Hoarding versus collecting: Where does pathology diverge from play?
Highlights
► Collecting is a widespread, normative human activity. ► Average collectors may share some features with HD patients. ► A minority of collectors will fulfill criteria for HD. ► There are important quantitative & qualitative differences between collecting and hoarding.
Introduction
The collecting of objects is a widely observed human behavior that is generally regarded as both benign and normative. Indeed, research in the area has revealed that the majority of young children (Baker and Gentry, 1996, Evans et al., 1997, Zohar and Felz, 2001) and up to a third of British adults (Pearce, 1998a, Pearce, 1998b) engage in “collecting” at any given time rendering it a pastime as pervasive in Britain as tuning into a World Cup final (Deans, 2010).
Industry has been quick to capitalize on the apparent mass appeal of this activity, resulting in large quantities of collector-based media in the form of print goods (see: Antique Collectors Club (ACC), 1966–2011, Miller and Hill, 1989, Marshall Cavendish, 1992, Blom, 2003), radio shows (see: In Celebration of, Radio 4; The Smell of Money, BBC4; A History of the World, BBC4; All Things Considered, NPR), and television programs (see: For Love or Money, Channel 4; Summer's Hour, BBC4; Bargain Hunt, BBC1; Cash & Cari, HGTV)(Pearce, 1998a, Pearce, 1998b). Proof of the population's sustained interest in collecting is evidenced by the continuing success of such endeavors; the BBC's Antique Roadshow, for example, is currently entering its 33rd season, attracts an average audience of 6 million and has spawned long-running sister series in the US, Canada and several European nations (BBC, 2007).
The ubiquity of this behavior has also attracted interest in the realm of academia. Researchers in areas ranging from economics and marketing (Belk, 1995; Baker and Gentry, 1996, Bianchi, 1997; Long and Schiffman, 1997, Burton and Jacobsen, 1991, Slater, 2001) to anthropology and museum studies (Pearce, 1994, Pearce, 1995, Pearce, 1998a, Pearce, 1998b; Elsner and Cardinal, 1994, Dilworth, 2003) have all examined collecting behavior in the context of their respective disciplines. In the field of psychology, and among its allied sciences, interest has also proliferated generating analyses of collecting behavior from the perspectives of psychodynamics (Formanek, 1991, Subkowski, 2006), behavioral neurology (Anderson et al., 2004, Volle et al., 2002) social psychology (Rudmin, 1991, McIntosh and Schmeichel, 2004) and a variety of others (Witty and Lehman, 1931, Furby, 1978).
Research concerning this type of object accumulation has, for the most part, treated collecting as an egosyntonic leisure activity that provides psychological benefit to its participant. Within the clinical psychology and psychiatry communities, however, investigations into object accumulation have increasingly focused on its ability, in some cases, to hinder normal performance. This excessive form of acquisition, widely referred to as “hoarding,” has resulted in a body of research elucidating its core features and highlighting its potential to impair individual, interpersonal and occupational functioning (Damecour and Charron, 1998, Frost and Hartl, 1996, Frost et al., 2000, Steketee and Frost, 2003, Thomas, 1997, Tolin, Frost, Steketee and Fitch, 2008, Tolin, Frost, Steketee, Gray and Fitch, 2008).
Work in this area has recently resulted in a new diagnosis, tentatively termed “Hoarding Disorder,” (HD) being considered for introduction in the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; APA, 2010). The proposal of this new disorder has, naturally, led to wave of publications analyzing its associated diagnostic criteria (Mataix-Cols et al., 2010, Saxena, 2007), their relationship with prior diagnostic options (Abramowitz et al., 2008, Pertusa, Frost, Fullana, et al., 2010, Pertusa, Frost and Mataix-Cols, 2010, Rachman et al., 2009) and the apparent suitability of these features for averting misclassification (Pertusa, Frost, Fullana, et al., 2010, Pertusa, Frost and Mataix-Cols, 2010).
Investigations of this latter type have, to date, focused primarily on ensuring that the emerging diagnostic criteria for HD are effective at differentiating pathological hoarding from the diagnoses to which hoarding behavior has previously been ascribed, like Obsessive Compulsive Disorder (Pertusa, Frost, Fullana, et al., 2010, Pertusa, Frost and Mataix-Cols, 2010) and Obsessive Compulsive Personality Disorder (Mataix-Cols et al., 2010). However, while addressing this type of misclassification is important, such studies offer only a partial consideration of the potential for diagnostic error in the generation of this new diagnosis. As Frances, 2009, Frances, 2010 argues in his critiques of the DSM-5, the creation of any new diagnostic option brings with it concerns that normative behavior is being incorrectly pathologized. Ensuring that the diagnostic criteria for HD are adept at avoiding overpathologization is, consequently, a point in need of consideration and, unfortunately, one which has received minimal attention in the recent literature (Mataix-Cols & Pertusa, in press)
The issue of excessive pathologization in HD, as with any mental disorder, stems from the increasingly prevalent idea that all behavior rests on a continuum; the closer to the center of the continuum, the more normative a particular behavior is thought to be — the further away, the more extreme. Under this model, the implementation of a psychiatric diagnosis can seem at odds with the inherent fluidity of the system, imposing a contrastingly rigid point at which a behavior loses its relationship with normality and becomes, instead, pathological. In hoarding, defining such a point means explicitly articulating the features that distinguish an adaptive or normative relationship with one's possessions, from a relationship that is more accurately defined as maladaptive or pathological. However, in a society that is arguably driven by consumption, understanding where that dividing line should be drawn represents a challenge. In the context of Hoarding Disorder, then, the question becomes: do the proposed diagnostic criteria offer an acceptable framework for establishing this line?
