Thanks to reality television, there has been a spotlight on hoarders lately. And you can expect a new legitimacy to this increased attention when the “bible” of psychiatric diagnoses adds hoarding to its list of disorders.
The Diagnostic and Statistical Manual of Mental Disorders, commonly known as the DSM, will soon publish its fifth revision with a definition of hoarding disorder: persistent difficulty discarding or parting with possessions, regardless of their actual value. What differentiates hoarding from normal collecting and accumulating is that the behavior results in significant distress, impairment, or even physical danger due to fire or sanitation hazards.
Medical providers have long considered this psychological condition a form of the anxiety disorder obsessive-compulsive disorder (OCD). However, compulsive hoarding is not always accompanied by anxiety. According to the International OCD Foundation, compulsive hoarding can be treated but has not responded well to the usual treatments that work for OCD.
Changes and additions to the manual have often inspired criticism and controversy because of its influence over what the American Psychiatric Association deems normal and abnormal. One of the most infamous cases occurred in 1973, when the DSM-2, under the pressure of public reaction, removed homosexuality as a disorder.
Controversy also surrounds the DSM because the diagnosis of psychological disorders relies on observation and subjective reports of symptoms. Unlike cancer, heart disease, and other conditions diagnosed with more objective tests such as blood work or imaging, defining a behavioral disorder is not a simple task for clinicians, specialists, and the public. Adding it as a legitimate part of the DSM will most likely result in changes in treatment and how the cost of treatment is covered by medical insurance.
“It’s a very controversial process because [the APA’s] purpose is to get the international communities of researchers and clinicians to agree on definitions for all the problems for which people might seek treatment,” said Dr. David Kerr, an assistant professor of psychology at Oregon State University. “With the increased awareness of [hoarding], there will be more of it that’s reported.”
Two reality shows have shed light on hoarding behavior and carved out a niche for the behavior in the media. A&E’s “Hoarders” and The Learning Channel’s “Hoarding: Buried Alive” follow the personal lives of hoarders to help them understand and rehabilitate the underlying behavior. Each hoarder receives treatment by a therapist and a professional organizer.
Kristin Bertilson of Corvallis has been featured on TLC’s show multiple times as a Certified Professional Organizer. She began working in the emerging industry a few years ago, with a client base mainly in need of managing their overwhelming, busy, and cluttered lifestyles. Bertilson’s approach is to create systems of organization that include goal-setting and several follow-up visits.
“What’s exciting [about the DSM definition] is that people can see it as a mental illness and insurance can start paying for it,” Bertilson said. “Hopefully this will encourage people to seek more help than they used to.”
A small percentage of her clients are people who hoard, many of whom she meets at a community class she teaches at the Chintimini Senior Center in Corvallis. “Beyond Collections: Coping with Clutter” aims to educate a wide swath of pack rats and collectors, and hoarders.
“I meet many of my clients with hoarding tendencies this way,” Bertilson said, “as it’s really hard for people to admit to hoarding.”
She said many people, including well-meaning loved ones, fail to treat hoarding behaviors because they try to treat the area instead of the person. She shared a story involving a woman who sent her mother to Hawaii for a week’s vacation while she cleared and cleaned her house. The clutter was back within a year.
According to the International OCD Foundation, hoarders whose homes are cleared without their consent often experience extreme distress and may become further attached to their possessions, leading to their refusal of future help.
Bertilson has observed that individuals who hoard have learned the behavior from spouses and from early childhood experiences.
“People are developing an attachment to things they shouldn’t be attached to, and aren’t teaching their children that it’s OK to throw things away,” she said.
She added that working with clients who hoard is a sensitive matter because of the emotional connections to material items.
“The attachment to those items is much higher,” she said. “Each item holds something you have to work through emotionally. I will push people to their goals but not at a speed that’s unhealthy.”
Release of the DSM-5 is scheduled for May 2013.
Other changes in the DSM-5 include the controversial decision to no longer consider Asperger’s syndrome its own separate disorder. Instead, Asperger’s, a mild form of autism, will fall under autism spectrum disorder to “help more accurately and consistently diagnose children with autism,” according to the APA.
Asperger’s is considered a high-functioning form of autism, affecting social interaction, behavior, and language comprehension. What does this change mean for Oregon, where autism rates are among the highest in the country?
“It’s not as if it’s going away or no longer exists,” said Tobi Rates, executive director of the Autism Society of Oregon. “It will simply be under the umbrella of autism spectrum disorder.
“Most likely those people who no longer qualify under the specific criteria for Asperger’s won’t be left high and dry,” she added. “There are other diagnoses, such as social communication disorder.”
However, Rates said the changing diagnostic criteria is a bit of a concern for the non-profit organization whose aim is to support, educate, and advocate for individuals with autism and their families. She said people may be more willing to accept an Asperger’s diagnosis rather than an autism diagnosis, which could possibly delay an individual’s willingness to seek services.
by Kerry Brown