Hoarding >> What Are The Causes Of Hoarding

The following are clues that hoarding might be secondary to an underlying medical condition: Onset later in life Passive rather than active accumulation of items (eg, failure to take out the garbage or recycling, stacking old newspapers) Objective cognitive impairments (eg, short-term memory loss, What Are The Causes Of Hoarding long-term memory loss on testing) 

Subjective memory loss (eg, medication non-adherence; neglecting medical, dental, and other important appointments) New overvalued ideas, delusional thinking, and hallucinations (including visual and auditory) New decrements in IADLs or BADLs (eg, no longer driving, no longer bathing or What Are The Causes Of Hoarding changing clothes). 

Ongoing What Are The Causes Of Hoarding alcohol, medication, or other substance misuse New or progressive sensory impairments (eg, vision and smell). New or progressive, CNS disease (eg, stroke, Parkinson disease) BADL, basic activities of daily living, CNS,central nervous system, IADLÃ, instrumental activities of daily living. 

Data from What Are The Causes Of Hoarding Gregory et al There is a strong association between hoarding and other mental health conditions. Although OCD was thought to be the main connection, hoarding is more strongly associated with anxiety disorders such as social phobias and generalized anxiety disorder. Substance abuse is commonly related to hoarding behaviour. 

Specific What Are The Causes Of Hoarding personality disorders have also been related to increased risk, most notably dependent, avoidant, schizotypal, and obsessive-compulsive personality disorders. The role these personality traits play is unclear, but they might predispose patients to respond to triggering events such as bereavement or illness.

One of the terms used to categorize extreme hoarding behaviour with severe squalor is Diogenes syndrome,named after the Greek philosopher who chose to live in poverty (most famously in a barrel) and who eschewed societal norms. This What Are The Causes Of Hoarding term arose from a 1975 case series in the Lancet but has come under criticism as a misnomer.

Patients with What Are The Causes Of Hoarding Diogenes syndrome display hoarding along with poor hygiene, social isolation, and indifference to their living situation, and usually have untreated medical conditions and sequelae of neglect (eg, insect bites, infections related to personal and food hygiene). 

Regardless of the What Are The Causes Of Hoarding historical accuracy of the term, it should be used only to describe a specific subset of patients with hoarding behaviour and should not be used interchangeably with Biologic basis Animal models using creatures that hoard as part of their survival strategy (eg, magpies, pack rats) and human acquired brain injury models have provided some insight into the biologic basis of hoarding behaviour.

Functional imaging suggests that the medial prefrontal area of the brain plays an important role. Symptom provocation studies also link hoarding to the anterior cingulate cortex, along with other limbic structures. Dopamine is thought to play a role based on animal models; dopamine-deficient animals have been What Are The Causes Of Hoarding shown to resume hoarding behaviour when given levodopa. 

It is much harder to determine the biologic basis of nonorganic hoarding, in which there is no identifiable neurologic cause or injury. Similar areas of the brain have been shown to be affected, but the studies are limited by small sample sizes and mixed populations of What Are The Causes Of Hoarding subjects with hoarding disorder and OCD.

It does appear that OCD What Are The Causes Of Hoarding patients without hoarding behaviour show activity in different areas of the brain than compulsive (OCD) hoarders. Usually, FTLD presents in patients younger than 70 years of age; 10% of cases present in those older than age 70, reflecting differences in underlying pathology.

Clinically, patients with FTLD and hoarding behaviour might not show deficits on common tests of frontal lobe function, such as the Frontal Assessment Battery, but they might have abnormal findings on testing of more medial function. The Iowa Gambling Task, which assesses medial-frontal function, has been shown to have positive findings in patients with frontal dementia and What Are The Causes Of Hoarding concurrent hoarding behaviour.

This is not a test commonly done by family physicians, but it does highlight that more common frontal lobe testing might have limitations. Management and ethical issues Health care professionals, families, and landlords find management of hoarding behaviour very challenging. A common What Are The Causes Of Hoarding feature of organic hoarding is a lack of interest in changing and diminished concern about societal norms. 

Conversely, patients with nonorganic hoarding might feel considerable distress about the possessions and junk overwhelming them but have great difficulty tolerating the distress caused by losing those possessions, and they are often resistant to What Are The Causes Of Hoarding interventions. This resistance is less common in patients with dementia and hoarding, but their cognitive issues raise other management and safety issues. 

Like many complex health problems, the principle of management is providing an interdisciplinary approach. Guidelines from Australia provide a possible approach to hoarding. In most areas a What Are The Causes Of Hoarding coordinated approach is limited or has only become recently available, and physicians in smaller communities and larger towns or small cities might have limited access to specific programs or services. 

Municipalities, recognizing the social and economic cost of hoarding, are developing What Are The Causes Of Hoarding guidelines and "extreme cleaning" teams. The family physician's initial role is in recognition and evaluation of medical and psychiatric comorbidities causing or contributing to the disorder. Treatment of health problems arising directly from the condition, such as edema, cellulitis, and malnutrition, will commonly fall to the family physician. 

The goal of treatment is usually to try to improve the situation without removing the patient from the home, except in situations of extreme risk or incapacity. Institutionalization of elderly patients with hoarding disorder or Diogenes syndrome might result in increased What Are The Causes Of Hoarding mortality.

 Likewise, aggressive removal of items and "extreme cleaning" might lead to considerable distress without decreasing the risk of the patient returning to the behaviour in the same location or wherever the person moves (or is moved to). Most agencies involved in hoarding management will use a step wise approach to cleanup and decluttering when the What Are The Causes Of Hoarding patient is engaged in the process and does not have substantial dementia or comorbid psychiatric conditions. 

Harm reduction, a strategy used in treating substance abuse, has been shown to have benefit for hoarding patients and their families.The process of What Are The Causes Of Hoarding treatment can take months to years. Pharmacologic and nonpharmacologic treatments have been studied for patients with OCD symptoms associated with hoarding or for hoarding that is thought to be due to OCD. Cognitive behavioural therapy is the most commonly cited approach and has been shown to be effective in up to 50% of people.

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