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A Quarterly Newsletter from NJ MentalHealthCares Winter 2016
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The NJMentalHealthCares Helpline helps individuals, families and communities identify, understand and effectively navigate programs that comprise the behavioral health and human services delivery systems. Built upon the philosophy of an individual's capacity for self-reliance and self-determination through advocacy, affirmation, education, NJMentalHealthCares has exemplified a commitment to service, community and integrity.
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Understanding Hoarding Disorder
Approximately two-to-six percent of the population suffers from hoarding disorder. Typical onset in hoarding behaviors begins before the age of 20 but is not prominent until after the age of 40. The average age of those seeking treatment for hoarding disorder is 50. Items hoarded would typically hold little value or meaning to others, such as: paper, receipts, junk mail, newspapers, books, clothing, containers, boxes and plastic bags.
There is significant health risk associated with hoarding disorder, including fire hazard and unsanitary conditions. Homes can become so cluttered with items that certain areas are inaccessible. Furniture and bedding are often not able to be used for their intended purposes. Kitchens cannot be used for food preparation. There can be air quality concerns due to dust and mold. Hoarding may also cause anger, resentment and depression among family members, and it can affect the social development of children. Unlivable conditions may lead to separation or divorce, eviction and even loss of child custody. Hoarding may lead to serious financial problems as well. Severe social isolation may occur as the person becomes embarrassed by the clutter in the home and stops socializing completely. Symptoms of hoarding disorder can include: - Persistent difficulty discarding or parting with their possessions, regardless of their actual value
- Emotional distress over parting with possessions
- Allowing possessions to accumulate to the point of congesting living space, often requiring intervention by others
- Allowing hoarding to interfere with day-to-day life, including work or relationships with friends or family
- Hoarding cannot be better explained by another mental disorder such as brain injury, obsessive compulsive disorder, or major mental illness
75% Of those who receive a diagnosis of hoarding disorder are comorbid with a mood or anxiety disorder, with depression being the most frequent and higher rates of generalized anxiety disorder and social phobia noted. Less than 20% have a diagnosis of Obsessive-Compulsive Disorder. Click here for more information about hoarding disorder.
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Decision Making and the Brain in Hoarding Disorder
A research team led by Dr. David Tolin of Hartford Hospital and Yale University used functional magnetic resonance imaging (fMRI) to investigate the neural basis for hoarding disorder. It compared the brains of patients with hoarding disorder to patients with Obsessive-Compulsive Disorder (OCD) and healthy controls as they decided whether to keep or discard possessions. The study was funded by NIH's National Institute of Mental Health (NIMH).
The researchers analyzed brain images of 43 people who had hoarding disorder, 31 people with OCD and 33 healthy controls. Participants were given six seconds to make a decision about whether to keep or discard junk mail that either belonged to them or to someone else. Participants later watched as the items they chose to discard were placed in a paper shredder. They were then asked to rate their emotions and describe how they felt during the decision-making tasks. When compared to those in the OCD or healthy control groups, the people who had hoarding disorder chose to keep more mail that belonged to them, took longer to make decisions and reported greater anxiety, indecisiveness and sadness than the other groups. The imaging analysis revealed that people with hoarding disorder differ from both healthy controls and patients with OCD in two specific brain regions: the anterior cingulate cortex and insula. Scientists believe that these areas are part of a brain network involved in processing emotion. Both regions were more active in people with hoarding disorder when they were making decisions about mail that belonged to them, but less active when making decisions about mail that didn't belong to them. These results suggest that decisions made by people with hoarding disorder about possessions are hampered by abnormal activity in brain regions used to identify the emotional significance of things. "They lose the ability to make relative judgments, so the decision becomes absolutely overwhelming and aversive to them," Tolin said. The scientists believe that these brain abnormalities are specific to hoarding and separate the disorder from OCD. Click here to read more about this study.
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