Question

Wendy Nichols was a 47-year­old single white woman referred to a community mental health team for the management of a mixed presentation of low mood and generalized anxiety. She had never taken any psychiatric medication but had completed a course of cognitive-behavioral therapy for a previous depressive episode 5 years earlier.

     Ms. Nichols's medical history was unremarkable. She lived alone in a two­bedroom apartment and had no family or friends nearby. She had a university degree and worked as a part-time sales assistant in a charity thrift shop. She said she had dated in college but had "somehow been too busy" in recent years. On initial examination, she was an articulate, well-dressed woman who was coherent and cooperative. She was clearly in a low mood. She complained about poor concentration and difficulties getting organized. She denied any substance misuse.

     The clinician noted that Ms. Nichols's purse was filled with bills and other pa­ pers. When asked, the patient initially shrugged it off, indicating that she "carried around my office." When the interviewer inquired further, it emerged that Ms. Nichols had had difficulty discarding important business papers, newspapers, and magazines for as long as she could remember. She felt that it all started when her mother got rid of her old toys when she was age 12. Now, many years later, Ms. Nichols's apartment had become filled with books, stationery, crafts, plastic packages, cardboard boxes, and all sorts of other things. She said she knew it was a little crazy, but these items could be handy one day. She said, "Waste not, want not." She also reported that many of her possessions were beautiful, unique, valuable, or had strong sentimental value. The thought of discarding any of these possessions caused her great distress.

     Over a series of interviews, the clinician developed a clearer understanding of the extent of the problem. Rooms in Ms. Nichols's apartment had begun to fill when she was in her early 30s, and by the time of the interview, she had little room to live. Her kitchen was almost entirely full, so she used a mini fridge and a toaster oven that she had wedged into piles of paper in the hallway. She ate her meals in the only available chair. At night, she moved a pile of papers from the bed onto that chair so she could sleep. Ms. Nichols continued to buy from the charity thrift store where she worked and also picked up daily free newspapers that she planned to read in the future.

     Embarrassed by the condition of her apartment, she had told no one about her behavior and had invited no one into her apartment for at least 15 years. She also avoided social functions and dating, because---despite being naturally sociable and very lonely---she knew she would be unable to reciprocate with invitations to her home. She was surprised to have told the clinician, because she had not told even her own mother, but she would like help. She declined the clinician's offer of a home visit but did offer some photographs from her telephone's camera. The photographs showed furniture, papers, boxes, and clothes piled from floor to ceiling.

      Aside from long-standing feelings of sadness and loneliness, as well as anxiety whenever she tried to clean up or whenever someone tried to befriend her, Ms. Nichols denied other psychiatric symptoms, including delusions, hallucinations, obsessions, and other compulsive behavior.

Using the DSM-V, what is your initial diagnosis (based only on the information given above):

Answer 1

Hoarding disorder diagnosis according to DSM5 people with the tendency of saving things Excessively and thought of releasing them creates huge stress in them.

Hoarder is unable to stop collection the unnecessary things. It causes a huge pile of the items around important locations of the house like kitchen, bathroom, bedroom etc. Makes them unusable and increases the risk of diseases and health-related issues.

In the given case Wendy Nichols's symptoms are very similar to the DSM 5 diagnosis symptoms.

Symptoms of hoarding are given below:

1. Unable to stop the collection of things.

2. Lesser space in the house

3. Depression

4. Isolation

5. Withdrawal

6. Feeling embarrassment of inviting people at home.

7. Disorganized.

Criteria of diagnosis of hoarding:

1. Continuous collection of things regardless of their necessity.

2. Unable to discard things and feeling stress by doing so.

3. Collection of things in Important place of the house.

4. Hoarding may cause social disabilities and distress

5. Hoarding is not related to other mental disorders like pacer William syndrome, cerebrovascular disease, head injuries.

6. It should not be confused with symptoms of another disorder like schizophrenic solutions, obsessive-compulsive disorder etc.