Diagnosis of compulsive hoarding

A progressive disease

As with many serious illnesses, diagnosis is not straightforward. Clutterers don't just become a fully-blown compulsive hoarder overnight, it is often a period of many years, even decades before the physical manifestations become visible to the world outside of the home.
Even when the 'stuff' is recognised as being a real problem it is usually very difficult for sufferers or their families to decide to take action seek outside help due to embarrassment and shame.

Barriers against diagnosis

By it's nature compulsive hoarding is a overwhelmingly secretive disease and a large percentage spend many years in isolation. We've all heard true-life stories of a friend of a friend who rarely leave the house except to buy food and put out rubbish.

Embarrassed to let friends and family into their own home, compulsive hoarders avoid having visitors. This embarrassment leads hoarders to avoid asking for treatment. Often they are only exposed by the referral of close family at a point of intervention.

Denial

Compulsive hoarders are often unable to grasp the fact that by refusing to part with their possesions they are hindering their own life. They tend to minimise the frequency of their hoarding behaviour as well as the volume of items they aready own.

Treatment is resisted as they fail to see compulsive hoarding as a psychiatric disorder that needs management. Put simply, they cannot see they are ill and need help.

Co-occurrence with other illnesses

Compulsive hoarding's relationship (co-morbity) to other mental illnesses is not yet widely understood, but co-occurence is with a number of other illness has been observed, other than OCD.

Major depression
General anxiety disorder (GAD)
Social phobia
Post-traumatic stress disorder (PTSD)
Attention Deficit Hyperactivity Disorder (ADHD)
Grooming disorders (Trichotillomania, skin picking, nail biting)
Dementia