Hoarding Disorder: A case series from the speciality OCD Clinic, NIMHANS, Bangalore

BACKGROUND: Hoarding Disorder (HD) is defined as the acquisition of and failure to discard large volumes of possessions, resulting in cluttering of living spaces. With an estimated prevalence of 2–5%, HD is associated with high levels of disability and impairment. To our knowledge, literature on hoarding from India is thus far confined to a single epidemiological prevalence study. AIM: To present a series of cases identified to have HD, each with a unique clinical profile, comorbidities, and possible underlying etiological factors. METHODS: We reviewed the case files of seven individuals diagnose to have HD, treated at the OCD Clinic, NIMHANS. Clinical characteristics, comorbidity, treatment, and outcome-related details were extracted. RESULTS: Three of seven patients had a primary diagnosis of HD. Three had comorbid OCD, two had comorbid psychosis, and one had autism spectrum disorder. One patient with schizophrenia developed hoarding after the initiation of clozapine, which interestingly remitted after reducing its dose. One patient developed HD following temporal lobectomy for refractory epilepsy. All of them had excessive acquisition and poor to absent insight. Five received CBT targeted toward reducing hoarding and clutter. Medication management varied from use of SSRIs to SGAs. Reduction in acquisition and clutter was noted in two of seven individuals following treatment. CONCLUSION: We describe these cases to illustrate the varying contexts in which HD may arise, as well as the challenges in their management. HD is likely underreported, particularly in the Indian context, and a thorough screening may aid in early diagnosis and initiation of treatment.