Hoarding Disorders Definition/Description • • • • Persistent difficulty discarding possessions regardless of value Such items may hold meaningful reminders of past events and provide a sense of security. Difficulties with emotional regulation, executive functioning and impulse control all contribute to excessive buildup of clutter. Chronic and progressive Epidemiology • • More common in males? Usually begins in early adolescents Aetiology • • Abnormalities in prefrontal white matter which connects cortical regions involving excusive functioning including working memory, attention, reward processing and decision making. Serotonin dysregulation Diagnosis DSM V A. Persistent difficulty discarding or parting with possessions, regardless of their actual value. B. This difficulty is due to a perceived need to save the items and to distress associated with discarding them. C. The difficulty discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use. If living areas are uncluttered, it is only because of the interventions of third parties. D. The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. E. The hoarding is not attributable to another medical condition (e.g., brain injury, cerebrovascular disease, Prader-Willi syndrome). F. The hoarding is not better explained by the symptoms of another mental disorder. • Specify if: - With excessive acquisition: difficulty is accompanied by excessive acquisition of items that are not needed or for which there is no space - With good or fair insight recognises that hoarding-related beliefs and behaviours are problematic - With poor insight: mostly convinced that hoarding related beliefs and behaviours are not problematic despite the contrary - With absent insight/delusional beliefs: completely convinced that hoarding related beliefs and behaviours are not problematic despite evidence to the contrary. Treatment and Management • • CBT Currently there is no evidence of pharmacological treatment efficacy