According to modern day literature, the Obsessive-compulsive disorder (OCD), affects approximately 2.5% of the worldwide population. For this reason, it is ranked as one of the most serious and prevalent psychiatric disorders that are characterized by grave symptoms. According to Wetterneck, Little, Chasson, Smith, Hart, Stanley and Bjorgvinsson (2011), this disorder is characterized by recurrent intrusive thoughts or obsessions, and persistently recurring behaviors or mental rituals, known as compulsions, that are aimed at attenuating anxieties that are primarily caused by obsessions. According to scholars, common obsessions related to OCD are such as the fear of contamination, intrusive violent images, an excessive concern about appearance, and need to save items of perceived value, among others. Besides, scholars contend that the clinical presentation of OCD is heterogeneous with persons suffering from various potentially non-overlapping symptoms. Hoarding, on the other hand, was initially considered as a primary symptom of OCD. However, based on modern-day literature, Hoarding Disorder (HD) is considered as a new form of Obsessive-Compulsive and Related Disorders (OCRDs). Being a new mental disorder, Hoarding can, therefore, be classified alongside OCD and other OCRDs.
Particularly, the intrusive thoughts that characterize OCD cause marked anxiety and patients often consider their constant compulsions as efforts to reduce, neutralize or mitigate the occurrence of these intrusive thoughts. In a similar regard, the time-consuming compulsions and obsessions often distract the OCD patients from completing the tasks at hand. This, in essence, impairs the individuals attention and concentration. Also, with OCDs, the compulsions that are as a result of the obsessional thoughts, images and involuntary urges play a significant role of reducing discomfort for the patient. However, research has it that these compulsions do not appear to be logically connected with the obsessions. For instance, if an OCD patient experiences an obsessional thought such as their family or a loved one could be in danger, this patient may neutralize this obsession by feeling the compulsive desire to turn on the lights a certain number of times before leaving the house (Storch & McKay, 2015).
According to the American Psychiatric Association (2013), OCD traps its patients in endless cycles of repetitive thoughts and behaviors. In this regard, the patient is continuously plagued with both distressing and recurring thoughts which consume a lot of time, stressing over obsessions that cannot be controlled. Similarly, these obsessive thoughts yield great anxiety, which in turn, leads to urgent impulses to perform rituals on a continuous basis. Although there is no particular understanding of what drives the fear of intrusive thoughts in OCD patients, scholars substantiate that this fear is partly due to the perception of the perceived level of danger and threat that an OCD patient believes may cause harm to themselves or to the people they love. Additionally, Shafran (2001) claims that the for many people with OCD, the constant fear of intrusive thoughts is substantiated by the fact that OCD causes an over inflicted sense of responsibility to prevent harm as well as the over-estimation about the perceived threat brought about by the intrusive thoughts.
The OCD related intrusive thoughts are also known to be directly related to psychological distress. In this regard, the psychological distress typically manifests as intrusive thoughts such as nightmares, or flashbacks which generally are about the traumatic event experienced. According to Shafran (2001), many at times, the OCD symptoms are clearly anxiety or fear oriented, while in other times, the clinical picture includes depressive symptoms, anger, and aggression, or dissociation. Therefore, a combination of these symptoms may be present after the exposure to an aversive or distressing event (APA, 2013). Thus, the conceptual overlap between OCD and trauma-related distress can be found in the way the individual thinks about and reacts to the intrusive thoughts inherent in the two situations.
While numerous studies discuss the neurological causes of OCD, there is an in-depth literature which gives evidence reports that both OCD and OCRD have an inherited transmission. According to Pato et al., (2015), there are those families that have at least four successive generations with define OCD cases. Nonetheless, based on the fact that it is possible for family members to learn certain OCD related behaviors from other relatives, critics of the OCD inheritable transmissions argue that the presence of OCD across generations is not a sufficient reason to unequivocally prove inheritance. However, in a research centered on understanding the cause for fear of intrusive thoughts, suggests that research done on inheritance involving both identical and fraternal twins provides supportive evidence for an inherited component in OCD and OCRD (Wetterneck et al., 2011). Additionally Morein-Zamir, Papmeyer, Pertusa, Chamberlain, Fineberg, Sahakian and Robbins (2014) contend that the intrusive thoughts associated with OCD are also significantly attributed to Obsessive-Compulsive Personality Disorder (OCPD). In this regard, research gives substantial evidence that OCPD features certain personality traits such as rigidity, perfectionism, inability to delegate tasks, excessive devotion to work and also hoarding. Besides, studies by the American Psychiatric Association (APA) substantiate that an individual is more prone to greater OCD chronicity if they suffer both concomitant OCPD and OCD.
