Piles of old newspapers, piles of clothes piled to the ceiling, and bottles scattered around. This is what the homes of those who face pathological hoarding look like. About 2.5% of the population meets the criteria for hoarding disorder according to the current definition, with similar rates in men and women and in developed countries
Find out where syllogomania comes from, what are its characteristics? How can it be treated?
Syllogomania – what is pathological hoarding?
Pathological hoarding is characterized by excessive accumulation of objects perceived by others as worthless or useless. The hoarding disorder is characterized by difficulty in getting rid of or parting with items, regardless of their actual value, and, in most cases, persistent acquisition of items. Items are accumulated in large quantities that fill and clutter active living space
The patient does not throw them away, and when someone else wants to do it, he reacts with severe stress and anxiety. The onset of the disorder can appear as early as the teenage years. It usually intensifies with age, taking an increasingly severe toll on daily functioning. People with hoarding disorder can be overwhelmed by a huge amount of stuff they can’t get rid of. In the worst cases, cluttered piles of stuff can limit functional living space, provoking anger in the rest of the population.
Pathological hoarding – symptoms of syllogomania
The hoarding disorder is characterized by three main features. The most obvious is the difficulty in getting rid of material possessions, the second is excessive or compulsive acquisition of new items. Not everyone with hoarding disorder has an acquisition component, although it can occur in most patients. The third primary feature is disorganization and the inability to prevent clutter.
Symptoms of pathological hoarding include:
- excessive acquisition of items of low utility and usefulness,
- the appearance of severe stress in the face of losing items,
- difficulties with decision-making, organization and planning,
- a belief in the high value of collected items and a feeling of the need to keep them,
- accumulating so many items that it becomes impossible to keep the living space clean,
- resisting throwing any items away (even when they are damaged, cannot be repaired or find any practical use for them).
The severity of symptoms can vary depending on the anxiety experienced, the current mental state and intellectual performance. Their intensity increases in stressful situations, such as illness, death of a loved one or retirement.
The phenomenon of pathological hoarding is also often combined with neglect of family relations. The patient does not notice his problem and gets angry when loved ones worry about his behavior. He feels misunderstood, so he moves further and further away from them. He may also fear that family members will start taking and throwing away his belongings, which further increases his distrust.
Collecting vs. hoarding – what are the differences?
A collector, unlike collectors who keep their collections neat and organized, creates clutter by having piles of papers and boxes of broken tools in the kitchen.
A collector looks for items that have a specific value. They usually belong to a specific category (for example, vinyl records, stamps, antique furniture, hard-to-find perfume or comic books from the communist era). He is able to store them properly so that they do not have a detrimental effect on his daily life.
In the case of pathological hoarding, it’s different – the patient accumulates unnecessary things and stores them in large quantities in the places where he or she lives on a daily basis. Over time, this makes it impossible to freely use living spaces, such as the kitchen or bedroom, for example, collecting clothes.
What does a hoarding patient accumulate?
Among the most commonly collected items are old newspapers, magazines, clothes, flyers, letters, free samples, documents, scrap metal, items thrown away by other people. In practice, however, any object can become an object of obsessive collecting.
The patient may collect:
- articles in such large quantities that he is unable to use them later (e.g., he brings dozens of newspapers every day that he won’t read, or stores hundreds of cosmetics that he won’t manage to use),
- things that are useful, but things that he doesn’t intend to use (he hides them “for later”, but never finds a good time to use them – instead, he constantly adds more),
- empty bottles, cans, scrap metal, waste paper (collecting them in the belief that one supports ecology, but instead of handing them over for disposal, the patient keeps them in his home),
- items that “could be useful” to someone else (e.g., daughter, granddaughter).
Collecting syndrome – an inherited disease?
Many people wonder whether hoarding is hereditary. However, the syndrome itself is not passed from generation to generation. It most often appears in the course of other psychiatric disorders, and finding a clear cause of its occurrence is very difficult. It happens that syllogomania is often present in other family members, but this is mainly related to genetically transmitted tendencies to certain disorders, as well as a predisposition to experience severe anxiety.
It is also worth remembering that if a child from an early age observes a parent who compulsively collects objects, he may imitate him. He unconsciously learns that collecting is something natural and desirable. Over time, he also notices that it is a way to cope with tension, which promotes the maintenance of this behavior. So while there is no gene responsible for collecting, the role of the environment is not worth overlooking.
Causes of syllogomania
Hoarding can be a consequence of:
- co-occurrence of other disorders,
- deficits in information processing,
- deficits in executive function and attention,
- misconceptions about object possession,
- problems in building healthy emotional attachment.
