Interview/ Dr T.S. Jaisoorya, associate professor of psychiatry, NIMHANS
Dr T.S. Jaisoorya has been with the National Institute of Mental Health and Neuro Sciences in Bengaluru since 2013. His areas of specialisation include obsessive-compulsive and related disorders, epidemiology and public health. Excerpts from an interview:
Q/ On a scale of severity as far as obsessive-compulsive disorders are concerned, where does hoarding fall?
A/ There are grades of severity, starting from a tendency to collect a little more than normal to a very severe, obsessive need to collect and a difficulty in discarding. That extremity would be exhibited in less than one per cent of the population. Hoarders should be distinguished from collectors who collect specific thing(s) and arrange them.
Q/ When does hoarding become harmful?
A/ When hoarding perishable items, which begin to rot and attract pests that then lead to infections. There is the possibility of falling over things and injuring oneself. Possessions could also catch fire and the danger would then spread beyond the immediate vicinity.
Q/ How easy/difficult is it to diagnose hoarding in a clinical situation?
A/ It is extremely difficult unless brought to attention by a relative/friend who accompanies the patient. In the rare instance that we make a home visit, we can see the problem for ourselves. Hoarders will defend themselves. Hoarding is also difficult to diagnose because, unlike other mental health issues in which the sufferer is likely to become violent or aggressive or display marked behaviour changes, hoarders will go unnoticed till they start getting into conflicts (for example, because of lack of space) with those they live with. Treating such patients is also difficult because of a lack of cooperation and of self-awareness about the problem.
Q/ With shopping becoming so easy now, is hoarding likely to increase?
A/ That and as more and more people start to live alone or in nuclear families, there is every likelihood of hoarding becoming more common. There are so many online apps now that the risks of expression of hoarding disorder are higher than ever before.
Q/ What about digital hoarding?
A/ All of us collect books, movies, articles, reports, photos in multiple hard drives and discs. We will never go back to look at these, but deleting them is difficult. This is an accumulation that all of us are undertaking.
Q/ What makes hoarding difficult to be recognised as a disorder?
A/ Hoarding has been recognised for centuries. We collect things with the thought that they might be useful later. Or, we might justify it to ourselves that it is not right to waste things. Some among us could reach the point of no return. Hoarding behaviour will be exhibited in adolescent or early adulthood. It is only when one’s hoarding starts to create problems for others and create friction within the family that it is recognised as a disorder.
Q/ Do hoarders display a similar attachment to people and relationships?
A/ On the contrary, a hoarder has replaced attachment to people and relationships with attachment to things, to material possessions. Attachment to inanimate objects is most important to hoarders. They are likely to live alone, be solitary and avoid friends and relatives. They will not invite anyone into their space because of the amount of things they have, and for the fear that it might invite comment from others.
Q/ Is hoarding a standalone problem?
A/ Very often, hoarding will be accompanied by other psychosomatic disorders such as depression. In the elderly, it might be accompanied by dementia.
Q/ What about treatment?
A/ Depending on co-existing conditions, medication and cognitive behavioural therapy together work best.
Q/ What is the one most important tip we can use to guard against hoarding?
A/ Over acquisition happens not because we buy more but because we cannot discard what we have. So be aware about things that you have not used in a while and give them away. Things will not be useful after some time. Learn to recognise that.