OCD and Hoarding

OCD and Hoarding: hoarding is one of the many manifestations of obsessive compulsive disorder.  OCD obsessive compulsive disorder can also be one of the easiest mental illnesses to treat and also the most difficult to treat depending on its severity. In minor cases OCD can be treated with medication and behavioral modification. One needs to understand their triggers and distinguish between an obsessive thought or a valid concern. Often once the individual learns this approach they find some mechanism by which they teach themselves to ignore the obsessive thought(s) and when they do-the thoughts go away and are virtually out of memory. I know an individual that told me that one of his obsessional thoughts is constant checking if he closed the garage door; after years of tiring from leaving for the office and then turning around to check the door several times he taught himself a little "trick". When he has an OCD thought about the garage door and recognizes it as an obsessive thought and not a valid concern, he says "the heck with it, I have homeowners insurance...if thieves break in I'll file a claim". He said that amazingly after he has committed in his mind to ignore the thought and move on; he can't remember the thought within five minutes of the episode. This is treating minor cases of OCD.More sever cases of OCD can be difficult to treat and sometimes might require surgery. Obsessive thoughts  usually result in the compulsive behaviors that cause an emotional relief from the obsessions. At least on a temporary basis. I have posted several articles on the causes of OCD and hoarding and this article will not delve into the chemistry and psychology behind OCD but rather we will discuss one of the more serious obsessive behaviors OCD and hoarding

Compulsive Hoarding behavior can be very distressing and most people even though they do this by saving items understand the disease and cannot stand to go through the ritual hoarding, yet they are  It is difficult for these people because they are usually too embarrassed to invite people over to their house; and instead of them just being able to clean up and throw away or get rid of the papers and knickknacks that tend to pile up, they aren’t able to do that because of an unrealistic fear that they may need to use it someday or need it for some other reason. They are stuck in this vicious cycle and therefore, don’t have much of a social life and are isolated because they forego inviting people over for the embarrassment that this would cause. The hoarding behavior can be one of the most challenging to treat.

Nevertheless, we now have many effective treatments for this if the person is able to acknowledge that there is a problem and go for help. Generally, a hoarding disorder treatment for OCD-hoarding type is treated with a multimodal approach. We have some medications that are now FDA approved to treat it.  Fluoxetine and Fluvoxamine  and an older medication, Clomipramine, can be quite helpful to the patient. Medication is important  and should be augmented with cognitive behavioral therapy and a more specific subtype of this is Exposure Response Prevention Therapy (e.g. where a person is exposed to the noxious stimuli or contaminant and then not allowed to wash his or her hands during the therapy session with the therapist). I have seen this be very effective with the person becoming more and more comfortable with the exposure. The person is then able to translate that in his or her life to for example not wash his or her hands so much or get rid of things during a session by physically bringing them into the session and at the same time throwing them away in front of the therapist. This gives the patient not only a sense of accomplishment; but also the sense that I can really do this. Then, the therapist will give the person homework to do at home starting with five things a day to throw away and sort ten things progressing with each session to eventually throwing 20 things away while sorting through 25. By this time, the patient is well on his or her way to getting the life back that they had only dreamed of before the treatment.
In more severe cases of Compulsive Hoarding Syndrome,  therapists and or home organizers sometimes will go out to the person’s home and work on the huge endeavor of cleaning it out and getting it organized, so that, one can live in it.  There is a cottage industry that has sprung up around the country and could very well have been fueled by OCD and harding. Some homes have become so filthy, that it is unhealthy to live in the home. This is a serious condition! Many times people only have a small path to go through in their homes because of all the clutter about with the hoarding behavior. Family members often send pictures of the patient’s home with only a small path to walk through with mountains of things three to six feet high on either side. This can be very disabling.
These person should always start on medication, so that, their minds allow them more readily to let go of these things that they have accumulated. Otherwise, to rip these things away from people can be quite traumatic, especially, since they have many times developed sentimental attachments to these things. You can realize that this is quite painful for these folks when you see them being brought to tears when these things are stripped away from them.
This is why I think that a combination of medication, psychotherapy and also organizational help is the best approach to treat this condition in patients.
In the most refractory cases of hoarding, there is a neurosurgery used to treat this as well; but this is, of course, reserved for the most treatment resistant patients as a last resort. This surgery that is performed by neurosurgeons involves severing some connections between the left and right hemispheres of the brain. This has been proven effective, and therefore, it is done. It is a very complicated procedure with never guaranteed positive results. I have never actually witnessed this being done in any patient. This is very invasive; therefore, we try to use the previous treatments aforementioned, especially since with a very motivated person, it can effective.
This article is for informational purposes only and not for diagnosing or treating any medical condition