Some studies suggest that people who experienced childhood trauma, were neglected by caregivers and grew up in an unfavorable environment are particularly vulnerable to the onset of hoarding. In adulthood, they develop syllogomania as a result of severe stress, usually after experiencing a difficult event (death of a loved one, loss of stable employment, divorce, fire, flood, impairment due to an accident).
Hoarding sometimes also results from growing up in extreme poverty. The patient has a growing tendency to collect objects, because they give them control over their surroundings and become a symbol of security. In addition, they don’t want to part with things because they believe they may become valuable or useful in the future.
What disorders can accompany hoarding?
Symptoms of hoarding not infrequently appear in the course of other disorders. The most common of these include:
- generalized anxiety syndrome,
- anxiety disorder
- autism spectrum disorder (ASD),
- obsessive-compulsive disorder (OCD),
- depression,
- attention deficit hyperactivity disorder (ADHD),
- hypochondriacal disorder,
- psychotic disorder.
the (un)safe world of unnecessary objects. The effects of syllogomania
Syllogomania is associated with uncontrolled hoarding. The compulsion to collect and acquire various objects leads to an excess of them, which significantly limits living space. For a person with the condition, it seems ridiculous to clean up the apartment – after all, this would involve throwing things away.
Thus, over time, a peculiar space is created, overflowing with objects perceived by the patient as valuable. Piles of outdated documents have sentimental value for him, piles of clothes seem useful, and mountains of books seem priceless. Being among them gives a sense of security, while the vision of losing them fills him with anxiety.
However, this safe and good world among hundreds of unnecessary objects is only apparent. The accumulation of such a huge amount of things in one’s space can pose danger and chronic difficulties. Sick people and those living with them cannot maintain proper hygiene in the apartment. On the other hand, in case of emergencies (such as loss of consciousness, heart attack or fire), services have serious difficulties in reaching the injured. They lose time to pave the way and in emergencies, after all, every second is precious and determines health and life.
Pathological hoarding vs. OCD – differences
Pathological hoarding was classified as a separate diagnostic entity in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association-5th ed. (DSM-5). Hoarding is no longer considered a symptom of obsessive-compulsive disorder or obsessive-compulsive personality disorder, and the current classification includes it as a compulsive spectrum disorder.
However, hoarding disorder is sometimes confused with symptoms of obsessive-compulsive disorder (OCD). So it is worth looking at the differences between syllogomania and compulsive hoarding.
Pathological hoarding:
- lack of insight (no or very little awareness of one’s problem),
- negligible interest in obtaining treatment,
- feeling satisfaction after collecting new items,
- collected items are usually items thrown away by other people, waste paper, free samples given away in stores,
- the disorder generally increases with age.
OCD:
- awareness of one’s own disorder,
- greater willingness to seek help,
- feelings of embarrassment and restraint after collecting new items,
- the objects collected are often very unusual – they are, for example, fingernails, hair, used diapers,
- symptoms generally reduce gradually with the duration of the disease.
For a person with OCD, collecting is a compulsive activity, perceived as embarrassing and unpleasant. However, the patient cannot resist the compulsion to collect, as it brings relief and temporarily reduces anxiety.
Pathological collecting is therefore not synonymous with obsessive-compulsive disorder. It is possible to suffer from pathological hoarding and not have any symptoms indicative of obsessive-compulsive disorder. However, about 20% of patients with hoarding also have symptoms of obsessions and compulsions (obsessive nature directed at one ‘s own health, need for symmetry, religious obsessions, rituals of counting, repeating, checking) – then we have a dual diagnosis. However, if collecting is only a compulsive behavior, the diagnosis of syllogomania is not made, but of obsessive-compulsive disorder.
What is Diogenes syndrome?
Diogenes syndrome is a disorder that is associated with compulsive hoarding of objects and food and storing them in one’s environment. In doing so, patients neglect hygiene to the extreme and are unconcerned about their health. They live modestly, in filth and disorder, amid waste and decaying food. However, they feel no shame about their situation and feel no concern about their steadily deteriorating quality of life.
Diogenes syndrome occurs in the elderly and those living alone. It is often a response to experienced traumas and high accumulation of stress. Unlike hoarding, the patient is not emotionally attached to the stored items. He or she also has no sentimentality toward them.
The main symptoms of Diogenes syndrome include:
- collecting objects and food and storing them in one’s environment,
- living in clutter, amidst junk that significantly limits space,
- difficulty getting rid of unnecessary items,
- neglecting health and hygiene,
- hostile attitudes toward other people,
- living in isolation,
- aggressive behavior,
- spurning help.
Family and loved ones. How to help a person suffering from pathological hoarding?
