Hoarding is not currently a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, but it is proposed for the next edition, DSM-5, which is scheduled for publication in May 2013.
I believe that hoarding is a symptom, not a distinct disorder, and that calling it a disorder of its own will lead to overlooking the actual disorder of which it is a symptom. It would be like saying that itching is a disorder. In most cases, itching is a symptom of something (perhaps something serious), not just an entity unto itself. You don’t want the doctor to tell you you have Itching Disorder when in fact you have skin cancer. I’m concerned that creating a diagnosis of Hoarding Disorder will encourage treating the symptom without searching thoroughly for the underlying cause.
I submitted the following through the feedback process at www.dsm5.org:
I am a mental health counselor, previously a professional organizer, and have worked with hoarding clients since 1997. In fact, the phenomenon of hoarding was among the reasons I sought my counseling credentials.
In my experience, hoarding clients have a disproportionately high rate of clinically significant unresolved trauma, and often, through insight-oriented therapy, they discover that their hoarding has been reactive to one or more specific traumas. When they identify hoarding as a maladaptive coping mechanism, many are then able to methodically disassemble the hoard over the course of treatment. I believe trauma should be included in the diagnostic considerations for the proposed Hoarding Disorder, and I feel strongly that the diagnostic criteria should include that symptoms are not better accounted for by Post-traumatic Stress Disorder.
Further, I believe there should be a timeframe similar to the distinction between Adjustment Disorder and PTSD, e.g. symptoms must persist for at least one year before a dx of Hoarding Disorder is made. This would allow for the natural, temporary pseudo-hoarding seen during uncomplicated bereavement or Adjustment Disorder.
I have further thoughts about this proposed diagnosis and would welcome the opportunity to discuss them.
Here’s hoping they call….
