1.

According to the latest version of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5), hoarding disorder is described as a pattern of compulsive behaviour involving
accumulating numerous possessions that are often of little value to anyone else. While we all
have possessions that we really don't need (hence the popularity of garage sales),
compulsive hoarders take the problem to extremes that can even endanger their lives.

2. The actual cause of hoarding disorder is unknown.

a. Unique Brain Patterns
One study
3
conducted in 2008 examined brain scans of compulsive hoarders and
discovered abnormal activity in the part known as the 'bilateral anterior ventromedial
prefrontal cortex' (BAVPC), or in layman's terms, a part at the back of the brain
associated with decision making. This part is unique to mammals and is thought to
be the most advanced part of the human brain. There have been several instances
where brain damage (from strokes, infections, injuries etc.) has resulted in a patient
developing compulsive hoarding habits. Interestingly, researchers found that these
patients had impairments in the BAVPC, the same part of the brain thought to be
responsible for compulsive hoarding in non-lesion patients, suggesting that this area
plays a key role in compulsive hoarding
b. Hereditary
c. Psycho-sexual development
Sigmund Freud (1856-1939), the father of psychoanalysis, believed that compulsive
hoarding was linked with the 'anal' stage of child development. The 'anal' stage
defines the period where very young children learn how to control their bowels and
bladder through toilet training. He argued that positive and negative experiences
during this stage would go on to determine an individual's future relationship with
material objects. For instance:
i. Strict toilet training (such as being punished by parents for wetting the bed) tends to
create an 'anal-retentive personality', where a person becomes obsessively tidy,
organised and rigid throughout adult life.
ii. Lax toilet training tends to create an 'anal-expulsive personality', where a person
becomes wasteful, messy and destructive.


3. What are the signs of compulsive hoarding?

a. Difficulty getting rid of items
b. A large amount of clutter in the office, at home, in the car, or in other spaces (i.e.
storage units) that makes it difficult to use furniture or appliances or move around
easily
c. Losing important items like money or bills in the clutter
d. Feeling overwhelmed by the volume of possessions that have taken over the house
or workspace
e. Being unable to stop taking free items, such as advertising flyers or sugar packets
from restaurants
f. Buying things because they are a bargain or to stock up
g. Not inviting family or friends into the home due to shame or embarrassment
h. Refusing to let people into the home to make repairs

4. Bodies have been found in their home, virtually buried under tons of newspapers, garbage
and others. Most often, people hoard common possessions, such as paper (e.g., mail,
newspapers), books, clothing and containers (e.g., boxes, paper and plastic bags). Some
people hoard garbage or rotten food. More rarely, people hoard animals or human waste
products. Often the items collected are valuable but far in excess of what can reasonably be
used.
5. Hoarding behaviors can begin as early as the teenage years, although the average age of a
person seeking treatment for hoarding is about 50. Hoarders often endure a lifelong struggle
with hoarding. They tend to live alone and may have a family member with the problem.
6. Severe clutter threatens the health and safety of those living in or near the home, causing
health problems, structural damage, fire, and even death.

Expensive and emotionally devastating evictions or other court actions can lead to
hospitalizations or homelessness .

Conflict with family members and friends who are frustrated and concerned about the state
of the home and the hoarding behaviors

7. Compulsive hoarding can be treated. Unfortunately it has not responded well to the usual
treatments that work for OCD. Strategies to treat hoarding include:
a. Challenging the hoarders thoughts and beliefs about the need to keep items and
about collecting new things
b. Going out without buying or picking up new items
c. Getting rid of and recycling clutter. First, by practicing the removal of clutter with the
help of a clinician or coach and then independently removing clutter
d. Finding and joining a support group or teaming up with a coach to sort and reduce
clutter
e. Understanding that relapses can occur
f. Developing a plan to prevent future clutter
8. Hoarding is often a symptom of hidden mental health problems, including depression, stress,
anger or anxiety. In this case, counselling can encourage awareness and exploration in a
safe and non-judgemental space with clear boundaries.
9.