- do not belittle the problem and react to it at an early stage,
- develop your knowledge of syllogomania to better understand the patient and his behavior,
- talk to the patient gently, do not criticize, ridicule or attack him,
- carefully watch the patient’s behavior and notice even small changes,
- raise awareness of the growing psychological problem, using simple words to do so,
- seek professional support and actively participate in it,
- understand that treatment requires a lot of strength from the patient,
- be beside the patient and show support regularly.
Living with a person suffering from hoarding requires large amounts of patience and understanding. The key is to start treatment and support your loved one in the process. The effects won’t be visible right away – but that doesn’t mean that therapy doesn’t work. Improvement appears gradually, thanks to regularity and commitment. The attitude of loved ones also plays a huge role here.
At the same time, you can’t forget about yourself either. Devoting all of one’s time to help, constantly thinking about a loved one’s disorder and worrying about his or her condition can make us feel much worse. Meanwhile, in order to be a support, you need to take care of yourself first. Those closest to sufferers of hoarding should take special care to meet their needs, look for ways to relax and express their emotions. If you are a loved one of someone who suffers from pathological hoarding, you may want to consider seeking the support of a psychologist. This will help you maintain mental balance and cope with daily challenges
Pathological hoarding – treatment and motivation
One of the reasons this problem is so difficult to treat is that people take pleasure in their acquisitions and personal belongings. People with mental disorders, such as depression or anxiety, often feel very depressed, which can motivate them to seek treatment. People suffering from syllogomania most often do not see their problem. They don’t look around for help options because they don’t think their behavior needs treatment.
Although hoarding is complex and difficult to treat, over the past few years psychologists have made progress in better understanding the cognitive and neural underpinnings of the disorder and what types of therapy can help.
People with hoarding can be effectively treated, although it is essential to arouse their commitment and desire to make a change. The main form of help is cognitive-behavioral therapy. Sometimes it is also necessary to implement pharmacological treatment, though mainly due to accompanying disorders such as depression.
Cognitive-behavioral therapy for pathological hoarding
Results show improvement in hoarding symptoms with cognitive-behavioral therapy, both for OCD and therapies aimed at specifically treating hoarding.
Cognitive-behavioral psychotherapy (CBT) focuses on changing habits and internal beliefs associated with collecting and storing unnecessary items. It also places a strong emphasis on psychoeducation, or learning about one’s disorder and gaining knowledge about the mechanisms that sustain the problem.
Psychotherapy for hoarding includes:
- Assessment of symptoms of hoarding and other problems.
- Formulation of a personal model to understand, the causes of the problem.
- Motivational interviewing to reduce ambivalence and low insight.
- Changing belief systems about acquiring new items.
- Transforming faulty thinking regarding the necessity and value of collected items, e.g., beliefs about possessions, including beliefs about future usefulness, concerns about waste.
- Training in categorizing, organizing and problem-solving skills.
- Developing skills, practicing sorting, decision-making and discarding.
Initially, the therapist may encourage patients to avoid situations that are difficult to resist because of a strong need to acquire. Gradually, however, she helps expose them to increasingly difficult acquisition stimuli. For example, they may first drive past a favorite store without going inside, then enter the store but not touch anything, and then pick up and look at items but not buy them.
Picking is associated with a wide range of information processing problems that lead to certain skill deficits. These include difficulty focusing on tasks, problems organizing items into logical categories, and limited ability to plan ahead to achieve goals. In therapy, a person with syllogomania is encouraged to categorize items. Some categories of things (especially sentimental ones) can be particularly difficult and can be addressed later in the exposure process. Exposure provides an opportunity to learn to tolerate negative emotions, as well as to challenge one’s beliefs about disposal.
Pathological hoarding is a mental disorder characterized by: compulsive accumulation of objects, difficulty getting rid of things, and littering of living space to the point of impeding normal functioning. Early diagnosis and comprehensive treatment can significantly improve the patient’s functioning and relationship with the environment.
Source:
Krzyszkowiak, W., Kuleta-Krzyszkowiak, M., Krzanowska, E. (2019). Treatment of obsessive-compulsive disorder (OCD) and related disorders (OCRD), Psychiatria Polska, 53(4), pp. 825-843.
Księżopolska, A., Kotapka-Minc, S. (2005). Pathological hoarding, Proceedings of Psychiatry and Neurology, 14 (suppl. 1/20), pp. 107-110.
Senger, M., Doruch, P., Rogacka, K., Kędziora-Kornatowska, K. (2022). Symptoms of pathological hoarding in selected mental disorders. A review of therapeutic options. Journal of Education, Health and Sport, 12(6), pp. 51-60.