• Not 'crazy cat ladies': Hoarding gets new diagnosis

    Las Vegas Review-Journal

    At least 15 truckloads of items were hauled from Kenneth Epstein's home on Oct. 5, the Las Vegas Review-Journal reported.

    By Diane Mapes

    Reality TV has brought national attention to hoarding, and now a recent change in the influential psychiatric diagnosis guide may actually bring help for millions of Americans suffering from the isolating condition.

    Hoarding – a psychological condition that can result in homes crammed floor to ceiling with papers, junk mail, books, clothing and other “valuables”-- has been associated with obsessive-compulsive behavior, although experts have long held that the two disorders aren’t necessarily connected.

    In the revised, fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5), "hoarding disorder" becomes a separate diagnosis, characterized by a "persistent difficulty discarding or parting with possessions, regardless of their actual value."

    The revised diagnosis should “result in more people having access to treatment," says Randy Frost, a professor of psychology at Smith College who specializes in hoarding issues. "Right now, there are very few clinicians who know how to treat it. Once it shows up in DSM, there will be much more pressure on clinicians to train in how to treat this problem."

    Hoarding isn’t just a messy garage or packed closet. According to the APA, it's defined by its harmful effects -- emotional, physical, social, financial and even legal -- both on the hoarder and the hoarder's family members.

    Hoarding is “a disorder that involves the living areas of the home being so cluttered they can't be used for their intended purpose,” says Frost, co-author of Stuff: Compulsive Hoarding and the Meaning of Things.

    Set to publish in May, the DSM is a guide doctors use to diagnose mental disorders. DSM codes are also used for insurance reimbursements and certain research grants.

    Rachel Kramer Bussel, a 37-year-old writer and editor from Brooklyn, says she's long had hoarding tendencies, although she only recently came clean about them in an essay on Salon.com, a difficult step considering the stigma surrounding the disorder.

    "I think people's only reference point is reality TV," says Bussel, who hasn't sought treatment but has worked with a personal organizer. "They think all hoarders are literally crazy cat ladies or people who don't function in the rest of society."

    Las Vegas Review-Journal

    Rachel Kramer Bussel carries two large bag stuffed with belongings that give her comfort.

    Bussel hoards books, clothing and other items at home; she also carries around at least two large bags stuffed with belongings she says give her "comfort". She says she hopes the new classification will help others become more accepting of the often-misunderstood disorder.

    The most common reaction to a hoarding confession is, "'Just get rid of everything. Get a dumpster and throw it all out and then you won't be a hoarder,'" Bussel says.

    In fact, recent research finds abnormal brain activity in people with hoarding disorder.

    There’s no hard evidence that hoarding is increasing, although certain societal factors -- such as the abundance of junk mail, our materialistic mindset, and an aging population (getting older increases the chance that a person will experience trauma or loss that contributes to hoarding) -- may translate into more hoarders, says David Kutz, an Albuquerque clinical psychologist specializing in hoarding and OCD.

    At least 4 million people in the U.S. would meet full criteria for hoarding, according to Kutz. Other data suggests between 2.5 to 6 percent of the U.S. adult population, or up to a 15 million people, may have hoarding disorder, says Frost, who conducted the first-ever study of hoarding in the U.S. in 1993. “That’s a whopping number," Frost says.

    Many hoarders don't recognize the problem. About “90 percent are sent by family members or a city counsel or the local sheriff,” says Kutz, who has appeared on A&E’s “Hoarders” three times.

    While experts and hoarders alike say they believe the new DSM classification will help hoarders get better treatment, Frost stresses there is no "magic pill."

    "We don't know yet whether there are medications that might be useful for this," he says. "But that's one of the things that will happen now that it's in the DSM. There will be an interest in researching this."

    Until then, hoarders can get help overcoming their urge to acquire and save through cognitive behavior therapy and/or peer support groups, a form of treatment that greatly helped Lee Shuer, a 37-year-old mental health worker from Northampton, Mass.

