Hoarding represents a severe form of psychopathology that is often seen in individuals with obsessive-compulsive disorder (OCD). A hoarder typically acquires a large amount of material possessions and fails to discard any, leading to debilitating clutter, impairment and distress. In addition, they often demonstrate low insight into their problem and show poor decision-making skills.
DISTRESS TOLERANCE
In fact, hoarding has been explained in terms of a cognitive dysfunction wherein the individual collects and fails to discard things as a dysfunctional coping mechanism to feeling distressed over not having things, losing a “good opportunity”, or having regret about discarding a possession.
For example, reports indicate that hoarders experience a great deal of distress over having to make a decision about their possessions, and as a result they feel lost about whether or not to discard a possession or to not acquire one. Thus, hoarding could reflect a state of low tolerance for distress.
ANXIETY SENSITIVITY
In addition, anxiety sensitivity has been identified as another important factor in hoarding. Defined as the “fear of fear”, anxiety sensitivity is the belief that anxiety could potentially be dangerous or harmful to the body, and therefore should be avoided at all costs.
Relatedly, recent studies found an association between anxiety sensitivity and hoarding. For example, one study reports that high anxiety sensitivity is a unique predictor of hoarding. Another one demonstrates that hoarders who are asked to discard a treasured object experienced intense anxiety. As a result, it has been proposed that hoarding might be a maladaptive response to the desire to avoid experiencing anxiety.
It is noteworthy to add that anxiety sensitivity is conceptually different from distress tolerance, as the latter refers to a decreased capacity to handle negative emotional experiences, while the former focuses on the fear of anxiety-related sensations. In hoarding for example, the combination of high anxiety sensitivity and low distress tolerance has been identified as a high predictor of hoarding behaviors. However, low distress tolerance is not enough in and of itself to predict hoarding as it stronger only when depression is also present.
In terms of treatment, therapy that focuses on lowering anxiety sensitivity and increasing distress tolerance could improve hoarding.
Reference:
Timpano KR, Buckner JD, Richey JA, Murphy DL, Schmidt NB. Exploration of anxiety sensitivity and distress tolerance as vulnerability factors for hoarding behaviors. Depress Anxiety. 2009;26(4):343-53. doi: 10.1002/da.20469. PMID: 19123454; PMCID: PMC2770430