User:GabriellePasturel/Hoarding and Traumatic Life Events

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This page reviews the relationship between traumatic life events, attachment styles, and hoarding behavior.

Summary of Hoarding Disorder
[See main article Compulsive hoarding]

Hoarding disorder is characterized by the Diagnostic and Statistical Manual of Mental Disorders (DSM) 5th Edition as an inability to discard items, regardless of their value, to the point that the accumulations of items result in cluttering severe enough to render areas of the home unusable and unsafe. Hoarding disorder symptoms can cause personal or interpersonal stress, or interfere with occupational functioning. Hoarding disorder should not be diagnosed if the person's symptoms are better explained by a medical condition or another mental disorder. Hoarding disorder was originally classified as a symptom of obsessive-compulsive disorder in the 4th edition of the DSM but is currently identified as a separate disorder in the DSM-5 under obsessive-compulsive and related disorders.

According to one meta-analysis, the average age of onset of hoarding disorder is between the ages of 16 and 17 years old. According to the DSM-5, hoarding disorder has a 2% to 6% prevalence rate in the United States and Europe. However, a more recent literature review of eleven studies found that the prevalence rate is approximately 2.5%. Individuals with hoarding disorder are more likely to be males and older adults. Individuals diagnosed with hoarding disorder are more likely to have a family member with the disorder, as the genetic loading of this disorder is approximately 50%.

Hoarding Disorder and Traumatic Life Events
According to the Centers for Disease Control and Prevention, traumatic events are defined as event a person experiences which causes stress and may result in feelings of horror or helplessness. Individuals with hoarding disorder are more likely to have experienced a traumatic life event. Trauma has been conceptualized as a source of vulnerability to the development of hoarding disorder. Traumatic life events reported by individuals with hoarding behavior include physical violence, sexual assault,  loss, interpersonal stress,  and loss or damage to belongings.

The development and symptoms involved in hoarding disorder have been considered to have an attachment theory component. Attachment theory, developed by John Bowlby and expanded by Mary Ainsworth, is a psychological concept used to describe how children bond and relate to their main caregiver, and how that bond impacts the child's relationship with others over time. Individuals with hoarding disorder frequently have interpersonal issues, including low marriage rates, lack of social support, and are more likely to live alone. Individuals with hoarding disorder who experienced a traumatic life event related to personal loss indicate that the personal loss either occurred prior to the onset of symptoms or worsened existing symptoms. Although it has been proposed that the behavior of hoarding items is a mechanism which provides a sense of comfort to those who have insecure attachment styles, the literature reviews are comprised of mixed results and more data is needed.

Despite individuals with hoarding disorder frequently reporting having experienced a traumatic life event, there is a low comorbidity rate between post-traumatic stress disorder (PTSD) and hoarding disorder. Sex differences of trauma and hoarding disorder diagnosis are limited with mixed results, however, compared to males, females diagnosed with hoarding disorder are more likely to have a comorbid PTSD diagnosis. Given the strong relationship between traumatic life events and hoarding disorder, it has been proposed that hoarding behavior acts as a protective mechanism against the development of PTSD. The items obtained by individuals who may view the world as unsafe or dangerous are thought to create a sense of security. Thus, the pleasure a person feels during the acquisition of items is thought to maintain the disorder through positive reinforcement. However, more research is required to determine how acquisition behavior interacts with the prevention or comorbid development of PTSD in individuals with hoarding disorder.

Psychotherapy Treatment
Although the American Psychological Association's Division 12 website does not include hoarding disorder in their list of diagnoses, there are some effective treatment options available to individuals with hoarding disorder. One meta-analysis found that cognitive behavioral therapy is an effective treatment for hoarding disorder. Cognitive behavioral therapy treatments for individuals with hoarding disorder can include individual and group therapy settings. Individuals with hoarding disorder can discuss their traumatic life events with a licensed clinical psychologist to determine how their traumatic life experiences impact their hoarding behavior.

The Treatments that Work book series has a two-book treatment manual for hoarding disorder which consists of a therapist guide and patient workbook. These manuals have a cognitive behavioral orientation. The therapist's manual consists of chapters dedicated to assessing hoarding severity, decreasing acquisition behavior, skills training, and working with patients to prepare them for life after treatment has ended. The aim of the cognitive behavioral treatment is to have patients maintain their non-hoarding behavior after treatment has ended and to prevent relapse.

Psychopharmacological Treatment
According to the therapist's guide to hoarding disorder in the Treatments that Work book series, selective serotonin reuptake inhibitors do not have adequate support for being an effective treatment for hoarding disorder. However, a more recent review of hoarding disorder treatments found evidence to support using the SSRI Paroxetine and the SSNRI Venlafaxine to treat hoarding disorder symptoms.