    "My mindset has completely changed," says Shuer, who began facilitating hoarding peer support groups after his hoarding habit went into "remission.” "I'm at the point where I can go to places where I used to acquire things - tag sales and thrift shops - and not buy anything. I can come across things that used to make my heart race but they don't turn me on any more. The thrill for excess is gone."

     For more on hoarding:

    OCFoundation.org's Hoarding Center

     Childrenofhoarders.com

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  • Kids' tantrums as disorder concern docs

    By Rachael Rettner, MyHealthNewsDaily 
    Some doctors are concerned about new guidelines allowing children who frequently throw tantrums to be diagnosed with a mental health disorder, arguing that normal kids can act this way, but also caution that such behavior could signal several other mental health conditions.

    The new diagnosis of "disruptive mood dysregulation disorder" will appear in the updated version of the psychiatric handbook the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), to be published in May. The American Psychiatric Association (APA) approved the final version of the manual on Saturday (Dec. 1).

    Although detailed criteria for the diagnosis have not been released, an APA statement said the condition could apply to "children who exhibit persistent irritability and frequent episodes of behavior outbursts three or more times a week for more than a year." The addition is intended in part to reduce the number of kids misdiagnosed as having bipolar disorder, who may be treated with powerful drugs.

    But some experts say the new condition was added to the manual too soon.

    "I think it's premature to put it in as a full diagnosis," said Dr. David Axelson, an associate professor of psychiatry at University of Pittsburgh School of Medicine, referring the condition's inclusion in the front of the manual with other well-accepted diagnoses, rather than in the appendix, which includes provisional diagnoses requiring further research.

    Some are concerned that a label of disruptive mood dysregulation disorder would turn normal kid behavior into a medical condition. [ See Typical Toddler Behavior, or ADHD? 10 Ways to Tell.]

    But Axelson said the diagnosis requires severe and frequent behavior problems, and if properly applied, kids without a true mental condition would be unlikely to be diagnosed. In addition to frequent outbursts for more than a year, children need to be at least 6, but younger than teenagers, to be given the diagnosis, according to early versions of the criteria.

    However, parents might overestimate how often their child behaves badly, because they focus on recent outbursts, and inaccurately reporting behavior to a mental health professional may lead to mislabeling, Axelson said.

    And although the diagnosis is intended to reduce misdiagnoses of childhood bipolar disorder and subsequent overtreatment, it could end up putting more kids on medication, Axelson said. That's because there are no treatments for the new condition, so doctors will likely prescribe medications for explosive anger — which are the same medications for bipolar disorder.

    Research suggests the new disorder could become common among kids already diagnosed with other mental conditions. A study by Axelson and colleagues, published in October, found that more than half of children with oppositional defiant disorder or conduct disorder met criteria for the condition, and it was hard to distinguish the disorders from each other.

    Also, the diagnosis was not particularly stable, meaning it was not repeatedly diagnosed in the same children over multiple evaluations. This counters the idea that the new condition is chronic, Axelson said.

    Some are concerned doctors will diagnose children with disruptive mood dysregulation disorder without checking for other mental problems.

    "Explosive behavior is like a high fever," said Dr. Gabrielle Carlson, a professor of psychiatry and pediatrics at Stony Brook University School of Medicine in New York. "If you have it, you know there's something wrong, but it doesn't tell you what's wrong."

    The focus could be taken off other conditions that can lead to explosive behavior, including attention deficit hyperactivity disorder, obsessive compulsive disorder and autism, Carlson said.

    But others see the move as positive. Lauren Wakschlag, a clinical psychologist at Northwestern University Feinberg School of Medicine who studies children's tantrums, said there are advantages to having this diagnosis for children's mood problems.

    Traditionally, these children may have been given any of several diagnoses, because tantrum behaviors overlap with those of other conditions.

    "Here, you have a unifying way to diagnose symptoms," Wakschlag said.

    However, because children's behavior can vary substantially between ages 6 and the teen years, more research is needed to determine how to diagnose children of particular ages, Wakschlag said.

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