Hoarding disorder might be impacted because even though people with hoarding disorders may hoard items of little use, the need for storing necessary supplies can impact and worsen the symptoms of hoarding disorders or even OCD with hoarding symptoms.

The other side of COVID-19: Impact on hoarding

Sentimental object attachment is a psychological phenomenon that is theorized to begin early in childhood, wherein children develop an emotional attachment to a certain object as a maternal substitute. While natural maturation and independence should diminish the role these objects play in emotional security, there is a growing body of evidence exploring how and why object attachment may persist into adulthood. Little information is known about the reasons individuals experience sustainment from specific objects, but childhood object attachment is associated with favor for unique individuals, thereby subsequently influencing preferences for authentic objects in adulthood. Individuals can experience strong emotional bonds towards an object, such that if the object is lost, they can experience great emotional distress. 

Object attachment

Individuals who have a propensity towards extreme object attachment may share the tendency to collect objects with hoarding disorder, however hoarding disorder typically involves the collection of any object that leads to “the accumulation of possessions that congest and clutter active living spaces,” regardless of any monetary or sentimental significance of an object, while object attachment behavior is much more focused on a limited array of personal belongings.

Differences between hoarding disorder & object attachment behavior

Hoarding disorder (HD) is associated with severe levels of functional impairment. Individuals with HD report higher levels of disability in various daily activities compared with non-pathological collectors. As such, HD may adversely impact health-related quality of life (QoL) in psychical and psychological domains. HD is associated with decision-making impairment, deficits in basic cognitive function, emotional dysregulation & intolerance, and behavioral avoidance. Such impairments may interfere with desired goal achievements. 

Moreover, clutter may reduce usable living space, thus physically interfering with daily activities or resulting in diminished social contact. 

Symptoms include: Excessively acquiring items that are not needed, a persistent difficulty throwing out or parting with things, feeling a need to save items, being upset by the thought of discarding items, obtaining clutter to the point where rooms become unusable, a tendency toward indecisiveness, perfectionism, avoidance, procrastination, problems with planning, and organizing.

Symptoms of Hoarding Disorder 

Attachment theory proposes the idea that hoarding disorder is related with poor emotional regulation due an anxious attachment style. Individuals with this anxious attachment style may have more difficulty in caring for others, often becoming too distressed and self-focused when called upon, wherein their inability to provide care may limit support they receive in retune and so they may experience decreased empathy and impaired social relationships. Furthermore, this theory states that when an attachment figure has consistently failed to provide support, anxiously attached individuals may seek secondary attachment strategies to manage their emotional needs, including nonliving objects as a substitute for love. Attachment theory posits that an individual’s inability to engage in empathetically meaningful relationships and utilization of objects for emotional comfort is a leading role in object attachment behavior. In support of this theory, studies have found a correlation exists between that a greater tendency to experience discomfort in social situations and an anxious attachment style & greater hoarding severity

Attachment theory of hoarding disorder

Many studies reveal conflicting information regarding the associations between traumatic experiences and OCD or hoarding symptoms. Previous studies have found a plethora of information regarding differences and similarities between the trauma experiences of those with OCD and those with hoarding symptoms. It is still unclear exactly what types of traumatic events are associated with each, if any, the association between the time a traumatic event occurred and symptom development (i.e., prior to the onset or after the onset of symptoms), and how many traumatic events these individuals with these disorders have experienced or may experience in the future. A study in 2014 sought to answer these questions.

The Links between Traumatic Events and OCD and/or Hoarding Symptoms

Reference for Treatment of Hoarding Disorder 

Reference for The Comorbidities of Hoarding Disorder

Several disorders can co-occur with hoarding disorder, but depressive disorders are the most common ones. Additional disorders that can co-occur with hoarding disorder include attention-deficit/ hyperactivity disorder, impulse control disorders, obsessive-compulsive disorder, and anxiety disorders such as generalized anxiety disorder and social anxiety disorder.

The Comorbidities of Hoarding Disorder 

Treatments for hoarding disorder consist of a biopsychosocial approach that mixes using SSRIs and cognitive behavioral therapy. Other therapies include working on attachment difficulties that might be the cause of hoarding disorder, and compassion-focused therapy, which attempts to eliminate the shame of having hoarding disorder. 

Treatment of Hoarding Disorder 

A key aspect of understanding hoarding disorder involves its prevalence, which refers to how frequently the condition occurs in the general population. This epidemiological data is crucial for grasping the scope and public health significance of the disorder.

Prevalence of Hoarding Disorder

While hoarding was historically viewed as a symptom of Obsessive-Compulsive Disorder (OCD), substantial evidence now supports its classification as a separate and distinct disorder.

Distinction Between Hoarding Disorder and OCD

A formal diagnosis of hoarding disorder is contingent upon the hoarding behavior not being attributable to another medical condition or being a symptom of a different disorder, such as schizophrenia.