The past decade has seen a notable increase in research on hoarding both as an independent disorder and also as a symptom of OCD. The notable increase in research covers hoarding with regard to its phenomenology, treatment approaches, as well as its pathophysiology. However, according to Sinclair (2011), hoarding and especially compulsive hoarding is described as the genuine difficulty of an individual to discard items. Based on this context, hoarding is, therefore ranked as one among the common diagnostic criteria for obsessive-compulsive personality disorder. Pato, Steketee, Eisen, Yip and Phillips (2015) highlight that, like in OCD, there is a great relationship between hoarding and Obsessive-Compulsive Personality Disorder (OCPD), which is characterized by an excessive need for orderliness, perfectionism, control and doing everything the right way. Nevertheless, there are those scholars who contend that hoarding is hoarding is inappropriately classified as an OCPD criterion. This being the case, several clinicians and researchers tend to consider hoarding as a critical symptom or subtype of the Obsessive Compulsive Disorder (OCD). For instance, the 2013 report by the American Psychiatric Association, classifies hoarding obsessions and compulsions and also investigations that concern hoarding involves comparing patients suffering from OCD, with or without hoarding. Nonetheless, the premise that hoarding is a critical part of OCD is derived from the early findings by scholars who contend that approximately one-third of individuals with OCD have hoarding symptoms.
Conversely, more recent studies provide ample evidence that does not only conceptualize hoarding as a symptom of OCD. For instance, Pato et al., (2015) point out that hoarding should be considered as a disorder on its own since it correlates more weakly with other symptoms of OCD, as compared to how these other symptoms correlate with each other. Still, this study found that a comparison between patients who hoard and OCD patients evidenced different functional neuroimaging findings, clinical profiles and also, response to treatment. Moreover, another study on hoarding among OCD patients substantiate that patients with hoarding are more likely to have symmetry obsession, ordering, repeating compulsions, and counting. Besides, unlike OCD patients, individuals with hoarding are more likely to suffer more significant problems with indecision, completing tasks and are also overly prone to illness severity.
According to a 2013 report by the American Psychiatric Association, the diagnostic criteria for the Hoarding Disorder (HD) are characterized by persistent difficulty discarding or even parting with certain possessions, regardless of the value other people may attribute to the specific possessions. This being said, the HD symptoms lead to clinically substantial impairment or distress in either the patients social or occupational areas. According to Sinclair (2011), the hoarding disorder is to a great extent, associated with very high levels of severe disability. Besides, this disorder is often accompanied by reduced insights. Despite the fact that it typically onsets by early adulthood, the disorder is not diagnosed if the disorder is not diagnosed if its symptoms are significantly attributed to other conditions such as brain lesions, lack of energy in major depression, and obsession in OCD among many others.
In conclusion, it is evident that OCD and Hoarding Disorder (HD) patients exhibit excessive habits that are mainly associated with the hyperactivation of a critical region that is implicated in the pathophysiology of OCD, the caudate nucleus. According to modern day literature hording is not only conceptualized as a symptom of OCD. Instead, hording is deemed as a disorder by itself based on the fact that a neuro-ethological view of hoarding as a spectrum symptom is seen not only in OCD, but also in other disorders.
APA. (2013). What Is Hoarding Disorder? Retrieved from https://www.psychiatry.org/patients-families/hoarding-disorder/what-is-hoarding-disorder
Morein-Zamir, S., Papmeyer, M., Pertusa, A., Chamberlain, S. R., Fineberg, N. A., Sahakian, B. J., Robbins, T. W. (2014). The profile of executive function in OCD hoarders and hoarding disorder. Psychiatry Research, 215(3), 659-667. doi:10.1016/j.psychres.2013.12.026
Pato, M. T., Steketee, G., Eisen, J. L., Yip, A. G., & Phillips, K. A. (2015). Obsessive-Compulsive and Related Disorders: Obsessive-Compulsive Disorder and Hoarding Disorder. Psychiatry, 1(11), 1095-1128. doi:10.1002/9781118753378.ch57
Shafran, R. (2001). Obsessive-Compulsive Disorder in Children and Adolescents. Child Psychology and Psychiatry Review, 6(02). doi:10.1017/s1360641701002544
Sinclair, L. (2011). Hoarding Disorder Data Suggest It's Not OCD Subtype. Psychiatric News, 46(20), 18-24. doi:10.1176/pn.46.20.psychnews_46_20_18_2
Storch, E. A., & McKay, D. (2015). Obsessive-Compulsive Disorder and Its Spectrum: A Life-Span Approach. Washington: American Psychological Association.
Wetterneck, C. T., Little, T. E., Chasson, G. S., Smith, A. H., Hart, J. M., Stanley, M. A., & Bjorgvinsson, T. (2011). Obsessivecompulsive personality traits: How are they related to OCD severity? Journal of Anxiety Disorders, 25(8), 1024-1031. doi:10.1016/j.janxdis.2011.06.011
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