Many of us may find that we have acquired too many possessions that clutter up our living spaces, but refuse to part with things “in case we might need them.”
Although many of us can identify with too much stuff, for some people a persistent difficulty in parting with possessions can become a problem: hoarding. When these tendencies significantly affect a person’s quality of life, it results in a condition called hoarding disorder.
Curiously, understanding how hoarding manifests itself and how it relates to other difficulties in everyday life has not received much attention until recently. It was not until 2013 that hoarding disorder was officially recognized in the DSM-5 (the American Psychiatric Association’s manual for the assessment and diagnosis of mental illness) and its key characteristics agreed upon.
In a recent study, we found that people with attention-deficit/hyperactivity disorder (ADHD) had a significantly higher incidence of hoarding symptoms compared to the general population. This indicates that hoarding should be routinely investigated in patients with ADHD.
Hoarding disorder is characterized by persistent difficulty discarding items, regardless of their actual value. This leads to excessive accumulation of possessions, cluttering living areas and interfering with their intended use. Hoarding disorder causes significant stress and problems in socialization, at work, and in other areas of daily life.
Anecdotally, we know that participants in hoarding research often report problems with attention, with many believing they should have received an ADHD diagnosis. In fact, there is evidence that people with a hearing disorder have greater attention problems compared to others.
ADHD is a neurodevelopmental disorder characterized by problems with attention. “Inattention” includes difficulties concentrating, but also considerable organizational difficulties, forgetfulness, procrastination and a distractibility that interferes with everyday life.
If there is a link between hoarding and inattention, what about people with ADHD? Do they have more hoarding problems than most?
We asked all patients in an adult ADHD clinic in the UK to complete a series of questionnaires about their characteristics and behaviours, including hoarding. We enrolled 88 people, a third of the patients. A control group of similar age, gender, and educational characteristics who did not have ADHD answered the same questions.
Using three different questionnaires, we applied thresholds previously established by hoarding researchers and clinicians to indicate hoarding disorder. About 20 percent of participants with ADHD reported clinically significant hoarding symptoms, versus 2 percent in the comparison group (nearly 2.5 percent prevalence of hoarding disorder in the population).
Hoarding was approximately equal in both sexes, with patients presenting with hoarding symptoms averaging around 30 years of age. Clinically significant hoarding in ADHD patients was associated with poorer quality of life and greater levels of depression and anxiety.
People with ADHD who were below the hoarding disorder threshold still reported significantly greater problems with hoarding compared to the control group. Additionally, those with more severe attention problems were more likely to report problems with hoarding.
Even if they don’t have ADHD or hoarding disorder, many people will relate to the difficulties that characterize these conditions, showing that symptoms exist along a continuum in the population.
We therefore re-ran the study online with 220 UK participants and found that this time 3.6 per cent was above the threshold and that there was again a strong association between inattention and hoarding.
The results of our study, which we believe to be the first to examine hoarding in adult ADHD patients, suggest that people with ADHD should be routinely screened for symptoms of hoarding — particularly given the limited awareness of impairments in the adult population connection with hoarding.
While patients did not spontaneously raise issues related to hoarding in the clinic, they were supportive of them once explicitly addressed in our study.
A limitation of our study is that hoarding symptoms were assessed using self-report questionnaires. Future studies should replicate the results with trained clinical staff assessing hoarding through interviews. Future research should also examine why this association exists between ADHD and hoarding disorder.
More generally, a challenge to understanding hoarding and providing effective treatment is that many of those suffering from a hoarding disorder have limited insight. That means they don’t necessarily recognize or accept that they have a mental illness or even have a problem at all.
Research on hoarding disorder has tended to focus on people who come forward or who are noticed by health and social care systems. Studies repeatedly describe samples of predominantly female participants in their late 50s.
But these participants report heavy hoarding that began much earlier in life, often by the age of 20. Additionally, indirect evidence from demographic studies suggests that hoarding is evenly distributed across genders.
The evidence from our study suggests that our understanding of hoarding can be enriched by reaching out to these younger people with ADHD who are hoarding for a fuller understanding of their symptoms. This could ultimately support more effective interventions and treatments for both ADHD and hoarding disorder, and help shed light on the connection between the two.
Sharon Morein, Associate Professor of Psychology and Mental Health, Anglia Ruskin University.
This article was republished by The Conversation under a Creative Commons license. Read the original article.