Hoarding Behavioral Disorder

Pathological or compulsive hoarding is a specific type of behavior or disorder characterized by extravagant collection of worthless, worn-out, hazardous, or unsanitary objects and the inability to discard them. Behaviors related to hoarding lead to significant distress or impairment of work and social life. Patients troubled with hoarding behaviors are diagnosed with Obsessive-Compulsive Personality Disorder (Compulsive Hoarding, 2010). Treatment options available for people suffering from hoarding behaviors are analyzed through determining numerical and verbal hypotheses that research the effects of previously failed treatment attempts. By understanding causes for the patients' failure to regularly take medications and attend therapy, the hypothesis is determined to create an atmosphere for hoarding patients that will allow successful treatment. In an attempt to lead research studies to the correct conclusion, the five steps of hypothesis testing are conducted.

Hoarding Hypothesis Testing

Hoarding is a debilitating mental disorder characterized by excessive collection of worthless, worn-out, hazardous, or unsanitary objects and the inability to discard them. People suffering with hoarding behaviors are typically diagnosed with Obsessive-Compulsive Personality Disorder (Compulsive Hoarding, 2010). The treatment options available for people suffering from hoarding behaviors can be analyzed through a numerical and verbal hypothesis, and the five steps of hypothesis testing.

Hoarding

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) classifies hoarding tendencies as diagnostic criteria for obsessive-compulsive personality disorder. The DSM-IV defines hoarding as the inability to discard worthless or worn-out objects with or without sentimental value (Obsessive-Compulsive Personality Disorder, 2000). Compulsive hoarding is associated with indecisiveness, procrastination, avoidance behaviors, perfectionism, and difficulty in organization. Hoarding can be a debilitating disorder that impairs daily functions, social and family interactions, increases depression and anxiety symptoms, poses a health risk to individuals exposed to unsanitary or hazardous household conditions, and possible issues with law enforcement or social services. The prevalence of hoarding is not fully known, but an estimated 1.2 million residents of the United States suffer from a type of hoarding behavior (Compulsive Hoarding, 2010).

Hoarding is characterized by the excessive acquisition of objects and the inability to discard them, even if the items are worthless, worn-out, unsanitary, or hazardous. People suffering from hoarding disorder may also hoard animals, with the most common animal being cats and dogs. Hoarders should not be confused with collectors, as items accumulated by hoarders are often worthless. People suffering from compulsive hoarding often experience exaggerated beliefs and feelings about the importance of objects and become excessively attached to possessions. Hoarders experience intense fear and anxiety about losing or discarding items. Typically hoarders keep every object that enters their household, regardless if it is trash that most people would discard without hesitation. Treatment is challenging for hoarders because most hoarders suffer from poor insight and do not understand their compulsions. (Compulsive Hoarding, 2010).

The DSM-IV does not currently recognize hoarding as a disorder separate from Obsessive Compulsive Personality Disorder, but proposed revisions by the American Psychiatric Association suggest hoarding disorder merits an inclusion in the fifth edition of the DSM (American Psychiatric Association, 2010).

Obsessive-Compulsive Personality Disorder

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) classifies obsessive compulsive personality disorder as a, "preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts" (Obsessive-Compulsive Personality Disorder, 2000, para 1). The presence of four or more of the diagnostic criteria from the DSM-IV is required for a diagnosis of obsessive-compulsive personality disorder. The signs and symptoms may include preoccupation with organization and order, stubbornness, inability to discard worthless objects, excessive devotion to work or daily organization, perfectionism that may interfere with completion of tasks, and inflexibility about issues of values, ethics, and morality (Obsessive-Compulsive Personality Disorder, 2000). Hoarding tendencies are classified as a symptom of obsessive-compulsive personality disorder, but not everyone diagnosed with the disorder exhibits hoarding behaviors. In contrast, people suffering with obsessive-compulsive personality disorder may be preoccupied with organization and immaculately clean households.