Diagnostic Exclusion Criteria for Hoarding Disorder

A psychologist is evaluating several individuals who accumulate a large number of possessions. Based on the defining characteristics of hoarding disorder, which of the following situations would be the strongest indicator of the condition?

Which of the following scenarios best illustrates the core characteristics of hoarding disorder?

Hoarding disorder is characterized by a persistent difficulty in discarding or parting with possessions, regardless of their actual value. This behavior frequently results in the accumulation of items that clutter and congest the individual's living area.

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- Depression
- Obsessive-Compulsive Disorder
- Hoarding Disorder
- Post-traumatic Stress Disorder
- Anxiety/ Panic Disorders
- Social Anxiety Disorder
- Body dysmorphic disorder
- Schizophrenia 
- Borderline Personality Disorder

Mental Disorders Affected By The Covid-19 Pandemic

List of Other Recognized Anxiety Disorders

Obsessive-compulsive and related disorders are characterized by intrusive thoughts and repetitive behaviors. Some examples of these disorders are: 
- Obsessive-Compulsive Disorder
- Body Dysmorphic Disorder
- Hoarding Disorder

Obsessive-Compulsive and Related Disorders

Obsessive-compulsive and related disorders are a group of conditions listed in the DSM-5 that are characterized by overlapping features, specifically the presence of intrusive thoughts and/or repetitive behaviors. This diagnostic category encompasses several distinct but related conditions, including obsessive-compulsive disorder, body dysmorphic disorder, and hoarding disorder.

Spielman, R. M., Jenkins, W. J., & Lovett, M. D. (2020, April 22). Psychology (2nd ed.). OpenStax. https://openstax.org/books/psychology-2e/pages/1-introduction

OpenStax Psychology (2nd ed.) Textbook

The COVID-19 pandemic and ensuing isolation measures has had negative psychological impact on the general population of China, measured by mean levels of stress, depression and anxiety. Authors conducted a cross-sectional study (Jan. 31 - Feb. 2) (n=1210, from 194 cities) using an online questionnaire disseminated to university students who were encouraged to pass it along. Overall, 75.5% of respondents reported psychological impacts resulting from the pandemic. Women, students, presentation of various symptoms (ex: dizziness, coryza), and low reported health-status are high risk-factors for worsened mental health. Identifying populations vulnerable to psychological distress, and factors favouring psychological health, provide insight for the formulation of psychological interventions.

Psychological response to the first wave of COVID-19 in China (stress, depression and anxiety)

Hoarding Disorder

Schizophrenia is a severe psychological disorder that leads to a profound breakdown in an individual's ability to function, often necessitating hospitalization. It is characterized by significant disruptions in thought, perception, emotion, and behavior, including symptoms like hallucinations, delusions, incoherent thinking, bizarre actions, flat emotions, and a lack of motivation for basic activities. It is important to distinguish schizophrenia from dissociative identity disorder ('split personality'), as the term 'schizophrenia' refers to a 'splitting of psychic functions,' not a divided personality.

Schizophrenia

- Factors increasing anxiety
- Protective factors against anxiety

Areas impact between COVID and Anxiety/Panic Disorders

Post-traumatic Stress Disorder (PTSD) is a condition where an individual experiences a collection of persistent symptoms following a traumatic or profoundly stressful event, such as combat, sexual assault, or a natural disaster. For a diagnosis, these symptoms must last for at least one month. The traumatic event can be witnessed firsthand or secondhand. Historically, PTSD was referred to by terms like 'shell shock' and 'combat neurosis' due to its frequent association with war, but it is now recognized as affecting a wider population.

Post-traumatic Stress Disorder (PTSD)

Laura J. Dixon, Sara M. Witcraft & Mary J. Schadegg (2023) COVID-19 anxiety and mental health among university students during the early phases of the U.S. pandemic, Journal of American College Health, 71:4, 1152-1160, https://doi.org/10.1080/07448481.2021.1923504 

The Effects of COVID-19 on Anxiety-Related Mental Health Concerns

Obsessive-compulsive disorder (OCD) is characterized by the presence of obsessions and/or compulsions. Obsessions are defined as intrusive and unwanted thoughts, mental images, fears, sensations, or urges. Compulsions are repetitive behaviors or mental acts that an individual feels driven to perform, often in response to an obsession. These cycles of obsessions and compulsions are typically distressing, time-consuming, and can significantly disrupt a person's daily activities.

Obsessive-Compulsive Disorder (OCD)

Body Dysmorphic Disorder (BDD) is a condition where an individual is intensely preoccupied with a perceived flaw in their physical appearance, which is often nonexistent or barely perceptible to others. This preoccupation can cause the person to believe they are unattractive, ugly, or deformed. The intense focus on these imagined defects leads to repetitive, ritualistic behaviors and mental acts. These compulsions can include constantly checking one's appearance in the mirror, attempting to conceal the perceived flaw, making comparisons to others, and in some cases, seeking cosmetic surgery.

