Inside the Hoarder`s Mind

Posted by Big Rat on Campus on Nov 7, 2012 in Rat News | Subscribe

It makes for fascinating reality television – the downward spiral of people living among mounds of belongings, from candy wrappers and new designer clothes to live and dead animals.

But Dr. Peggy Richter began shedding light on compulsive hoarding long before TV cameras and other media provided a public window into the often shocking and heartbreaking condition.

Dr. Richter, director of the Clinic for OCD and Related Disorders at Sunnybrook, is internationally known for her work in obsessive-compulsive disorder (OCD) and its subtypes, which include hoarding. In fact, Dr. Richter and her team have identified some of the genes that put people at risk of OCD. She’s also the only psychiatrist in Toronto specializing in treating hoarders, whose compulsive behaviour can put their and others’ health at risk.

Dr. Richter said there have been dramatic changes in the way OCD is perceived and studied since she graduated from the University of Ottawa’s medical school and did her residency and fellowship work at the University of Toronto.

“Twenty years ago, when I was specializing in OCD, OCD itself was considered rare,” she recalls. “When I wrote my first research grant to look at the genetic basis of OCD, I remember getting a letter of rejection at first, and one of the critiques said there is very little evidence it’s genetic. If someone said that now, it would be laughed at.”

The seriousness of hoarding was even more underestimated, she adds. “At that time, hoarding was considered just one symptom of OCD and not a very prominent one, and very little was known about it.”

OCD is an anxiety disorder involving the brain and behaviour: The Boston-based International OCD Foundation says almost everyone has clutter, but hoarders take it to the extreme, living in filth as their lives are destroyed.

It’s estimated five per cent of the population have hoarding tendencies. Behaviours typically surface in the early teens, and the average age of someone seeking treatment is about 50.

“When hoarders look back, they remember by age 13 they were having problems making decisions with what they can part with,” says Dr. Richter. “Usually, hoarding is kept in check by family influences; parents say, ‘We’re cleaning out your room,’ or in college, there may be restraints in terms of what they can accumulate. As they age, the problems seem to build through the lifespan.”

There are also growing concerns about the personal and public health dangers of hoarding.

For example, a cigarette tossed on junk piled up on a Toronto high-rise apartment’s balcony started a fire late last year that left 1,200 people homeless and sent several to hospital. The fire quickly spread because of the excessive amount of material in the apartment.

As well, TV shows such as Hoarding: Buried Alive feature story after story of extreme cases: in one episode, the Humane Society seized 2,000 pet rats from one California homeowner and put them up for adoption.

More often than not, however, hoarding’s clinical component – the underlying psychiatric illness – is not addressed in such programs, which usually concentrate on forced cleanouts of homes, Dr. Richter stresses. “These shows do one very positive thing: They raise the visibility and awareness of the illness and lead to the increasing likelihood that family members of people affected by hoarding will come forward and seek help,” she says. But “forced cleanouts can be very traumatic – the literature shows 90 per cent of those going through forced cleanouts reaccumulate and fill their homes again within a year.”

Dr. Richter and others are working to have hoarding get its own unique psychiatric classification, which, if approved, would be significant for future research, treatment and care.

“Hoarding seems to be somewhat different from other forms of OCD in a number of ways,” she says. “Neurological research now suggests … it is associated with change and function in different areas of the brain,” and may require more targeted treatment.

“We’re even looking at the genetic basis – hoarding seems to run in families, but runs separately from OCD – and recognizing there is a much larger number of people afflicted with hoarding than we ever considered five or 10 years ago, and, in most cases, it doesn’t accompany OCD.”

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