and has only one close friend in the area. She said she feels isolated. But she is not alone in her compulsion. Hoarding is considered by medical experts to be a subtype of obsessive-compulsive disorder (OCD), although it has many differences from traditional OCD. Statistics are not readily available, but experts say many other Oklahomans share her problem. However, few are as open as Williams about the problem and about wanting to take steps to change.

"Less people who have the hoarding behavior recognize that they have a problem than other people with OCD," said Jeff Dismukes, spokesman for the state Mental Health and Substance Abuse Department. "It's kind of a calming thing to them. Sometimes, if they're depressed, they feel good when they sit in the middle of all their things they think are helping them. They think they need them."

There are three basic symptoms of compulsive hoarding:

•The acquisition of a large number of possessions — typically things most people would consider to be of limited or no value — and the subsequent failure to discard those possessions.

"So, it's different from somebody who collects things that are truly part of a collection or truly have some sentimental meaning," said David Tolin, Ph.D., author of "Buried in Treasure: Help for Compulsive Acquiring, Saving and Hoarding." Tolin is an adjunct associate professor of psychiatry at Yale University School of Medicine and the founder and director of the Anxiety Disorders Center at The Institute of Living.

•The clutter is extreme enough that it precludes the activities for which the spaces it occupies were designed.

"For example, my desk is a mess," Tolin said. "I've got books on it and papers and pens and coffee cups and all kinds of stuff, but fundamentally, I can still use it as a desk." Were the clutter more severe, the desk would no longer function as a desk but would become more of a storage space.

"People who hoard frequently tell us that they have beds that they can't sleep in or kitchens that they can't cook in or showers or bathtubs that they can't bathe in because these things have been essentially converted to storage," he said.

•The clutter, acquisition behaviors and difficulty discarding are noticeably affecting the person's quality of life.

Williams exhibits all three symptoms. In fact, she has an additional problem associated with compulsive hoarding: She is depressed. She takes Paxil, an anti-anxiety medicine, but said she doesn't think it's helping. Her lack of medical insurance has kept her from seeking professional help for her compusive hoarding.

"It's a little more complicated than just getting the right medication, because they also need to have therapy to alter the behavior that's become a pattern," Dismukes said. "It's really not something you can just decide to get over."

Compulsive hoarding can be dangerous. In 2006, a Houston woman died in a house fire, largely because her clutter-filled home hindered firefighters' efforts to save her. Perishable food can attract pests, and piles of flammable items are fire hazards. Extreme clutter also presents risks of falling or being buried in things.

But there is hope. Oklahoma's public health departments offer assistance, regardless of one's insurance status, Dismukes said.

"We want anybody to come to us. Whether it's in our system or not, we'll get them to where they belong," he said.

"Oklahomans are really good having this 'pull yourself up by the bootstraps' type mentality. It's something we sort of pride ourselves on, but the issue is, mental illnesses are not something you just pull yourself up by the bootstraps and get over."

A stigma exists, he said, that people with mental illnesses are somehow at fault Compulsive hoarding
From Wikipedia, the free encyclopedia
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Compulsive hoarding in an apartmentCompulsive hoarding (or pathological hoarding) is extreme hoarding behaviour in humans. It involves the collection and/or failure to discard large numbers of objects even when their storage causes significant clutter and impairment to basic living activities such as moving around the house, cooking, cleaning, showering or sleeping. Hoarding rubbish may be referred to as syllogomania. A slang term for a compulsive hoarder is pack rat or packrat.

1 Characteristics
2 Case study
3 Related conditions
4 Physiology and treatment
5 See also
6 References
7 External links

[edit] Characteristics
While there is no definition of compulsive hoarding in accepted diagnostic criteria (such as the current DSM), Frost and Hartl (1996) provide the following defining features:[1]

the acquisition of, and failure to discard, a large number of possessions that appear to be useless or of limited value
living spaces sufficiently cluttered so as to preclude activities for which those spaces were designed
significant distress or impairment in functioning caused by the hoarding

[edit] Case study
The following (edited) case study is taken from a published account of compulsive hoarding:[2]

The client, D, lived with her two children, aged 11 and 14, and described her current hoarding behaviour as a 'small problem that mushroomed' many years ago, along with corresponding marital difficulties. D reported that her father was a hoarder and that she started saving when she was a child. In addition to hoarding, she reported several other obsessive-compulsive symptoms, such as fear of hurting others due to carelessness, an over-concern with dirt and germs, a need for symmetry and a need to know or remember things. D also suffered from a handwashing compulsion and engaged in lengthy cleaning rituals of household items. The volume of cluttered possessions took up approximately 70 percent of the living space in her house. With the exception of the bathroom, none of the rooms in the house could easily be used for their intended purpose. Both of the doors to the outside were blocked, so entry to the house was through the garage and the kitchen, where the table and chairs were covered with papers, newspapers, bills, books, half-consumed bags of chips and her children's school papers dating back ten years.

[edit] Related conditions
It is not clear whether compulsive hoarding is a condition in itself, or simply a symptom of other related conditions.[3] Several studies have reported a correlation between hoarding and the presence and / or severity of obsessive-compulsive disorder (OCD). Hoarding behaviour is also related to obsessive-compulsive personality disorder (OCPD). There may be an overlap with a condition known as impulse control disorder (ICD), particularly when compulsive hoarding is linked to compulsive buying or acquisition behaviour. However, some people displaying compulsive hoarding behaviour show no other signs of what is usually considered to be OCD, OCPD or ICD. Those diagnosed with attention-deficit hyperactivity disorder (ADHD) often have hoarding tendencies.[4]

[edit] Physiology and treatment
People who exhibit compulsive hoarding tend to absorb glucose into the brain differently than people who do not exhibit this behavior. The difference in cerebral metabolism of glucose is greatest in the rear and central parts of the brain.[5]

A 2004 University of Iowa study found that damage to the frontal lobes of the brain can lead to poor judgement and emotional disturbances, while damage to the right mesial prefrontal cortex of the brain tends to cause compulsive hoarding. [6]

OCD disorders are treated with various antidepressants: from the TCA family clomipramine (brand name Anafranil); and from the SSRI family paroxetine (Paxil), fluoxetine (Prozac), fluvoxamine (Luvox), sertraline (Zoloft), and citalopram (Celexa). With existing drug therapy OCD symptoms can be controlled, but not cured. Serveral of these compounds have been tested successfully in conjunction with OCD hoarding, but paroxetine in particular is indicated for treatment of compulsive hoarding.[7] As always, care must be taken in the use of prescription medication. Antidepressant drugs have been linked with increased suicide rates. The U.S. FDA now requires a "black box" warning on many of these drugs. Paroxetine has also been associated with birth defects. Lawsuits have been filed against this drug. A 2006 study of this usage of the drug to treat compulsive hoarding was conducted by the University of California, San Diego.

OCD disorders are also treated with psychotherapy.


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