How Hoarders Process Information

I found the following article to be incredibly fascinating, and concur with study author Jennifer M. Sumner’s statement that hoarders have difficulties with establishing bulk categories for their possessions. This results in a complete inability to organize items, so they accumulate. I have included a link to the original post for reference.

mind of a hoarder

Inside the Mind of a Hoarder
A new study hints at the real reason behind the mess.
By Agata Blaszczak Boxe

When Paul Hammond, a resident of Mobile, Alabama, started collecting used cars and appliances to sell for scrap metal, he probably did not suspect that his habit would one day turn into a serious hoarding issue and land him in jail.

But, over the years, random items kept piling up in his yard, and Hammond just was not getting rid of them. After numerous complaints from the neighbors, who accused him of turning his property into a junkyard, county authorities got involved and cited him for criminal littering. They also threatened to put him in jail if he did not clean up.

When Hammond’s brother came to visit him for the Fourth of July several years ago, he saw about 90 cars, about 50 refrigerators and 100 lawn mowers in the yard. The brother quit his job for four months to help Hammond get rid of the stuff. But the county officials were not happy with the job the men did and they put Hammond in jail for five days.

“I thought I was a law-abiding citizen,” Hammond told A&E’s show Hoarders. Although he was released after the five days, he was still facing up to 90 more days in jail if he did not clean up around the time the TV crew came to film an episode about him.

Hammond is one of the many people with hoarding disorder who end up being overwhelmed with possessions they can’t organize or get rid of. Hoarding is a disorder that may be present on its own or as a symptom of another disorder, for example, obsessive-compulsive disorder (OCD), attention-deficit/hyperactivity disorder (ADHD) and depression. To try to understand what mechanisms in the brain may be responsible for hoarding behavior, researchers have recently begun to look at the neurocognitive aspects of the disorder, but studies have yielded mixed results.

For example, one study looked at people with obsessive-compulsive disorder and found that those who had high levels of hoarding behavior performed significantly worse on tests of decision making, planning and properly shifting attention, compared with people with OCD with lower levels of hoarding. However, it’s difficult to conclude that these cognitive traits are responsible for hoarding because another study found people with hoarding disorder actually performed better on the same type of test than participants with non-hoarding OCD.

In a new study, published in Neuropsychology, researchers looked at neurocognitive functioning in 26 people with hoarding disorder and 23 people without the disorder. The researchers thought the discrepancies between the results of previous studies could have been caused by the effects of medications used by some of the participants, so in the new study, they decided to only include people who were not taking any medication that could affect their brain functioning in any way.

The new study found no significant differences in how people in both groups performed on tests examining their verbal memory, attention, or executive functions such as planning, organization and decision-making.

But the researchers did find a difference between the groups: when they asked the participants to categorize different stimuli in a separate test, the people with the hoarding disorder appeared to use different learning strategies during the categorizing task, compared with the controls. Namely, they tended to use explicit learning, which is about developing and verbalizing rules to remember something, explained study author Jennifer M. Sumner, of the University of California San Diego School of Medicine. In contrast, most people without the disorder used implicit learning, which is an unconscious, non-linear and non-verbal way to learn new information.

The researchers don’t know for sure how these results should be interpreted. But the findings do make them wonder whether, in people with hoarding disorder, the inability to organize and sort through their possessions might have something to do with how they process information, Sumner said.

It could be, for example, that people with the disorder try to come up with rules as to where different objects should go, but because they may end up creating too many rules, “it ends up being chaotic and cluttered,” Sumner said. Conversely, people without the disorder “might look at objects in their home and have this implicit, intrinsic subconscious ability to know where objects go, to know what is not important and what they can get rid of,” she told Braindecoder. “So they don’t have that clutter.”

In fact, previous research has suggested that people with the disorder tend to be under-inclusive in how they categorize the things they have, Sumner said.

“If you give them 10 objects to sort, they may put them in 10 different categories because they are all unique and complex in their own way,” Sumner said. But if a person without the disorder is given the same 10 objects, they may be able to put them in just two different groups, so they are easily organized and there is no clutter, she said.

“So we have this ability implicitly to decide where things should go,” which many people with hoarding disorder may not have, Sumner said.

Are You A Skin Picker?

DermatillomaniaI know that many of you may find it irresistible to pick and squeeze acne blemishes and scabs which pop up on your skin. However, there are individuals who take this compulsion to an extreme and create abrasions and divots in their skin even when there is no blemish in sight. These people suffer from a form of obsessive-compulsive disorder known as dermatillomania or skin picking disorder.

The characteristics which separate a dermatillomania sufferer from a relatively “normal” tendency to pick are:

• Repetitive picking at the skin
• Picking which is severe enough to cause tissue damage
• Social distress

People who suffer from skin picking disorder also commonly have depression and/or anxiety and low self-esteem. Common areas which sufferers tend to pick at are the face, scalp, cuticules, arms, forearms, back, hands and feet. Most of the time people will pick with their fingernails, but may also use their teeth, tweezers or scissors. This tendency may be triggered by boredom, stress, or anger, and is often such an absent-minded activity that people may not even be aware that they are picking. The picking behavior often provides relief from tension, but what frequently follows is guilt and feelings of shame. The most extreme cases are best treated with psychotherapy and medication, while milder cases can often be successfully treated with behavior modification.

I frequently see patients who have neurotic excoriations (areas of irritated, abraded skin) and areas of brown hyperpigmentation (from older spots which have been picked) which are dead giveaways to skin picking disorder. The typical patient I see is anxious and perceives any real or fabricated skin imperfection is distorted in significance. The sufferer may experience satisfaction after picking at the skin, but a vicious cycle sets in by which the open sores are constantly picked at, making them far worse and decreasing the likelihood that they will heal without some permanent scarring.

Here are a few suggestions for mild skin pickers to practice in order to break the cycle of picking.

1. Avoid spending excessive amounts of time looking in the mirror for areas to pick.
2. Remember that the zone of infection is an inverted triangle spanning across the eyes and down to the area below the mouth.
3. ANY area of the skin that is picked at can develop infection.
4. Keep fingernails short to make it more difficult to use your nails as a picking tool.
5. Avoid using tweezers to pick at skin.
6. When you get an acne blemish, DO NOT pick at it or attempt to extract it. Instead, apply ice to the blemish, use hydrocortisone cream, or apply old fashioned toothpaste (Crest original formula is perfect) to the blemish.
7. Remember that an acne blemish is far better than an abrasion, scab that doesn’t heal from constant picking, brown hyperpigmentation, or a permanent sunken scar.

I am saddened by the people who come in for cosmetic dermatology treatments who exhibit the signs of skin picking disorder. The most common patient is female, between late teens to early 40’s, and has a palpable anxious energy. Though I can always spot a patient with the disorder by the telltale excoriations, the patient’s embarrassment is heightened when the cover-up makeup comes off and I can see hyperpigmentation from areas that were picked at previously. I cannot tell you how many attractive women have come into my office who have essentially ruined their skin by picking at it. No blemish is worth picking at, especially when permanent scarring can result.