Ayesha Alvi is Group Head, Islamic Bioethics, Center for Study & Research, New Delhi, Former Head, Department of Genetics & Molecular Biology, Jazan University KSA. Mohammed Rizwan is Deputy Director, Center for Study & Research, New Delhi, India

Introduction:

In the world of mental health, amidst the more familiar conditions like obsessive-compulsive disorder, depression or anxiety, there is a complicated and frequently misperceived condition called hoarding disorder that frequently goes unnoticed because it’s not a disorder that can be easily identified by looking at a person, but there’s no denying its significant impact on the lives of those who have it and the people who love them.

By definition, “Hoarding disorder” is “Persistent difficulty discarding or parting with possessions, regardless of their actual value.” It falls under obsessive-compulsive (OCD) and related conditions, meaning it shares certain characteristics or traits with OCD. OCD is a psychological condition in which people experience recurring, unwanted thoughts, ideas, or emotions (obsessions). To get rid of the thoughts, they feel compelled to do something repetitively (compulsions) such as hand washing/cleaning, counting, checking on things, or engaging in other activities that severely disrupt their daily routine and social interactions. Therefore, hoarding disorder is similar to OCD in that it involves obsession and attachment to things or activities. However, it goes far beyond these obvious symptoms of having difficulty in discarding or throwing useless belongings, gathering objects and maintaining an untidy home.

In this condition, people even find it difficult to classify objects or to determine what should be thrown away or kept. Patients or subjects suffering from this disorder find it easier to give up on the idea of discarding the belongings hoarded because it seems so challenging or upsetting. This disorder has been shown to affect people of all ages, genders, and socioeconomic backgrounds. It is a truly egalitarian mental health challenge.
Unlike other psychological disorders, hoarding disorder has no obvious symptoms; thus, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is widely used by mental health professionals for diagnosing mental health conditions, points out few specific criteria for its diagnosis; the main symptom is an inability to part with belongings, no matter how invaluable or useful they are. Getting rid of even seemingly insignificant items may trigger significant distress and anxiety in them simply because possessions hold profound emotional and psychological acquaintances for them.
Hoarding can be classified as mild, moderate, or severe, depending on how much it is interfering with day-to-day activities. Moreover, it can be difficult to persuade people with hoarding disorder to seek treatment because they do not see their condition as a problem. Still, comprehensive therapy is typically advised by psychologists for two reasons: first, it will help family members understand the patient’s condition, which will change how they approach the patient; and second, it will help the patient live a safer and more fulfilling life. Understanding hoarding disorder will also help us to appreciate its profound effects on day-to-day living, as seemingly insignificant objects can contribute to strained relationships, emotional isolation, and compromised safety and hygiene.
So, to better understand and identify the presence of this condition in ourselves or our loved ones, we will look at the telltale signs and symptoms and attempt to investigate the etiologic and extrinsic factors that contribute to the hoarding condition. Further, complex interactions between neurological complexity, life experiences, and genetic components of the disorder will be discussed. Additionally, as we proceed through the pages that follow, this article will emphasize the importance of raising public awareness regarding this often-overlooked mental health issue. But first, let’s delineate a fine line that can distinguish hoarding behaviour from a typical saving attitude.

Hoarding Vs Saving: Hoarding and saving are two distinct patterns of behaviour that involve the collection and continued possession of goods or belongings. As a result of this, many people have the misconception that it’s all about gathering a lot of stuff. There is, however, a clear distinction between the two behaviours: those suffering from hoarding conditions experience intense emotional attachment to their possessions, which makes them extremely distressed when they have to consider discarding them. While “saving” is a more carefully planned and regulated activity. It is driven by a desire to meet one’s financial commitments, work toward specific goals, or accumulate savings for unexpected expenses. People who save regularly usually know exactly what they want to achieve and choose carefully what and how much to save. In a similar vein, there are differences in the consequences and societal and financial implications of these two behaviours. Understanding these distinctions is important for addressing the hoarding issues and advocating saving behaviour.

Economic Implications of Hoarding Behaviour: Hoarding has several negative consequences. Stuff that builds up over time can make living spaces untidy and potentially hazardous. This is because hoarders prioritize their possessions over other people’s comfort and safety which often leads to social isolation and strained relationships. Hoarding can also lead to financial problems because money meant for necessities is inadvertently spent on acquiring more possessions.

Societal Implications of Hoarding Behaviour: Hoarding behaviour has far-reaching societal consequences that frequently affect family members, especially first responders, as well as friends who struggle to understand and cope with the disorder. In dealing with hoarding cases, even communities may face difficulties, necessitating a delicate balance between individual rights and public safety. Because of the negative consequences, society frequently stigmatizes hoarding behaviour in comparison to saving behaviour. Increased awareness, education, and support for people who suffer from hoarding behaviour can help reduce the societal impact of the behaviour and foster a more compassionate and effective response.

