Buried at home, literally submerged by objects of any nature. This is the image that more than any other characterizes people with accumulation disorder (Hoarding disorder), otherwise said disposophobia.
Some of you may have happened to follow the American television series that bears the names of the same name, intrigued by the extreme conditions in which they manage to live, or rather survive, these “disposophobic” people.
The Accumulation disorder (disposophobia) It is characterized by the excessive acquisition of objects and, at the same time, by the inability to throw them away.
Objects can be the most disparate: from newspapers to clothing, from waste to old food containers. It is precisely the difficulty in throwing away the things that can lead to significantly bulky the spaces of the house, up to hindering normal daily activities such as cooking, cleaning, moving at home, even sleeping.
The large quantities of objects accumulated by those suffering from disposophobia They can threaten the health and safety of those who live in the house or close. Fires, falls and even diseases may occur, given the poor hygienic conditions in which these disposophobic people find themselves living.
Another element that characterizes people with compulsive accumulation It is the progressive isolation to which they meet as a result of the embarrassment and shame they feel compared to inviting guests in their home. In many cases, conflicts are created with family members and also with neighbors.
The removal and hostility of the same increase the suffering of these people who suffer from disposophobia In a vicious circle that heavily compromises its psychological functioning, leaving them in a condition of total abandonment.
What is the dimension of the phenomenon of compulsive accumulation in our country?
One of our study published on Behavioral and Cognitive Psychotherapy (Bulli et al., 2014) The goal of evaluating the prevalence of the accumulation behavior in a non -clinical sample of adults. 1012 subjects participated in the study by filling out a self-report questionnaire validated in Italian, the Saving Inventory-Revised (SI-R; Melli, Chiorri, Smurra & Frost, 2013).
The result caught us a little surprise: well the 6% of the sample he said to implement a set of prerogative behavior of people who suffer from Accumulation or disposal disorder.
The analysis of demographic variables showed how there were no significant differences in sex, age, civil status, qualification and employment.
Since, before the publication of the DSM-5 (APA, 2013), the accumulation disorder It was classified as a subgroup of the obsessive-compulsive disorder (DOC), the report of the accumulation disorder with obsessive symptoms.
The relevant figure that emerged is that the correlation coefficient between a questionnaire that measures the presence of obsessive symptoms and the Si-R questionnaire was not much greater than the degree of correlation between the symptoms of accumulation and anxiety and depression measures.
This result is consistent with previous studies, conducted both on clinical and non -clinical population, according to which the accumulation behavior he is symptoms of disposophobia may be present transversely in various psychiatric, neurodegenerative and in some cases genetic clinical manifestations, and therefore the Compulsive accumulation disorder It cannot be merely classified as a doc subtype.
Compulsive and DOC accumulation disorder: what differences?
From a phenomenological point of view, the fear of losing something important for the person, the fear of getting rid of things from which he feels emotionally linked or the fear of making mistakes about what is better to keep or throw could be considered similar to obsessions, while not throwing objects away, just as some acquisition behavior could be assimilated to compulsions.
However, many research has provided tests in support of important differences between compulsive accumulation and obsessive-compulsive disorder.
For example, thoughts related to accumulation in patients with Accumulation disorder (disposophobia) they are not perceived as intrusive or unwanted; They are not repetitive, as are typically the obsessions in DOC patients.
Compulsive accumulation is a passive phenomenon, in which intense discomfort is tried only when these people find themselves dealing with the need to get rid of what they are in possession of. The experience of acquiring things, on the other hand, is felt as egosintonic, pleasant, or in any case such as to generate a feeling of security.
One of the peculiar characteristics of the subjects with disposophobia It is a strong attachment to the things they possess, sometimes attributing to them a strong identity sense. Here the scenario of having to get rid of things to which they feel they are very affectively linked to the person as a very painful person. Sometimes these subjects come to think that inanimate things have real feelings.
The patient obsessive-compulsiveon the other hand, even in cases where one manifests one Symptomatology of accumulationis in no way interested in the intrinsic value of the object. For example, accumulation behavior could be the consequence of superstitious thoughts like “if I throw away an object, I fear that something negative can happen to a loved one”.
In this case, therefore, the difficulty in getting rid of that object is not linked so much to the attribution of an emotional value to it, but rather it represents a protective strategy in response to intrusive thoughts of a catastrophic nature.
On the other hand, the meaning attributed by patients with patients is different accumulation disorder to the same inability to throw away. Since objects are an integral part of their personal identity, their memory, the get rid of it is equivalent to a real mourning experience. Hence the prevalent emotions of pain and anger of those who suffer from disposophobia.
A psychiatric entity in its own right
In recent years, the study of accumulation disorder He received growing attention and his nosographic characterization has been the subject of a lively scientific debate.
Although this behavior has often been reported as a symptomatological manifestation of the obsessive-compulsive disorder, strangely was not directly mentioned in the DSM-IV-TR as a symptom of the doc. Rather, it included in one of the 8 criteria for the obsessive-compulsive personality disorder.
Not doc therefore, but not even phobia, although the accumulation disorderas already mentioned, is also mentioned as disposophobia (literally ‘fear of throwing’). This term can deceive, unable to provide an exhaustive picture of the clinical complexity of these patients.
The nosographic ambiguity of accumulation disorder It was resolved in the DSM-5 (APA, 2013) through its recognition as an entity in its own right in the international psychiatric panorama.
This categorization can better do justice than a disorder that has main characteristics also in the brain level.
A study conducted by Tolin and collaborators of the Yale University School of Medicine, published in 2012 on Archives of General Psychiatry, in fact, showed how the subjects with accumulation disorder They present fundamental differences, compared to obsessive-compulsive patients and normal adults, both in the anterior tracked cortex, associated with the detection of errors in conditions of uncertainty, and in the medial and anterior insula, linked to the evaluation of the risk and importance of the stimuli and the emotionally charged decisions.
According to the authors, the compulsive accumulation disorder would seem characterized by a marked avoidance of the decision -making process for possession.
It seems crucial in this the emotional bond with the things and importance that for these patients have objects considered of any value for most people. These are the cases where objects can take over people’s lives, making them slave.
