The accumulation or dysposophobia disorder is a mental disorder recently recognized as an autonomous entity and category in itself in the fifth edition of the diagnostic and statistical manual of mental disorders (DSM-5) and is currently categorized in the MacRocastoria “Obsessive-compulsive disorder and related disorders” (American Psychiatric Association (APA), 2013).
The main characteristics of the accumulation disorder They include the tendency to acquire and preserve a large amount of objects, a marked inability to get rid of it despite not having any apparent value, and a compromise of the daily functioning caused above all by the difficulty in keeping household spaces in order (APA, 2013).
Individuals with Accumulation disorder They are often resistant to change, and symptoms can persist throughout life (Grisham, Frost, Steketee, Kim, and Hood, 2006). Furthermore, if not treated, the gravity of the symptoms will probably worsen every decade that passes (Ayers, Saxena, Golshan, and Wetherell, 2010). Although recent studies have reported that the initial debut occurs frequently during childhood and adolescence (APA, 2013; Ayers et al., 2010), The average age of those looking for treatment is 50 years (Samuels et al., 2008).
This is explained by the fact that the symptoms generally become clinically significant with age (APA, 2013). Furthermore, often those who are affected by this condition do not directly require treatment for the accumulation disorderbut due to the presence of a comorbidity disorder (Tolin et al., 2008) making the request not very immediate and bringing symptoms that are now quite serious and chronic in therapy (Ayers et al., 2010; McGuire et al., 2013).
A recent study conducted by Frost and collaborators (2015) highlighted the main ones reasons that could be implicated in the pathological accumulation of objects without apparent value.
From an in -depth investigation by the authors it emerged that the reasons most reported by those who suffer from the disorder are: a) emotional attachment to objects; b) the concern and avoidance of waste; c) Aesthetic motivations and) the information content of the object.
All four reasons were more frequent in clinicians, rather than in control groups. Investigating and understanding the underlying motivations can be useful for the purpose of setting the treatment.
According to a recent article published by Kress et al. (2016) which summarized the most relevant data in literature on the diagnosis and processing of accumulation disordercognitive-behavioral therapy is considered the treatment of election (Steketee, Frost, Tolin, Rasmussen, & Brown, 2010; Tolin et al, 2007).
However, previous searches have shown that the CBT protocols used with patients with obsessive-compulsive disorder are ineffective with those who present accumulation disorder (Mataix-Cols, Marks, Greist, Kobak, & Baer, 2002; Steketee and Frost, 2003).
In multiple studies that explore the CBT for individuals with obsessive compulsive disorder, the accumulation behaviors have proved to be a significant predictor of drop-outs, of poor results and minimum clinical advantages compared to those without accumulation behavior (Mataix-Cols et al., 2002; Steketee and Frost, 2003).
Consequently, specific CBT protocols have been developed for the disposophobia focusing in particular on the beliefs and dysfunctional behaviors linked to accumulation, on the reduction of emotional stress, and on the potential related deficits of information processing (Frost & Hartl, 1996; Steketee and Frost, 2007; Tolin et al., 2007).
The cognitive-behavioral treatment It focuses on the reduction of symptoms within the three main areas of the disorder: the disorganization, the difficulty in throwing away and getting rid of the accumulated objects and the tendency to excessive acquisition.
The components of the treatment include (a) skills training aimed at strengthening problem solving, decision -making process, and organization; (b) gradual exposure in imagination or in vivo to stressful stimuli (exposure and prevention of response (ERP) and (c) cognitive renovation of dysfunctional beliefs related to the disorder (Steketee and Frost, 2007; Tolin et al, 2007).
In the current literature, no differences in treatment on the basis of sex, race or ethnicity have been reported. However, further exploratory investigations are needed on the effectiveness of these interventions (Steketee et al., 2010).
Research has demonstrated the usefulness of integrating the use of CBT into the CBT approach home visits and techniques deriving from motivational interviewwhich seem to improve the results of the treatment (Steketee et al., 2010). The techniques of the motivational interview have the purpose of improving awareness, increasing adherence to treatment compared to homework and reducing resistance in completing it.
Steketee and Frost (2007) have created a protocol of 26 weekly sessions that include both home visits and on the workplace by social workers. Also the home visits In fact, they allow therapists to improve and maintain the patient’s motivation, in addition to providing assistance in getting rid of the objects and skills of organization and management of the house (Murof, Steketee, Bratiotis, and Ross, 2012).
In a qualitative study aimed at investigating the satisfaction of clinics and patients about the treatment for the Accumulation disorder With the CBT, the patients reported having found home visits effectively in support of the agreed objectives, the planning of the treatment and the generalization of the exposure exercises (Ayers, Bratiotis, Saxena, Wetherell, 2012).
Other research have shown that patients with accumulation disorder can benefit as well as cognitive-behavioral therapy, from family-based interventions, by multidisciplinary approaches based on community and pharmacotherapy.
Therapeutic approaches based on the family include psycho-education and the formation of parental figures and can be particularly useful in cases of children and adolescents with accumulation disorder (Ale et al., 2014).
Ale and colleagues (2014) reported that the accumulation behaviors in children are often reinforced by the behavioral responses of the parents. However, the effectiveness of these interventions must still be tested; Consequently, the results should be interpreted with caution.
Since the accumulation disorder It affects a wide variety of sectors of life, research has shown that a multidisciplinary approach based on the help of the community could improve the results of the treatment (Muroff et al. 2012). This would imply the use of community resources, and the assistance of professionals from different disciplines.
Bratiotis (2013) theorized a multidisciplinary approach for this disorder similar to the interventions used to deal with social problems such as domestic violence and abuses on minors. For example, home visits by non -trained clinicals could provide support and assistance in the organization and elimination of the objects accumulated in domestic spaces.
Finally, as regards pharmacological interventionsthere are currently no randomized controlled studies that have tested its effectiveness (Kress et al., 2016), although there is some evidence that the accumulation symptoms can improve with the use of SNRI and SSRI antidepressants when they are in comorbidity with depressive or anxious symptoms. However, the adherence to pharmacological treatment can be problematic for the bad management of drugs caused by the disorganization of the environments in which they live.
The first hypotheses about the combination of psychotherapy treatment With pharmacological interventions, they indicate greater effectiveness than the single treatment mode (Saxena, 2011).
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