Body Dysmorphic Disorder (BDD)

Generalized Anxiety Disorder (GAD) is characterized by a persistent and relatively continuous state of excessive, uncontrollable, and often pointless worry and apprehension. Individuals with this disorder typically worry about routine, everyday matters, such as health, finances, or the safety of family members, without any justified reason. For a diagnosis, this diffuse worrying must occur more days than not for a period of at least six months, not be attributable to another disorder, and be accompanied by at least three of the following symptoms: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep difficulties.

Generalized Anxiety Disorder

This disorder is hallmarked by the experience of multiple, unexpected panic attacks. These attacks are often associated with intense fear that occurs quickly. Generally, this diagnosis is applied if you have had four or more panic attacks, and fear their reocurrence. Having one panic attack, is not a panic disorder. Worry over panic attacks and avoidance of situations, places, etc. that are associated with panic attacks can lead to further problems. 

Recurrent panic attacks may show temporal lobe abnormalities. Those who suffer from panic disorder typically have lower temporal lobe volumes. These attacks can occur unexpectedly or by a trigger. 



Panic Disorder

The term 'phobia' originates from the Greek word for fear. A phobic disorder is defined by an intense, persistent, and irrational fear of a particular object, activity, or situation. This overwhelming fear compels the individual to actively avoid the source of their phobia. Exposure to the phobic stimulus results in significant distress and dysfunction, even when the person intellectually understands that their fear is excessive. Phobic disorders are generally categorized into three types: specific phobias, agoraphobia, and social phobia.

Phobic Disorder

https://books.google.co.in/books?hl=en&lr=&id=AbYwDwAAQBAJ&oi=fnd&pg=PA2&dq=hypochondria&ots=wBYJuZQSsU&sig=teQPxyaj2KUQ0DsgOF1f8rEyrlQ&redir_esc=y#v=onepage&q=hypochondria&f=false

Hypochondriasis: Illness Anxiety Disorder and Somatic Symptom Disorder

Hypochondriasis, commonly known as hypochondria was considered a disorder where an individual believes that they have illnesses or symptoms of diseases, even when they did not. It caused anxiety and distress for patients, and potentially impeded their day-to-day functioning. However, in the DSM-V (Diagnostic and Statistical Manual of Mental Disorders), hypochondria itself was declassified as a separate disorder and instead was considered a symptom or manifestation that occurred in two different disorders. Certain characteristic features of hypochondriasis were classified under Illness Anxiety Disorder and more severe manifestations under Somatic Symptom Disorder. These disorders are both largely characterized by the preoccupation over certain undiagnosed or unexplained symptoms that persist in the individual. 

Hypochondriasis 

References  for Associations between Hoarding Disorder and  Obsessive Compulsive Disorder

Obsessive-compulsive disorder is characterized by intrusive thoughts that trigger repetitive and self-reinforcing behaviors. The obsessive component of this disorder can act as both an antecedent and a consequence, as the compulsive behavior is performed to quell the obsession, but ends up making the obsession even stronger. 

Obsessive-Compulsive Disorder (OCD) 

Body dysmorphic disorder is a condition where an individual becomes excessively preoccupied with one or more perceived flaws in their physical appearance. These perceived defects are typically nonexistent or unnoticeable to others, but they cause the person to experience significant anxiety about how they appear.

Body Dysmorphic Disorder

The DSM-5-TR separates Obsessive-Compulsive and Related Disorders into the following specific disorders:
- Obsessive-Compulsive Disorder (OCD)
- Body Dysmorphic Disorder
- Hoarding Disorder
- Trichotillomania (Hair-Pulling Disorder)
- Excoriation (Skin-Picking) Disorder
- Substance / Medication-Induced Obsessive-Compulsive and Related Disorder
- Obsessive-Compulsive and Related Disorder Due to Another Medical Condition
- Other Specified Obsessive-Compulsive and Related Disorder


[DSM-5-TR] List of Obsessive-Compulsive and Related Disorders

Specific areas of the brain are associated with obsessive-compulsive and related disorders. The orbitofrontal cortex is linked to obsessive-compulsive disorder (OCD), the anterior cingulate cortex is associated with hoarding disorder, and the prefrontal cortex is connected to body dysmorphic disorder.

Brain Regions Implicated in Obsessive-Compulsive and Related Disorders

A clinical psychologist is evaluating three different clients. Client A is unable to discard any possessions, leading to a dangerously cluttered home. Client B spends several hours each day examining and trying to hide a small scar on their arm that others do not notice. Client C feels an overwhelming need to tap every doorway they pass through exactly three times. According to the diagnostic framework used by mental health professionals, what is the primary characteristic that groups these distinct conditions into the same diagnostic category?

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