Causes and Contributing Factors for Hoarding Disorder:

Although the exact cause of hoarding disorder is still unknown, current research suggests a complex interplay of genetic, environmental, and neurological factors. Traumatic life events, such as the death of a loved one or going through a difficult transition in life, or depression or anxiety, can sometimes be the cause of hoarding behaviour in certain individuals. Regarding the genetic component, it has been observed to run in families, whereas, on the neurological front, hoarding disorder has been linked to anomalies in the parts of the brain, especially with those parts that are directly in charge of emotion control, and decision-making. This may help to explain why hoarders struggle to organize their living spaces or declutter their homes and experience emotional distress when attempting to discard items.

Signs and Symptoms

It is critical to recognize the symptoms of compulsive hoarders to help treat the condition before it worsens. It’s important to note that hoarding disorder can vary in severity, with some individuals experiencing more pronounced symptoms than others.

Some common symptoms include:

Excessive Accumulation: Hoarders amass an excessive number of items, frequently filling their living spaces. This includes not only common items such as clothing and household goods, but also newspapers, magazines, old containers, and even items that others may regard as useless.

Difficulty Discarding: Individuals suffering from hoarding disorder find it extremely difficult to let go of possessions, even those that most people would consider worthless. When they try to get rid of items, they are distressed.

Cluttered Living Spaces: Hoarders’ homes are often cluttered and disorganized to the point where rooms become unusable for their intended purposes, such as cooking, bathing, or sleeping.

Emotional Attachment: Hoarders frequently develop strong emotional bonds with the items in their possession, viewing them as comforting and secure or as extensions of themselves.

Avoidance of Visitors: Due to embarrassment & remorse, hoarders frequently avoid mingling with visitors, which can lead to social isolation.

Loneliness and Depression: People with hoarding disorder may find it difficult to maintain relationships and general well-being, which can result in social disengagement, loneliness, and feelings of sadness and anxiety.

Impact on Daily Life and Treatment Options

Hoarding disorder can have an awful effect on an individual’s daily life. Accumulation of stuff often results in unhealthy living conditions as moulds and pests can develop, and there is also a risk of fire hazards. However, the good news is that hoarding disorder is treatable so people can manage their symptoms and improve their quality of life by combining psychotherapy, medication, and support.
Here are some therapy and management options available;

Cognitive-Behavioural Therapy (CBT): Cognitive behavioural therapy (CBT) for hoarding disorder is frequently used in conjunction with behavioural interventions. As a result of this, it assists people in recognizing and addressing hoarding-related ideas and behaviours. In essence, it encourages them to change their emotional attachment to their belongings and gives them direction for better decision-making. A qualified mental health professional who has received cognitive behavioural therapy (CBT) training typically administers the therapy and, if necessary, can customise the treatment plan to meet the specific needs of each patient. This is how CBT operates:

Psychoeducation: Psychoeducation is one of the most important aspects of treating hoarding disorder. It essentially assists in dispelling myths, reducing stigma, and providing practical information to promote empathy and effective support for individuals suffering from hoarding disorder. A psychotherapist explains the nature of the problem, its symptoms, severity, and impact on daily life to both the person in need and the first responder, preferably a member of their immediate family. This effectively sets the stage for the development and carrying out of a successful treatment plan and support network.

Cognitive Restructuring: Cognitive therapy assists people in recognizing and addressing irrational beliefs and thought patterns associated with hoarding. People with hoarding tendencies, for example, may believe they must keep everything for fear of needing it in the future. CBT helps people examine and reframe their beliefs.

Exposure & Response Prevention (ERP): Exposure and Response Prevention (ERP) is a therapeutic technique frequently used to treat anxiety-related disorders like hoarding disorder and obsessive-compulsive disorder (OCD). ERP is a systematic and controlled approach to assist people in overcoming their fears and anxieties. It entails gradually exposing people to situations that might have caused hoarding behaviours. This could entail carefully identifying and discarding belongings. The goal is to teach them that it’s okay to be uncomfortable and to alleviate the guilt associated with throwing things away.

Skill Building: Cognitive behavioural therapy also employs skill-building exercises such as decision-making, problem-solving, and organizational training. These exercises train people to make more thoughtful and efficient decisions about what to keep and discard.

Home Visits: In some cases, therapists may conduct home visits to work closely with the person in question in their living environment. This helps to motivate and encourages them to change their outlook towards hoarding habits.

Relapse Prevention: After the active phase of treatment, the psychotherapist taught relapse prevention and maintenance strategies.

Medication: In some cases, medication such as antidepressants may be prescribed to alleviate anxiety and depressive symptoms that are often associated with hoarding disorder. Nevertheless, it’s essential to consult with a mental health specialist for a proper evaluation and treatment plan.

Support Groups: Joining support groups can give a sense of psychological support and understanding. Sharing experiences and learning from others can also play an invaluable role in the recovery process.
Treatment often requires a supportive and non-judgmental approach. Family involvement and support can also be beneficial.

