OMED: Hoarding poised to grow in prevalence, DO says
Should Gerald G. Osborn, DO, prove correct, those tragic and bizarre stories of people buried beneath their own clutter may well lose their newsworthiness before long.
He predicted revelations of compulsive hoarders will become more commonplace. “With the increasing openness in our society, more of these people are being discovered,” said Dr. Osborn, professor and chairman of psychiatry at the Lincoln Memorial University-DeBusk College of Osteopathic Medicine (LMU-DCOM) in Harrogate, Tenn. “And I would expect the prevalence of these cases will continue to grow during the next few years and certainly in the next decade as the society continues to age.”
“I would expect the prevalence of these cases will continue to grow during the next few years.”
Dr. Osborn spoke before a conjoint meeting of the American Osteopathic Academy of Addiction Medicine and the American College of Osteopathic Neurologists and Psychiatrists, held Oct. 25 in conjunction with the AOA’s 115th Annual Osteopathic Medical Conference and Exposition in San Francisco.
Estimates of compulsive hoarding’s prevalence range from 2% to 5% of the U.S. population, and half of these people are genetically predisposed for the condition, said Dr. Osborn, who is also LMU-DCOM’s associate dean for international medicine.
More than a messy room
According to Osborn, the commonly used criteria for identifying compulsive hoarders consist of three behaviors, all of which have to be present:
- Acquisition of and failure to discard a large number of possessions of useless or limited value.
- Living space so cluttered that it precludes activities the spaces were designed for.
- Significant distress or impairment in social or occupational functioning caused by the hoarding.
“This isn’t about just having a messy room,” said Dr. Osborn. “A lot of times those piles of papers on your desk are just indicative of being just too busy and overwhelmed. Hoarding often stems from high levels of trauma or from stressful lives.”
He cited the example of sentimental hoarding, which might start as a desire to keep a deceased loved one’s memento and then spirals out of control. “There are a lot of people who have very difficult lives. Bad things happen, which creates an urge to save. And the saving cascades into hoarding. We see this with elderly people with increasing frequency. If there’s no early intervention, it gets worse and puts people in life-threatening circumstances,” Dr. Osborn said.
Compulsive hoarding is often comorbid with a number of other mental health problems. Hoarding is diagnosed in 24% of patients with general anxiety disorder, 15% to 35% of people with obsessive compulsive disorder, 20% with social phobia, and 36% of those with major depression, Dr. Osborn said.
“When we consider treatment for these people, we really need to moderate our expectations because this behavior does not easily go away,” he continued. Selective serotonin reuptake inhibitors have been shown to reduce symptoms in 40% to 60% of people with the disorder, he said.
Confrontational intervention also helps in some cases. “But you can’t clean their houses for them. You have to help them do it themselves,” Dr. Osborn explained. “You might start by saying, ‘I want you to pick out just 10 things in this crowded house to throw out.’ ” The combination of cognitive behavior therapy with family or friends’ intervention has also helped hoarders, he said.