The Hoarding Phenomenon in Schizophrenia Spectrum Disorders.

The presence of hoarding behavior among patients with schizophrenia has been known for more than a century. Nevertheless, only a few studies have examined the hoarding phenomenon among patients with schizophrenia, and no studies have examined the potential motivation. Hoarding disorder became a separate diagnosis in DSM-5. Studies about hoarding disorder use primarily quantitative approaches (e.g., scales, self-administered questionnaires, and structured interviews) when assessing the patients. The main objectives of this study were to examine the meaning of hoarding for patients with schizophrenia spectrum disorders and to explore associated psychopathology which may motivate the hoarding. We have examined 13 patients diagnosed with schizophrenia spectrum disorders showing hoarding behavior. The patients underwent semistructured, narrative interviews about the following domains: the time of onset of hoarding, the meaning of hoarding and associated psychopathology, the presence of insight into hoarding, and problematic issues about discarding. The study shows that hoarding begins very early in life for these patients and can be motivated by various psychopathologies. Diminished sense of basic self and transitivistic experiences were mentioned by several patients as motivations for collecting objects. Furthermore, the difficulty with discarding reflected a huge ambivalence and ruminations. Our findings suggest that thorough and comprehensive assessments of people with hoarding symptoms are necessary to assure the correct diagnosis and to understand the patient. An increased knowledge of the patients' motivations for hoarding behavior may also be useful for the treating personnel and may prevent social adversities. We think it is questionable that in the DSM-5 hoarding is not mentioned in the description of schizophrenia but has been elevated to a separate disorder.