Hoarding Disorder - Research Paper Example

Hoarding Disorder Hoarding Disorder A female client from a Western country enters my office with an apparent hoarding disorder. Theclient is a single 27-years old woman and comes from an affluent family. The woman has excessive acquisition, where she displays difficulty of discarding possessions accompanied by an excessive acquisition of objects that are not necessary. The customer has good insight beliefs. She tells me during our talk that she is completely convinced that hoarding-related beliefs and conducts that involve difficulty in discarding items are problematic. The client says she has trouble with discarding items even when such items do not have any value. She says that her living areas are congested and accumulated with possessions that negatively compromise with the intended use of the living areas. The client confesses to me that she has impaired interpersonal skills and her social and occupational functioning is not right. She clinically distressed. According to my client, she always feels responsible for the fate of her possessions and thinks parting with such possessions is being wasteful. The client fears that vital data could be lost if she throws away some of the possessions that congest her living areas. Some of the items that congest her living areas include books, clothing, paper-bags, mail, magazines and newspapers. She experiences distress when she is required to discard these items. Such piling of clutter in all living spaces makes it hard for her to comfortably utilize the available scarce space in her living areas. There are other features of the client that support the diagnosis of the hoarding disorder in her. According to what she tells me, she experiences traits like indecisiveness, perfectionism, avoidance, persistent procrastination, difficulty in planning and organizing her work. The client has a general anxiety disorder and social phobia. She also experiences post-traumatic stress disorder. She stays in unsanitary living conditions due to the cluttered living spaces resulting from the difficulty of planning and organization of the items piled in those living spaces. The client also reports to me that a family member, her paternal aunt, also has a hoarding disorder. The hoarding disorder of the client could be because of genetic inheritance. Assessment Assessment of the hoarding disorder includes: Looking at the level of the clutter in the client’s living rooms Evaluation of beliefs of the client about possessions Evaluation of data processing, decision-making and organization difficulties of the client Avoidance conduct evaluation - compulsive hoarders may avoid recurrent duties such as checking mail, replying to calls, cleaning dishes or social obligations like paying bills Evaluation of daily functioning like sleep-wake cycles and daily routines. Investigation of regular and daily intake of medications and readiness to comply with regular therapy Assessment of job place and social functioning and engagements Investigation of other mental ailments such as depression, anxiety and social phobia The scale I used to assess hoarding disorder in the client is called the Hoarding Rating Scale (HRS). It is a five-item interview that can be administered to a potential victim in the form of a questionnaire. The questions are about clutter, difficulty discarding, excessive acquisition, impairment and distress resulting from the hoarding disorder. The assessment gave a score of 16, indicating presence of a possible hoarding disorder. Compulsive hoarding is currently considered to be kept by a pattern of maladaptive beliefs, avoidant conduct patterns and cognitive impairments. The impairments can be connected to abnormalities in particular brain regions associated with executive functioning, impulse control, and processing of reward value, from a neuropsychological and a neuro imaging point of views. Neuropsychological assessments show that individuals who often hoard report challenges of sustaining attention. Neuropsychological experiments indicate that hoarding has a connection with reduced nonverbal attention, greater variability in reaction time, greater impulsivity and minimal ability to detect intended stimuli. Several individuals with hoarding challenges also cite poor memory. They report that they reserve certain possessions because fears that they might forget relevant data or lose a vital memory if they discard an item. They confess that they prefer to leave objects out in the open, like piling vital papers on the table, instead of placing them in a filing cabinet. The reason for this difficulty to discard the items is the fear of forgetting where they placed the item. Neuropsychological assessments of memory functioning have showed that hoarding disorder victims show impaired and quite slow recall (both verbal and visual). They utilize inefficient visual recall strategies compared to non-hoarding participants in the tests (Steketee G. and Frost RO. 2007). Despite the clear memory deficits, people with hoarding problems often report overtaxing their existing memory capacity. It is because they depend on a memory-based method of finding items, rather than a category-based way. People with compulsive hoarding try to organize and find items based on visual-spatial recall (recalling the place where an object was last seen), instead of organizational recall (remembering where a certain category of item is usually positioned). The difficulty of discarding items is also thought to result partially from challenges of executive function (higher-level cognitive functions such as decision-making and organization). Self-confessed indecisiveness has been associated with hoarding in college and society studies. Compared to participants with OCD, hoarding participants depict greater indecisiveness on a self-report evaluation. Research clinicians rate them as more indecisive. A research utilizing the Iowa Gambling Task, which demanded participants to sacrifice immediate rewards in order to optimize long-term gain, indicated that OCD victims with hoarding symptoms performed more poorly than do OCD victims who lack hoarding symptoms (Grisham JR. et al. 2007). This result was not repeated in a separate investigation of basic hoarding victims. The ability to organize items, an essential skill in maintaining an institution, also looked to be compromised in hoarding individuals. When required to organize their personal items, hoarding people took longer and made more categories (with a smaller number of objects per arrangement), than did non-hoarding individuals on the other side. Neuroimaging investigations show that several impairments observed among hoarding people are commonly linked to frontal cortical parts, specifically the prefrontal cortex and anterior cingulated cortex (ACC). In conclusion, evidence from neuropsychological studies and neuroimaging research propose that compulsive hoarding entails abnormal activity in regions of the frontal lobe. The regions include an orbito-frontal cortex, ventro-medial prefrontal cortex, and anterior cingulate cortex (Lawrence NS. et al. 2006). Such abnormalities probably underlie the challenges of neuropsychological functioning that several researchers have observed. They include challenges with sustained attention, difficulties with memory, and problems with executive function. There is a direct link between such disruptions of brain activity and the challenges that my hoarding client encounters during daily decision-making process. The consequence for my client is that organization, deciding, and discarding becomes a very overwhelming and unpleasant experience that she chooses to avoid it altogether.  References Grisham JR, Brown TA, Savage CR, Steketee G, Barlow DH. (2007). Neuropsychological impairment associated with compulsive hoarding. Behav Res Ther. 45:1471-1483. Lawrence NS, Wooderson S, Mataix-Cols D, David R, Speckens A, Phillips ML. (2006) Decision-making and set shifting impairments are associated with distinct symptom dimensions in obsessive-compulsive disorder. Neuropsychology. 20(4):409-419. Steketee G, Frost RO. (2007) Compulsive hoarding and acquiring: Therapist guide. New York: Oxford University Press. Read More