Byline: Thomas Maier, M.D.
Houses full of garbage; apartments cramped up to the ceiling with rubbish; uninhabitable dwellings with people living amidst waste and obviously not feeling too disturbed by their neglected surroundings; patients with brain damage compulsively collecting useless items; children grasping for everything passing their reach; unobtrusive housewives procrastinating to tidy up their houses.
Such are the conditions referred to as hoarding or hoarding behavior in current literature (Maier, 2004). There is no consistent definition of hoarding, and the term is used in different clinical and nonclinical contexts to describe a broad spectrum of behavioral abnormities. The notion describes a phenomenon characterized by the excessive collection and failure to discard poorly useable objects (Frost and Hartl, 1996). Originally, the term was used to describe food collecting behavior in animals, especially in rodents. Bolman and Katz (1966) introduced the notion to human psychology when mentioning a psychopathological phenomenon in an anecdotic case report. In the following years, more and more investigators described different types of excessive collecting behavior in humans. The mental disorders reported in association with hoarding cover almost the whole range of psychiatric syndromes.
Hoarding is either a very unspecific symptom or a collective name for various similar, but distinct symptoms. In geriatric literature, hoarding is often reported in association with self-neglecting behavior; it is considered to be the main symptom of Diogenes syndrome. In recent years, the condition has been described chiefly as a symptom of obsessive-compulsive disorder. Indeed, many investigators consider hoarding to be a compulsion, while others emphasize more the similarities with impulse-control disorders or with tic disorders.
It was in 1975 when Clark and colleagues presented 30 cases of elderly patients with extreme neglect of their homes as well as of their own personal appearance and health. A behavioral abnormity they found in some, but not all, of these individuals was described as "hoarding of rubbish." Clark et al. (1975) diagnosed different somatic and/or psychiatric disorders in these patients, however, half of them showed no symptoms of mental disorders.
The notion of Diogenes syndrome was proposed (after the Greek philosopher who lived in a barrel); defined as a combination of self-neglect, neglect of the surrounding dwelling space, collecting of large quantities of useless items, social retreat, lack of insight, and refusal of treatment and help. Since Clark and colleagues' (1975) first description, many investigators have reported similar cases of neglecting and hoarding behavior in elderly people. A perfect and memorable picture of a hoarding person has been given more than a hundred years before by the Russian author Nikolai Gogol in his novel Dead Souls (first published in 1842). His character named Plyushkin has become proverbial in Russian language to denominate a hoarding person.
Hoarding in Elderly Patients
Hwang et al. (1998) evaluated 133 elderly patients with dementia who were admitted to a psychiatric hospital. Hoarding behavior was found in 22.6% of the patients. Hoarding occurred in various types of dementia and was associated with other repetitive and unintentional behaviors such...