Hypothesis Testing

The hypothesis that has been applied concerns a sample group of 100 diagnosed cases of severe hoarding that will be tested by administering the prescription medication Paxil over a 12-month study. The population group consists of an additional group of 100 diagnosed cases of severe hoarding and will be given a placebo.

Population one will be administered Paxil once daily for 12-months. Population two will be administered a placebo once daily for 12-months. The prediction of stated hypothesis is that at the end of the 12-month period there will be a 40% decrease in symptoms by those in population 1. The comparison distribution will become evident in the decrease of hoarding tendencies and behaviors. The effectiveness of Paxil versus the placebo medication will become evident at an early stage. The cut-off date of six months has been chosen. The hypothesis predicts there will be less than a five percent chance of a drastic decrease in hoarding behaviors prior to the six month cut-off. The chosen parameters of this study have been set up to ensure Paxil is the prescribed medication for patients to achieve optimal results.

Numerical and Verbal Hypothesis

According to the Surgeon General of the United States of America, at any given time one percent of the total population demonstrates symptoms of severe hoarding (Deegan, 2008). The recent prevalence of hoarding is estimated to be reaching levels of 30% to 40% of patients that suffer with obsessive-compulsive personality disorder. The research question is drawn from data that shows a high percentage of hoarders will find recovery difficult due to a lifestyle with minimal structure, mercurial sleep/wake cycles that lead to the patient neglecting to take medication, and absence of therapy sessions. The display data expresses that patients taking medication similar to Paxil and receiving cognitive behavioral therapy will show improvement. The numerical and verbal hypothesis will attempt to conclude that a sample size of 100 confirmed cases of severe hoarders, over 12 months, will show a 25% to 34% reduction in hoarding behaviors when patients are administered Paxil and receiving cognitive behavioral therapy. The null hypothesis states that the routine of prescription medication and administration of cognitive behavioral therapy may only result in temporary relief of hoarding behaviors, and the hoarders will eventually return to their previous lifestyle.

Cognitive behavioral therapy is a strategy used to conceptualize compulsive hoarding behaviors by focusing on four main components which are: information processing deficits, difficulty in forming emotional attachments, behavioral avoidances, and erroneous beliefs about the nature of possessions. Cognitive behavioral therapy will target decreasing clutter, improving decision-making and organizational skills, and strengthening the ability to resist urges to save possessions for people exhibiting hoarding tendencies (Bratiotis, 2007).

Exposure and response prevention, or exposure therapy, is a significant component of treating people with hoarding behaviors in cognitive-behavioral therapy. Patients will learn to conceptualize hoarding in terms of issues with anxiety, avoidance, and information processing. Therapists will gradually expose patients to situations that provoke anxiety, such as asking a patient to discard an item or make a decision about where it should go. Patients must select the first item available in the pile; make a decision about the item: discard, keep, or recycle, and then continue to the next item in the pile. Patients must also designate areas for possessions to be organized and stored for safe-keeping. Preventing incoming clutter is another step in treating hoarding behaviors. Patients must work on resisting the urges to acquire new items and are asked to log every item acquired or purchased. Therapists also require daily schedules to be maintained to develop habitual adaptive behavior such as taking medications at a set time, sleeping normal hours, and being active throughout the day. As treatment progresses, patients start working toward more long-term structure, which may include part-time work, volunteer work, trying new hobbies, or enrollment in educational or technical classes. Hoarders will be encouraged to incorporate recreational time in each day as well (Bratiotis, 2007).

Conclusion

Hoarding is a debilitating disorder that must be rigorously treated with pharmacological medications, cognitive behavioral therapies, and support from loved ones. The data and information collected through research studies suggest small populations of people are afflicted by hoarding behaviors, but appropriate intervention can render positive results through extinction of hoarding behaviors.

References

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Bratiotis, C. (2007). Cognitive behaviorial treatment interventions for compulsive hoarding.

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Compulsive Hoarding. (2010). Obsessive-compulsive disorders. Department of Psychiatry.

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