Every time Juan enters his living room he must sit in a chair because the sofa has it full of clothes. In the bathroom it hardly fits and in the bedroom you can only use half of your bed. The most important rooms in the house are full of clothes, electronic devices and magazines. Juan lives alone and suffers from accumulation disorder. His best friend visits him from time to time and puts order in his house, but soon he returns to have items accumulated everywhere. What is this disorder?
- 1 Diagnostic criteria of accumulation disorder
- 2 Features
- 3 Risk factors and prognosis
- 4 Differential Diagnosis
- 5 Treatment
Diagnostic criteria of accumulation disorder
To expose the diagnostic criteria of the accumulation disorder, the latest version of the Diagnostic and Statistical Manual of Mental Disorders will be used (DSM-V, 2014). The diagnostic criteria are as follows:
TO. Persistent difficulty in getting rid of or giving up possessions, regardless of its real value.
B. This difficulty is due to a perceived need to keep things and the discomfort one feels when one gets rid of them.
C. The difficulty of getting rid of possessions gives rise to accumulation of things that congestion and clog the habitable areas and greatly alter its intended use. If the habitable areas are clear, it is only due to the intervention of third parties.
D. The accumulation causes clinically significant discomfort or social deterioration, labor or other important areas of operation.
E. Accumulation cannot be attributed to another medical condition.
F. Accumulation is not best explained by the symptoms of another mental disorder.
It must be specified if this disorder is accompanied by excessive acquisition, that is, there is an excessive acquisition of things that are not needed or for which space is not available.
In diagnosis, it is also important to specify if it occurs:
- Good or acceptable introspection. The person recognizes that beliefs and behaviors related to accumulation are problematic.
- Little introspection. The person is convinced in itself that the beliefs and behaviors related to accumulation are not problematic despite the evidence to the contrary.
- Absence of introspection and / or delusional beliefs. The person is totally convinced that beliefs and behaviors related to accumulation are not problematic despite evidence to the contrary.
The central characteristic of the accumulation disorder is the lasting difficulty in separating or disposing of possessions, regardless of their real value. That is, the difficulty in getting rid of a cheap vase may be the same as the difficulty in getting rid of an expensive vase. When reference is made to "lasting difficulty" it is in reference that it occurs over a long period of time.
The main reasons for not getting rid of the elements is usually utility, aesthetic value or a strong sentimental attachment. There is also a strong fear of losing important information. The objects that are usually accumulated more frequently are: old clothes, magazines, newspapers, books, papers and electronic material. Although you can actually save any object. How many rooms have we seen full of objects that no longer served?
Those who suffer from the accumulation disorder, when they are exposed to the idea of discarding their possessions, they experience strong discomfort and anxiety. This fact, evidence that keeping is an intentional act. And in this way, the accumulation can be such that it prevents a room from being used for the intended purpose. For example, a living room may be so crowded that it loses its functionality, or a bathroom may be so full of gossip that the person cannot shower.
Risk factors and prognosis
Temperamental Indecision is an important factor in people with accumulation disorder and their relatives in the first degree.
Environmental Those who suffer from this disorder usually report retrospectively on traumatic stressful life events prior to the onset of the disorder.
Genetic and physiological. The accumulation behavior is usually familiar and approximately 50% of those who suffer from this disorder report that they have a family member who does too.
Major depressive episode If the accumulation of objects is considered a consequence of fatigue, psychomotor retardation or loss of energy during a major depressive episode, accumulation disorder is not diagnosed.
Obsessive-compulsive disorder. If accumulation is a direct consequence of obsessions or compulsions, accumulation disorder is not diagnosed. People with OCD that accumulate, usually have more strange objects such as nails, hair, urine, feces, garbage, etc. In addition, the behavior is usually unwanted and worrying for the subject with OCD.
Neurodevelopmental disorders If the accumulation of objects is a consequence of a neurodevelopmental disorder such as autistic spectrum or intellectual disability, accumulation disorder is not diagnosed.
The most common treatment is cognitive behavioral therapy. Through therapy, different elements are worked with the person:
- Learn to resist the urge to get more and more objects.
- Identify and criticize the thoughts and beliefs related to the acquisition and accumulation of objects.
- Offer guidelines for the classification of objects and learn which are expendable.
- Learn to socialize and reduce moments of loneliness.
- Provide guidelines for decision making.
- Increase motivation levels.
American Psychiatric Association (2014). Diagnostic and Statistical Manual of Mental Disorders. DSM-5. Madrid: Pan American Medical Editorial