Hoarding disorder, or why refusing to throw anything away is all in the brain
08:11 GMT, 10 August 2012
People who can’t bear to throw things away really do have brains that work differently, claim researchers.
Brains scans confirm that victims of hoarding disorder have abnormal activity in regions of the brain involved in decision making – particularly in what to do with objects that belong to them.
Hoarders not only collect too many things, they feel unable to throw them out even if they’re useless.
Hoarding could now be considered a separate disorder from Obsessive Compulsive Disorder. Pictured is the bedroom of a chronic hoarder
A new US study shows for the first time that a particular brain region becomes over-active when hoarders are asked to dispose of their own possessions.
However, the same part of the brain is under-active when hoarders are asked what to do about items not belonging to them.
The study suggests hoarding disorder exists in its own right, and is not just a symptom of Obsessive Compulsive Disorder (OCD) as doctor have long thought.
The findings may also partly explain why people have different attitudes toward personal possessions, even if they don’t have a full-blown disorder.
Up to three million Britons are believed to suffer from hoarding disorder, which some have dismissed as laziness or untidiness.
But victims who are often live surrounded by growing piles of objects ranging from newspapers to clothes are paralysed by anxiety about dealing with the problem.
TV presenter Jasmine Harman last year made a documentary about her mother Vasoulla’s struggle to combat extreme hoarding.
Her London home was filled from floor
to ceiling with clothes, bags of toys, even bits of broken appliances
that had accumulated over 30 years.
the latest study, US researchers led by David Tolin of the Institute of
Living, Hartford, Connecticut, used functional magnetic resonance
imaging (fMRI) to measure brain activity when decisions had to be made
about whether to keep or discard possessions.
TV presenter Jasmin Harman, pictured left, opened up about her mother Vasoulla's, right, compulsive hoarding in a BBC television programme My Hoarder Mum and Me
The front lawn of a chronic hoarder, even after 50 ton of rubbish has been removed
The brain scans compared the reactions of 43 patients diagnosed with hoarding disorder, with 31 patients with obsessive compulsive disorder and a group of 33 healthy individuals.
The objects used in the study were paper items, such as junk mail and newspapers, that either did or did not belong to the participants.
The researchers found patients with hoarding disorder had abnormal activity in the anterior cingulate cortex and other regions involved with decision-making and categorisation.
When deciding about items that did not belong to them, the patients had relatively low activity in those brain regions.
But when asked to decide about the fate of items that did belong to them, these regions showed ‘excessive functional magnetic resonance imaging signals’ compared with the other two groups.
The study results are published in the medical journal Archives of General Psychiatry.
Dr Tolin said ‘These differences in neural function correlated significantly with hoarding severity and self-ratings of indecisiveness among patients with hoarding disorder and were unattributable to OCD or depressive symptoms.’
He said the findings suggest ‘problems in decision-making processes that contribute to patients’ difficulty in discarding items’.
The hoarders chose to discard significantly fewer of their own possessions than those from the other two groups.
Hyperactivity in these brain regions would contribute to decisions by hoarders to save excessive amounts of their possessions, partly because it primes them to reject what seems to be a risky option – chucking things out.
There is a ‘subjective sense that the wrong decision is being made’ said Dr Tolin.
British experts said the findings would help to classify hoarding disorder as a distinct mental health problem in the US ‘bible’, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Prof David Mataix-Cols, from the Institute of Psychiatry, King’s College London, Advisor to the DSM-5 Obsessive-Compulsive and Related Disorders workgroup, said ‘The difficulty to discard possessions, even those of little apparent value, is one of the landmark features of the newly proposed Hoarding Disorder (HD).
‘Decision-making difficulties are thought to contribute to the inability to discard possessions.
‘This study is the first to investigate what happens in the brain when individuals with Hoarding Disorder make decisions about what to keep and what to discard.
‘The results are very timely given the current deliberations to include a new diagnostic category in DSM-5 and further delineate the differences between HD and OCD.
This is important because until recently hoarding was thought to be a symptom of OCD. Now we know that most hoarders don’t have OCD.
‘However, like most neuroimaging studies, the results only describe the brain regions implicated in deciding whether or not to discard items but do not explain the causes of such difficulties in individuals with HD.
Studies that tap into those causal mechanisms are sorely needed.