Hoarders: from Reality TV to Reality
Hoarding isn’t a new condition. In 1947, a pair of brother achieved legend status by starving to death amid piles of possession in a New York brownstone. Homer and Langley Collier were the last elderly remnants of a wealthy Manhattan family. They moved to a fashionable Harlem neighborhood in 1909, and as the neighborhood lost its cachet and transitioned downward, the brothers sank into increasingly reclusive and paranoid behavior. In the end, Langley was killed in an avalanche of trash while bringing Homer dinner, and bedridden Homer starved to death. There have been others, some famous, some not, usually considered, kindly, to be eccentric. Still, it was rare enough to be largely unknown.
Until three years ago, when reality TV producers evidently ran out of people who want to marry dads, moms, little people, Gypsies, rednecks, and big fat Greeks…and discovered hoarders. In 2009, A&E introduced the disturbing new show Hoarders, and before long, TLC followed with Hoarding: Buried Alive , followed shortly by Confessions: Animal Hoarding on Animal Planet, because one show about mental illness is simply not enough.
As viewers tuned in, presumably to make themselves feel better about their own housekeeping skills, the psychiatric community also took note. In the upcoming 5th edition of the Diagnostic and Statistical Manual (DSM), the American Psychiatric Association (APA) is considering adding hoarding as a diagnosable mental disorder in the manual due for publication in May 2013.
In the current DSM, hoarding is considered an offshoot of obsessive-compulsive disorder (OCD). The new classification has a defined and separate set of symptoms:
Unofficially, diagnostic criteria for hoarding disorder has been circulating within the psychiatric community for nearly a decade. The disorder is characterized by:
- The acquisition of a huge number of possessions of limited value and the inability to discard anything.
- Living spaces so cluttered they become useless and difficult or impossible to navigate.
- Significant distress or impairment in functioning due to hoarding.
Hoarding disorder is estimated to occur in 2% to 5% of the total population.
This may be the first time ever that a reality show inspired a reality. The shows are deeply personal and often humiliating, and painful for the hoarder, the hoarder’s friends and family, and sometimes for the viewer. For researchers, it offered insights that might be gleaned in no other way. In clinical trials, the research is centering on the decision-making process. When faced with a decision to keep or discard an item they own, the anterior cingulate cortex and insula of people with hoarding disorders goes into overdrive, and the subjects report a feeling of indecisiveness and uncertainty, making it impossible to formulate a decision.
It seems like good news for people suffering from this disorder, since it has significant differences from OCD. A separate diagnosis means separate approaches to treatment. The question is whether other reality shows may lead to additional medical research. Are there other shows that might result in new diagnoses? Should the medical community be looking at the bad behavior exhibited by denizens of the Jersey Shore or at the compulsion to have dozens of children like the Duggars?