Hoarding Disorder: A Co-Occurring Disorder

One of the major reasons that hoarding disorder is one of the most complicated mental health issues to treat is that is a co-occurring disorder, which means that it is almost always (92% of the time, in fact) shows up alongside another mental health diagnosis- like major depressive disorder or generalized anxiety disorder. The idea of co-occurring disorders helps guide the way we think about the behavior of people who are affected by them. We understand that the symptoms of one psychiatric disorder are highly intertwined with symptoms of the other.

The term co-occurring disorder (or dual or comorbid disorder) is typically used in the field of substance abuse treatment, referring to the idea that people who abuse substances like alcohol or drugs are likely to be struggling with another diagnosable mental health condition as well. For instance, if someone is struggling with alcoholism that is co-occurring with generalized anxiety disorder, we may explain that some of the behavior of abusing alcohol may be exacerbated, or made worse, when life gets particularly stressful and anxiety increases. From there, the outcomes of excessive alcohol use can create additional stress in a person’s life, which can further increase anxiety, thus increasing alcohol use. It’s a slippery slope.

Things are similar with hoarding disorder. By applying an understanding of co-occurring disorders, we can start to make sense about why efforts to address the symptoms of hoarding (like difficulty parting with items or excessively acquiring things) seem so difficult for the person struggling with them. For instance, if a person has co-morbid diagnoses of hoarding disorder and major depressive disorder, that person may really struggle with motivation to work on discarding items or struggle with paying attention and decision-making about their possessions. While symptoms of hoarding disorder do include having a difficult time parting with items, they do not include a lack of motivation, inattentiveness, or indecision. However, all three of those are symptoms of depression. In this case, the person’s depressive symptoms are making the symptoms of hoarding disorder even more challenging to manage.

There are a lot of diagnoses that can co-occur with hoarding disorder- in fact, almost any of them can. The most common ones are mood disorders (like depressive or bi-polar disorders) or anxiety disorders. Obsessive compulsive disorder (OCD) is a common co-morbid condition, as is attention deficit hyperactivity disorder (ADHD). We also see a fair amount of other types of diagnoses alongside hoarding disorder, including post-traumatic stress disorder (PTSD) or other types of organic brain illnesses, like dementia or schizophrenia. When symptoms of any of these other types of mental health diagnoses show up, it can make managing symptoms associated with hoarding to be a very difficult task.

As mental health professionals, we can use strategies developed for other co-occurring disorders in our effort to support our clients. By prioritizing treatment interventions that help reduce the most significant symptoms first, we can then work more easily on addressing the direct symptoms related to hoarding. For instance, if a client has a diagnosis of an anxiety disorder and is actively experiencing panic attacks, it would benefit the clinician to first work with the client on improving emotional regulation skills and distress tolerance prior to focusing attention on decision-making and discarding items.

By recognizing hoarding disorder as a co-occurring condition, we can help better understand the challenges people who hoard face and work with them to develop more effective approaches to treatment.

-Jennifer Sampson, Ph.D., LMFT, is the President of the Board of Directors at The Hoarding Project

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