Rashmi Parmar, M.D. helps discuss why people with ADHD may be more prone to hoarding, according to recent studies.
It can be challenging to manage ADHD due to difficulties with concentration. Now, a study published in Journal of Psychiatric Research found inattention may be a predictor of challenges related to hoarding.
This study was based on self-reports of ADHD, hoarding disorder and OCD-related symptoms from ADHD Clinic participants, as compared to a control group of similar age, gender, and education levels, and clinically significant hoarding symptoms were found in 20% of ADHD patients.
Since hoarding disorder remains largely under-diagnosed and under-treated, these research findings may be utilized to better inform psychoeducation regarding hoarding when working with ADHD patients.
Understanding the Research
This study was based on ADHD, hoarding disorder and OCD-related symptoms from 88 patients in an ADHD Clinic, as opposed to a control group of 90 individuals of comparable age, gender, and education.
Researchers found that approximately 20% of ADHD patients reported clinically significant hoarding symptoms, while 2% from the control group did. Inattention was a clinically significant predictor of hoarding.
This study’s use of self-report among its participants is a limitation of this research, as their disclosure of symptoms may not necessarily meet the full criteria for receiving a clinical diagnosis of hoarding disorder.
Treating ADHD May Address Hoarding
Psychiatrist with Mindpath Health, Rashmi Parmar, MD, says, “The study highlights an interesting link between ADHD and hoarding disorder, a combination that we are not inclined to look for clinically but definitely warrants further attention based on the findings of the study.”
Dr. Parmar explains, “The idea that ADHD and hoarding disorder are linked is not a commonly known fact. When you consider both these conditions, it is not hard to understand how one can influence the other. Both these conditions involve the core symptoms of disorganization, inattention, executive dysfunction and some impulsivity.”
Hoarding disorder is a type of a mental illness in which a person has persistent difficulty discarding or parting with their possessions or belongings regardless of their actual value, according to Dr. Parmar. “Previously thought as a subtype of OCD, hoarding disorder now qualifies as an independent condition in DSM-V,” she says.
Commonly hoarded items include household things like newspapers, magazines, and plastic bottles, but Dr. Parmar notes that it can also include situations in which a person has a hard time passing up bargain finds at thrift stores or may collect things of a unique nature.
Dr. Parmar highlights, “A person struggling with hoarding disorder can get significantly distressed, overwhelmed or anxious even with the thought of giving away or clearing out their possessions.”
Over time, accumulated things create clutter, as Dr. Parmar notes that it can lead to family discord, health issues, reduced living space, financial burden, socially isolative behavior, inability to function, etc.
Dr. Parmar explains, “The predominantly inattentive subtype of ADHD has the strongest link with hoarding disorder according to prior research done in this area. People who are hoarders usually struggle with impaired decision making, planning and organizing things.”
By jumping from task to task without sorting or prioritizing or completing tasks, Dr. Parmar notes that clutter can easily develop. “For someone who struggles with both ADHD and hoarding disorder, treating one condition may lead to some improvement in the other condition as well,” she says.
For example, Dr. Parmar highlights how treating the inattention with a stimulant can actually help a hoarder focus on decluttering parts of their home by sorting and clearing things without getting distracted.
Similarly, treating underlying anxiety and mood disorders may result in some improvement of inattention symptoms, according to Dr. Parmar. “Both these conditions can go undiagnosed for a long time, partly due to lack of awareness and insight into these conditions,” she says.
When noting the limitations of relying on self-report limitation, Dr. Parmar recommends that an in-depth guided interview by a trained professional may have have been more accurate in thoroughly evaluating these conditions and the link between them.
In addition to ADHD, Dr. Parmar explains that several psychiatric and medical conditions can present with inattention and impaired decision-making as a part of their symptoms. “It can certainly be hard to distinguish the root cause of inattention symptoms in people struggling with two or more conditions together,” she says.
Challenges with Executive Functioning Can Hamper Decision-Making
Licensed clinical social worker and autistic psychotherapist who specializes in ADHD, neurodivergence, and autism, Sharon Kaye-O’Connor, LCSW, says, “Some challenges that may be experienced by ADHDers include difficulty regulating attention and with executive functioning.”
Kaye-O’Connor explains that if someone has trouble switching tracks, getting started on a project, or making decisions, as with an ADHD diagnosis, tasks can become even more difficult and time-consuming.
In this way, Kaye-O’Connor highlights, “The task of organizing, decluttering, or getting rid of things is a whole complex process that involves making multiple decisions that can feel overwhelming and sometimes impossible.”
Overwhelm can contribute to difficulty with executive functioning, which can lead to more overwhelm, as Kaye-O’Connor notes that it can be a cycle that leaves a person feeling really stuck.
When overwhelmed, Kaye-O’Connor highlights that even tasks that seem “simple” to others might feel insurmountable. “Struggles with executive functioning can make decision-making incredibly difficult,” she says.
Kaye-O’Connor explains that many questions arise when faced with the possibility of getting rid of something. “Have I used this in a while? Will I need this in the future? Does this have sentimental value?” she asks.
Furthermore, Kaye-O’Connor outlines that even if getting rid of an item, more questions can arise. “Should I throw it in the garbage? Donate it? Where would I donate it? How would I get it there?” she asks.
Those questions do not even include if regret will follow, so Kaye O’Connor notes how the process of deciding what to do with even one single item can bring up many feelings that can become overwhelming.
Kaye-O’Connor explains, “As we learn and discover more about the nuanced experiences of ADHDers, learning from ADHD voices will be the key to gaining more insight into the complexities of ADHD life.”
Hoarding Disorder Can Be Difficult to Treat
Licensed mental health counselor who specializes in ADHD, holistic therapy, family support, adolescent development, and anxiety disorders, Julia M. Chamberlain MS, INHC, LMHC, says, “Further research will need to be conducted to solidify the relationship; however, this could be a key component in undertaking the development of hoarding disorders.”
With hoarding disorder, Chamberlain notes that an individual exhibits an inability to discard or let go of tangible items, which results in an unrestricted accumulation over time. “This poses a threat to hygiene, fire hazard safety, and other health concerns,” she says.
Treatment for ADHD can often result in a decrease of associated symptoms such as inattention, according to Chamberlain. “This would offset the risk of developing hoarding behaviors,” she says.
Chamberlain explains, “This publication is significant because it challenges the previously accepted origin of hoarding behavior. This can impact how hoarding is assessed and how it is treated.”
Since hoarding usually develops in adulthood, Chamberlain notes that this could contribute to early detection and prevention. “However, this is only one publication and more research is needed to fully solidify the association between ADHD and hoarding,” she says.
Inattention is not the only risk factor associated with hoarding, as Chamberlain highlights that depression and anxiety are also risk factors. “Individuals who struggle with hoarding tend to report distorted or irrational values to the items they hold onto,” she says.
Chamberlain explains, “Many individuals with hoarding disorder do not feel that it is a problem and therefore are resistant to treatment. For in-home providers, sometimes, additional service professionals such as clean-up/hazmat teams are needed to aid in cleaning the home due to safety hazards depending on the severity of the hoarding.”
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