1. By Dr.Shewikar El Bakry

2.  Hoarding is defined as the acquisition of, and
inability to discard, worthless items even
though they appear (to others) to have no
value.
 Hoarding and saving behavior has been
observed in several neuropsychiatric disorders,
including schizophrenia, dementia, eating
disorders, autism, and mental retardation , as
well as in nonclinical populations , but it is
most commonly found in patients with OCD.

3.  1- The hoarders show a unique pattern of Brain
activity.
 2- Don't respond well - if at all - to standard
anti-obsessional treatments.(drugs and CBT).
 3- Hoarders do not come forward for
treatment.
 4- Hoarders tend to believe they are acting
rationally and have less insight to the problem.
 5- hoarders had more severe family and social
disability, anxiety, depression, and personality
disorder symptoms

4. Large-scale factor and cluster analytic studies
of OCD have identified four principal symptom
factors:
1) aggressive, sexual, and religious obsessions
with checking compulsions;
2) symmetry obsessions with ordering,
arranging, and repeating compulsions;
3) contamination obsessions with washing and
cleaning compulsions;
4) hoarding, saving, and collecting symptoms.

5. 1-Frost and colleagues have argued
persuasively that hoarding and
saving symptoms are part of a
discrete clinical syndrome that also
includes
indecisiveness, perfectionism, procr
astination, difficulty organizing
tasks, and avoidance

6.  2-Compulsive hoarding is most
commonly driven by obsessional
fears of losing important items that
the patient believes will be needed
later, distorted beliefs about the
importance of possessions, and
excessive emotional attachments to
possessions

7.  3-Hoarders usually fear making
"wrong decisions" about what to
discard and what to keep, so they
acquire and save items to prepare
for every imaginable contingency.
 4-The most commonly saved items
include newspapers, magazines, old
clothing, bags, books, mail, notes,
and lists.

8.  5-Living spaces become
sufficiently cluttered to preclude
the activities for which they
were designed, causing
significant impairment in social
and/or occupational functioning
associated with poor response
to medications and cognitive
behavior therapy.

9.  6- Reluctance or inability to return
borrowed items. As boundaries blur,
impulsive acquisitiveness could
sometimes lead to kleptomania or
stealing.
 7- A survey of elderly hoarders
found that hoarding constituted a
physical health threat to 81% of
identified patients, including the
threat of fire hazard, falling,
unsanitary conditions, and an
inability to prepare food.

10. Book hoarding
Bibliomania is an obsessive-compulsive disorder
involving the collecting or hoarding of books
to the point where social relations or health are
damaged.
Animal hoarding
Animal hoarding involves keeping higher than
usual numbers of animals as pets without
having the ability to properly house or care for
them, while at the same time denying this
inability.

11.  higher rates of hoarding and tics in the first-
degree relatives .
 Compulsive hoarding also has a different pattern
of genetic inheritance than other OCD symptom
factors. The hoarding/saving symptom factor has
a recessive inheritance pattern, whereas the
aggressive/checking and symmetry/order
symptom factors show a dominant pattern .
 A genome-wide scan conducted in sibling pairs
with Gilles de la Tourette’s syndrome found that
the hoarding phenotype was significantly
associated with genetic markers on chromosomes
4q34-35, 5q35.2-35.3, and 17q25

12. In relation to
comparison subjects,
compulsive hoarders
had significantly lower
cerebral glucose
metabolism in the right
posterior cingulate
gyrus

13. In relation to
comparison
subjects,
compulsive
hoarders had
significantly
higher
metabolism in
the left
dorsolateral
prefrontal cortex

14. In relation to
comparison
subjects, nonh
oarding OCD
patients had
significantly
higher glucose
metabolism in
the left
thalamus

15. In relation to
nonhoarding OCD
patients,
compulsive
hoarders had
significantly
lower regional
cerebral glucose
metabolism in
the dorsal
anterior cingulate
gyrus

16. Medications for Compulsive Hoarding
The compulsive-hoarding syndrome has often
proven refractory to these standard
medications for OCD.
Cognitive-Behavioral Therapy (CBT) for
Compulsive Hoarding
CBT for compulsive hoarding is directed towards
decreasing clutter, improving decision-
making skills, and improving organizational/
sorting techniques.

23. Behind Closed Doors: The Horrors of Animal
Hoarding
By
Rebe
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