Understanding the Role of Islamic Psychotherapeutics for Overcoming Hoarding Disorder:

Treating hoarding disorder with an “Islamic Psychotherapeutic” approach entails combining psychotherapy such as CBT or exposure therapy with spiritual guidance (Quranic wisdom, prophetic traditions (Sunnah), and Islamic psychological principles). Purely because Islamic teachings consistently emphasize on the sense of maintaining a balance in life and avoiding excessiveness (“But waste not by excess, for indeed, He does not like the wasteful” (The Quran, 6:141). in spending and savings that can eventually culminate in a hoarding attitude. Therefore, hoarding can be seen as the outcome of failing to strike this balance. It reflects or symbolizes an excessive attachment to worldly possessions, which again contradicts Islam’s principles of a sense of contentment with what one has and moderation. Believers are encouraged to be mindful of both their possessions as well as the rights of others. For example, according to Sahih al-Bukhari hadith, Prophet Muhammad (PBUH) taught us the transient nature of material possessions and the importance of using wealth for the benefit of others, “The son of Adam claims, ‘My wealth, my wealth!’ Have you anything in your possession other than what you ate and gave as charity so that it was left in the hands of others or you left it to be consumed by the insects or you left it to be spoiled?”.
So, psychotherapists can draw inspiration from the Islamic teachings on charity, detachment from worldly belongings, and gratitude to assist the person who is struggling with the condition. Such an approach can help provide emotional support, which can eventually help them strive to realign their lives and overcome their hoarding attitude.
Listed below are some indications of how Islamic teachings can be incorporated into hoarding disorder psychotherapy:

Understanding Mental Health as Part of Overall Well-Being:  Islam encourages believers to take care of their physical, mental, and spiritual well-being. Psychoeducation can be presented as a means of improving overall well-being and fulfilling religious obligations to maintain good health.

Cognitive-behavioural techniques:  Cognitive-behavioural therapy (CBT) can be modified to incorporate Islamic values and beliefs. Patients can be guided through the process of identifying negative thought patterns and replacing them with more constructive, faith-based mindsets and convictions.

Compassion and empathy:  Islam places a strong emphasis on compassion and empathy for those in need. A therapist can encourage individuals suffering from hoarding behaviour to consider how their behaviour affects their relationships with family and the community at large. Similarly, loved ones, family members, and communities can play an important role in providing a supportive environment for individuals suffering from hoarding behaviour, assisting them in accessing appropriate treatment and coping strategies. This can help them recognize the importance of change and encourage them to seek treatment.

Mindfulness and gratitude:  Islamic practices, such as daily prayers and supplications, can be integrated into therapy to promote mindfulness and gratitude. These practices can help people experiencing the condition become more aware of their thoughts and emotions, as well as nurture a sense of contentment with what they have.

Balance and Moderation:  Islamic teachings promote the principles of moderation and balance in all facets of life. Therefore, a therapist through psychoeducation, can highlight how this equilibrium is upset and how treatment can assist sufferers in regaining equilibrium in their lives.

Seeking Knowledge and Seeking Help:  Islam promotes knowledge acquisition, and psychoeducation is consistent with this idea. It is crucial to communicate that getting professional assistance including hoarding disorder therapy is a way to learn how to deal with a particular problem.

Integration of Community Support:  Islam places a strong emphasis on faith and assisting those in need, so that those suffering from hoarding disorder can seek psychological support from others in their neighbourhood, community-based services, or their mosque. In addition, therapy based on faith principles or faith-based coping strategies can be designed to complement the treatment. This could entail incorporating spiritual guidance, practising mindfulness, or utilizing prayers into their overall treatment plan.

Hope and Resilience: Islam encourages people to be resilient and hopeful when faced with any type of adversity. Psychoeducation can place a strong emphasis on the possibility of hoarding disorder recovery and the power of faith in helping individuals overcome this condition.

Stigma Reduction: Psychoeducation can help reduce the stigma associated with mental health conditions in Islamic communities. By providing information about the biological and psychological aspects of hoarding disorder, individuals and their families can better understand that it is not a sign of spiritual weakness or punishment from God.

Conclusion:

For the epilogue, hoarding disorder is a serious mental health condition that affects many aspects of a person’s life. We can provide support and compassion to those living with this challenging disorder by understanding its causes, comprehending its symptoms, and seekingappropriate therapy so that individuals suffering from the hoarding condition can regain control of their lives and overcome the burden of excessive possessions with the right help and intervention. Raising awareness of hoarding disorder is critical for reducing stigma and facilitating early intervention and support for those in need. Incorporating an Islamic perspective into the psychoeducation and treatment of “Hoarding Disorder” can be a beneficial approach to making individuals and their families feel more at ease and supported in seeking help. It is important to collaborate with mental health professionals who are culturally competent and aware of the specific needs and beliefs of individuals from Islamic backgrounds.

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