Hoarding: a symptom, not a syndrome.

Background: Hoarding behavior in humans spans a continuum from normal collecting to pathological self-neglect and can be associated with a variety of psychiatric disorders.

Method: The authors summarize research in the past 15 years characterizing hoarding behavior in groups of college students, in nonclinical populations of self-named "pack rats," in outpatients treated for obsessive-compulsive disorder (OCD), and in individual pathological hoarders presented in psychiatric case reports. Two new case reports of pathological hoarding are presented here.

Results: The literature suggests, as do the 2 case reports presented, that certain factors may be common to all groups of hoarders, as they all show poor insight, lack of resistance to the compulsion to hoard, and poor treatment motivation.

Conclusion: Possible biological and psychosocial determinants of pathological hoarding include association with schizophrenia, OCD, and tic disorders, as well as a possible link through the neurotransmitter dopamine. Management issues range from psychopharmacologic treatment with antipsychotic medication to behavioral therapy and environmental manipulation.