My Diagnosis

How Household Junk Can Grow Into Mountains

June 1, 2004
By ANAHAD O'CONNOR


People 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.