History
Patients with hoarding typically lack awareness (insight) in relation to their hoarding and are usually urged to seek help by concerned or frustrated relatives. As hoarding can co-occur with major depression and anxiety disorders, screening for hoarding can help detect a problem. [11]
Physical Examination
Patients may have cellulitis or skin infections due to living in squalid conditions. They may also have fractures due to falls due to accumulated objects acting as trip hazards.
Types of Hoarding
Object hoarding
Hoarding is distinct from collecting, which is considered a normal behavior. [12] The average collector typically does not show patterns of excessive acquisition or lack of insight into their condition.
The most commonly saved items among object hoarders are newspapers, magazines, old clothing, bags, books, mail, and paperwork. However, the nature of items is not limited to possessions that most people consider useless or of limited value. Many hoarders collect and save valuable items as well.
Object hoarding is distinct from animal hoarding with the most prominent difference being the extent of unsanitary conditions and the poorer insight into animal hoarding.
Animal hoarding
Persons who hoard animals keep an unusually high number of pets in their homes without having the resources or ability to properly care for them. However, these persons have trouble comprehending that they are not adequately providing for the animals and are placing them in harm's way; they believe they are providing good care for the animals. Most individuals who hoard animals also hoard inanimate objects.
An animal hoarder is distinct from a breeder although some hoarders are former breeders who have stopped selling and therefore have accumulated a large number of animals that they cannot care for.
Animal hoarders in the United States can be legally persecuted under state animal cruelty laws. Illinois and Hawaii are the only 2 states at this time to have animal-specific hoarding laws. The Illinois Humane Care for Animals Act was passed in 2001. Violation of Section 3 (which requires the provision of food and water, adequate shelter and protection from the weather, veterinary care, and humane care and treatment) is a misdemeanor; a second or subsequent violation raises the offense to a Class 4 felony. [13] Hawaii outlaws animal hoarding and criminalizes it as a misdemeanor.
Complications
Object hoarding
Clutter impairs basic activities such as cooking, cleaning, attending to personal hygiene, sleeping, and moving throughout the living space. Quality of life is significantly impacted in a negative way. Hoarding can put individuals at risk for falling, fire, impaired function, economic burdern, and other adverse effects.
Animal hoarding
Animal hoarding is related to a number of individual and public health and safety concerns. [14, 15]
Animals suffer from overcrowding, malnourishment, and neglect. Humans suffer from poor sanitary conditions, fire hazards, zoonotic diseases, envenomation, and neglect (of themselves and of their dependents). Animal waste poses health risks to both animals and humans. Ammonia levels can be life-threatening.
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This photo shows the cluttered living space of a compulsive hoarder. Courtesy of Wikimedia Commons.
