How Household Junk Can Grow Into Mountains
eople who compulsively hoard objects have singular patterns of brain activity that distinguish them from other patients with obsessive compulsive disorder, a new study finds.
Researchers say the study, based on brain scans of compulsive hoarders, provides the first solid evidence that hoarding defines a distinct subset of patients. The research might also open a door to new treatments for the illness, which is often unaffected by standard drugs.
"This adds to the evidence that O.C.D. is a heterogeneous disorder, not a single entity," said Dr. Sanjaya Saxena, director of the research program on the condition at the Neuropsychiatric Institute at the University of California, Los Angeles. "More specifically, it shows that compulsive hoarding may be a variant or subtype that requires its own type of treatment."
Scientists have long been puzzled by pathological hoarding, which afflicts up to 40 percent of the seven million to eight million Americans with obsessive compulsive disorder. As a group, studies show, excessive hoarders, who fill their houses with accumulations of junk, usually newspapers, bags of old clothing and lists, experience more anxiety, depression and social disability than obsessive compulsive patients with other symptoms. The hoarders are also less likely to seek help. Experts say eviction notices or social workers often bring to light compulsive hoarders' problems.
The new study, in The American Journal of Psychiatry today, compared 45 obsessive compulsive adults, including 12 hoarders, with 17 healthy participants. Compulsive hoarders, compared with people with other compulsive symptoms, had decreased activity in the anterior cingulate, a brain structure involved in decision making and problem solving.
The hoarders also showed less activation than the healthy subjects in the posterior cingulate, an area involved in spatial orientation, memory and emotion..
The findings, said Dr. Dennis L. Murphy of the National Institute of Mental Health, who was not involved with the study, are the first step toward defining "hoarding as not just a phenomenon, but as something that might have a different basis in brain activity."
Dr. Saxena said the study might explain why hoarders are so attached to their possessions. Deciding what to keep and what to discard is often a struggle. They are tormented by fears of throwing out items that may be needed one day. Often, the objects are kept in the open, stacked to the ceiling in the living room, the kitchen or even on the bed, Dr. Saxena said. That may result from the lower activity levels in brain regions that govern memory and spatial orientation.
"It may have to do with the difficulty they have in their visual spatial processing," he said. "And they may have some trouble remembering where things are and feel that they need to have them in sight."
Hoarders rarely respond to serotonin enhancers like Prozac, Luvox or other standard drugs used to treat obsessive compulsive disorder. The researchers said they were looking into the effectiveness of newer drugs, including one that can increase activity in the anterior cingulate