Does Autism Lead To Hoarding? An Exploratory and Reflective Blog…
By: Olivia Handoko
Tags: Hoarding, Autism, Psychology

But to what extent do these overlaps and similarities share the same features?

A few studies have looked more specifically into how ASD and Hoarding Disorder share similar characteristics with one another but differences in how they’re being executed by those with ASD compared to those with HD as well as other disorders (including OCD and anxiety disorders).

In a study done by Pertusa et. al (2012), a look into Hoarding Disorder was investigated to see if autistic traits were more prevalent in these patients than any other psychiatric controls. Pertusa et. al (2012) investigated two goals:

the presence of autistic traits (how much and to what extent) and theory of mind deficits in individuals with HD compared to those with ASD, OCD, anxiety disorders, and individuals without any comorbidity (health nonclinical controls)

the presence of hoarding behaviors in those with ASD compared to individuals that have HD, OCD, anxiety disorders, and nonclinical controls

Pertusa et. al hypothesized that those with a hoarding disorder would show more autistic traits as well poorer theory of mind than any other group investigated, especially individuals who have OCD but do not hoard. However, it was found that those with HD and individuals with OCD who do not hoard did not differ in their social deficits and interpersonal impairments as well as emotional intelligence with other groups. This was proven by the results of both the Autism Spectrum Quotient and Eye Test that is commonly used to measure the presence of autistic traits. This suggests that the presence of hoarding does not mean that an individual may have autism or that autistic traits influence hoarding behaviors. In fact, many individuals who hoard are seen to be less likely to marry and are often more socially isolated and have socially impaired traits than individuals who do not hoard. However, it is possible that these social deficits are consequences as result of their hoarding behaviors rather than impairment of the mind. The act of hoarding can create environments that can be embarrassing especially to those who hoard. Individuals who hoard often have a hard time letting go of seemingly trivial items which may cause disruptions in familial and friend dynamics who also feel frustrated and embarrassed by their love one’s behaviors; thus, leading to relationships drifting apart.

Another aspect of investigation was the amount of hoarding symptoms within the ASD group as compared to the other groups. Pertusa et. al hypothesized that individuals with ASD would reveal more hoarding symptoms than their anxiety disorder patients but would exemplify fewer symptoms compared to those with a Hoarding Disorder. The results of this study revealed that patients with ASD did, in fact, have more hoarding symptoms than did their anxiety disorder counterparts as well as fewer than those found in the Hoarding Disorder group. However, hoarding symptoms between the ASD group and OCD group were said to have no differences. It can be suggested that the presence of hoarding behaviors and/or Hoarding Disorder could be influenced by the presence of OCD; however, the presence of ASD is unrelated to the presence of OCD (Pertusa et. al, 2012).

Individuals with ASD display repeated collections that revolve around some kind of “special interest”. One example could be an interest in dinosaurs in which case the individual has many items that have a theme related to all kinds of dinosaurs. This characteristic, as Pertusa et. al points out, could be attributed to the high scores that patients with ASD performed on the Saving-Inventory Revised. The SIR test is designed to access hoarding; however, it doesn’t specifically focus on its own category of “special interests” which Pertusa et. al suggests “..maybe an overlapping content that can’t be ruled out”. Whether the collection of “special interests” specific to individuals with ASD can be seen as a type of hoarding and the reason for hoarding behaviors in the Autism community is still up for interpretation and further research. It’s possible hoarding scores in individuals with ASD are due to these “special interests” and not so much that hoarding is an independent behavior in people with ASD (Pertusa et. al, 2012).

This idea is further emphasized in a study done by Steenvoorden (2012) on the comparison between hoarders with autistic traits versus individuals who hoard without posessing any autistic traits. This comparison will help investigate and identify if there are any hoarding characteristics that can be discriminated between the two groups and possibly be explained by the presence of autistic traits.

