Hoarding may become an official disorder

Posted: January 10, 2011

Hoarding may be bizarre enough behavior to sustain several reality TV shows, but, surprisingly, it isn't an official psychiatric disorder.

That may change in May 2013, and University of Pennsylvania therapists will play a key role in the decision.

Penn Medicine is one of seven institutions chosen as field trial sites for the forthcoming edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5. Therapists at Penn's outpatient mental health clinic will test how well the revised guide to mental illnesses, which introduces hoarding disorder, works in the real world. They'll see whether therapists agree on diagnoses for patients with generalized anxiety disorder, obsessive-compulsive disorder (OCD), and hoarding, anxious depression, binge eating, and personality disorders.

The current 943-page DSM was updated in 2000. It is used for research and billing. It is also a measure of how society distinguishes normal behavior and eccentricity from illness.

The challenge is to more clearly define mental illnesses "within the context of culture," said Mahendra Bhati, a Penn psychiatrist who will lead the field trials here.

Behavior or feelings aren't considered illnesses unless they cause significant problems. The guy who dedicates a room to sports memorabilia is probably just a collector, while someone who crams his house so full of Eagles stuff that he can't use it has a disorder, Bhati said.

Psychiatrists treat hoarding now, but often lump it into OCD, he said. "What research is showing is that hoarders are probably different than people with classic obsessive-compulsive disorder," he said. People with OCD often fear contamination and know they have a problem, he said. Many hoarders think they're fine and are not driven by anxiety.

The DSM famously once included homosexuality, but now does not. Binge eating disorder, which was first described by Penn obesity expert Albert Stunkard, made the last list but was said to need more study. Anxious depression - recognition that anxiety and depression often go together - is a new diagnosis this time, at least so far. It's all still in flux.

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