Hoarding: A Symptom, Not a Syndrome

Background: Hoarding behavior in humans spans acontinuum from normal collecting to pathological self-neglect andcan be associated with a variety of psychiatric disorders.

Method: The authors summarize research in thepast 15 years characterizing hoarding behavior in groups ofcollege students, in nonclinical populations of self-named”pack rats,” in outpatients treated forobsessive-compulsive disorder (OCD), and in individualpathological hoarders presented in psychiatric case reports. Twonew case reports of pathological hoarding are presented here.

Results: The literature suggests, as do the 2case reports presented, that certain factors may be common to allgroups of hoarders, as they all show poor insight, lack ofresistance to the compulsion to hoard, and poor treatmentmotivation.

Conclusion: Possible biological and psychosocialdeterminants of pathological hoarding include association withschizophrenia, OCD, and tic disorders, as well as a possible linkthrough the neurotransmitter dopamine. Management issues rangefrom psychopharmacologic treatment with antipsychotic medicationto behavioral therapy and environmental manipulation.