According to the results, it seems that hoarders with ASD and hoarders without ASD did not differ in any of the measurements used for hoarding behaviors. These tests include the Saving Cognitive Inventory that assesses hypothesized beliefs and and attitudes among those with comorbid hoarding (Steenvoorden, 2012) as well as the Saving Inventory Revised and Clutter Image Rating (CIR) that was used to measure an individual’s ratings on a range of clutter present. These results suggest that hoarders with or without autism possess qualities in hoarding that are quite similar. Both groups are similar in their extent of posessions acquired, the amount of clutter present, as well as the inability to discard. Both groups showed equal signs of distress and impairment when it came to discarding items, suggesting that individuals with or without ASD share similar beliefs and attitudes regarding their hoarding behaviors. Some of these behaviors include emotional attachment to their items, the need for control, the belief that their posessions are their responsibility, and a similar amount of trust in their ability to remember memories (Steenvoorden, 2012).

It seems that the manifestation of hoarding does not differ when autistic traits are present. However, similar analysis on the types of items hoarded suggest that, consistent with the study done by Pertusa et. al, hoarders who do have ASD tend to collect items within a “special interest”. Nonetheless, when providing treatment for hoarding and hoarding disorder, clinicians do not have to worry too much about autistic traits as it doesn’t influence how hoarding behaviors are manifested. Rather, in the case of hoarding in autistic patients, it is best that treatment be specialized for autism patients (Steenvoorden, 2012).

In another study by Xu et. al (2015), a large sample of Chinese university students was explored to identify the relationship that autistic traits may have on hoarding when mediating the effects of anxiety and depression. Though the mediating effects were weak, there was a signficant correlation that helped in explaining the relationship between autistic traits and hoarding (Xu et. al, 2015). According to Xu et. al (2015),

“Hoarding in people with high autistic traits could be influenced by anxiety and depression”

The results from the study showed that the higher an individual scored on tests measuring anxiety and depression, the more autistic traits and hoarding behaviors they owned. At least in a non-clinical population, anxiety and depression seem to mediate the manifestation of hoarding in individuals with autistic traits. The reason for this could lie in the idea of “sameness” that individuals with autism find comfort in. Any changes to their environment may cause all sorts of emotions that can lead them feeling anxious and depressed (Xu et. al, 2015). To alleviate these negative feelings, a person with autism may develop repetitive behaviors (in this case, hoarding) to produce an environment that will once again be familiar which ultimately leads to feelings of attachment (Xu et. al, 2015).

Youths who were tested in a study done by Buissonnière-Ariza et. al (2018) found similar correlations. A co-occurrence of anxiety disorders and OCD combined with the presence of ASD was associated with increased hoarding severity (Buissonnière-Ariza et. a, 2018). The symptoms within OCD that were identified to be responsible for hoarding severity are elevated anger, temper tantrums, and argumentative behavior (Buissonnière-Ariza et. al, 2018) which also positively predicted ASD-related traits associated with social difficulties as well as restricted and repetitive behaviors. Hoarding severity was also positively related to internalizing symptoms (feelings of loneliness, sadness, etc) in children with ASD and comorbid anxiety/OCD (Buissonnière-Ariza et. al, 2018). The symptoms of anxiety and OCD may elicit feelings of worry and fear which in turn leads to safety behaviors including the acquiring of items (Buissonnière-Ariza et. al, 2018) that may exceed to extreme cases such as hoarding behaviors. The acquiring of items allows youth to distract themselves and prevent having to face unwanted feelings such as distress due to loss (Buissonnière-Ariza et. al, 2018). As stated (Buissonnière-Ariza et. al, 2018),

“Momentary relief experienced by the child when retaining objects increases probabilities of maintaining that behavior over time”

These findings suggest that individuals who do have ASD coupled with anxiety, depression, and/or OCD may be more at risk of hoarding behaviors than any other groups. It is worth mentioning that, perhaps, early interventions when it comes to emotional regulation as well as difficulties in organization and planning could alleviate the manifestation of hoarding in individuals who have ASD or possess autistic traits. As identified in the study done by Buissonnière-Ariza et. al, youths that underwent only 16 weeks of CBT sessions to focus on their anxiety/OCD symptoms showed significant reduction in hoarding severity.