To adequately address this question, the concepts underlying hoarding as a behavior — and characteristics underlying hoarders as a population — need to be articulated and analyzed in relation to what we will term “normative object relations”, that is, a combination of object acquisition, interaction and overturn that is characteristic of a large segment of the population. For this type of comparison to be possible, however, a relevant population of acquirers must be agreed upon and examined.
We propose that “collecting,” as well as “collectors,” represent both relevant and appropriate constructs for the purposes of such a comparison. With estimates of its population prevalence exceeding 30%, collecting can reasonably be asserted to represent the object-relations practices of a substantial portion of the population (Pearce, 1998a, Pearce, 1998b). Furthermore, the extensive body of literature surrounding the behaviors of collectors and the features of their collections enables the type of systematic and objective examination needed for assessing the boundaries of the HD diagnostic criteria.
That a relationship between hoarding and collecting has been cited in the current hoarding literature only adds to this rationale. Conceptualizations of hoarding as “an excessive form of collectionism,” have, for example, appeared across several studies and have highlighted the potential for shared features between these behaviors (Mataix-Cols et al., 2010, Pertusa, Frost, Fullana, et al., 2010, Pertusa, Frost and Mataix-Cols, 2010). Meanwhile, other work has emphasized, and in some cases relied upon, the separateness of these concepts; a study by Frost and colleagues, for example, required that potential hoarding participants “save a large number of items that were not part of a collection,” implying that items acquired for the purposes of building a collection are not sufficient to constitute a hoard (Frost, Krause, & Steketee, 1996, p. 122).
The idea that hoarding is, at once, sufficiently like collecting as to be framed as its excessive form, while also being sufficiently distinct as to enable the use of collecting behavior as a means of parsing hoarders from nonhoarders, highlights the complex theoretical interplay that has, to date, characterized these two constructs. Without clear agreement on the features differentiating these behaviors, the question of whether the diagnostic criteria proposed for Hoarding Disorder have been framed in a way that sufficiently considers these differences remains unclear.
The purpose of this review will be to address the lack of discussion provided in the existing hoarding literature regarding whether, why and at what point collecting behavior can, or should, be treated as distinct from pathological hoarding. In particular, this review will seek to synthesize the available literature on collecting and examine the relationship of its findings to the current conceptualization of Hoarding Disorder. To this end, the proposed diagnostic criteria will be used to organize the reporting of results, with the primary purpose being to assess the ability of each criterion, as written, to differentiate normative collecting from pathological hoarding. The discussion section will then reflect on the implications of findings for the existing diagnostic criteria, providing suggestions for future work in this area.
Section snippets
Defining the constructs
While the authors are unaware of any empirical studies focused on defining the difference between hoarding and collecting behavior, there has been “much ink spilled” over the independent definition of each construct (Pearce, 1998a, Pearce, 1998b, p. 2). The content of these debates has been summarized elsewhere, both for collecting (Pearce, 1998a, Pearce, 1998b, Chapter 1) as well as for hoarding (Frost and Steketee, 2010, Mataix-Cols et al., 2010) and will, consequently, not be reviewed here.
Search methods
A literature search was carried out via the PubMed, PsychInfo and Science Direct databases, using the key terms “hoarding,” “hoarder,” “collecting,” “collector,” and “collection.” In an attempt to cast a wide net — necessary given the academically diverse contributors to the collecting literature — a search was also carried out using Google Scholar. Key terms used in this search were identical to those listed above. Examination of returned results, in particular the reference sections of
Criterion A
Do collectors experience a persistent difficulty discarding or parting with possessions regardless of the value others may attribute to these possessions (alternative wording: regardless of their actual value)?
Discussion
The purpose of the current review has been to examine whether, where and to what extent collecting behavior overlaps with the working diagnostic criteria for Hoarding Disorder. This is a crucial question, as it is paramount that the proposed criteria are sufficiently strict and do not over-pathologize essentially normal behavior (Mataix-Cols et al., 2010, Mataix-Cols and Pertusa, in press). To address this question, the collecting literature relevant to each of the proposed DSM-5 criteria has
Disclosures
The authors report no financial relationships relevant to the subject of this article.
The views of the authors are their own and do not necessarily reflect the official views of the DSM-5.
Acknowledgements
The authors would like to thank Dr. David Nordsletten and Ms. Lorena Fernandez de la Cruz for their illustrative and editorial assistance with this manuscript. We would also like to extend our thanks to Dr. Susan Pearce for her provision of additional references.
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