Anxiety and Hoarding in the Elderly

In many cases, anxiety is a normal response to stress. The feeling of elevated alertness is a part of the body’s fight or flight response, which helps us to quickly assess and react to high stakes and dangerous situations. When this response is triggered only situationally, in appropriate conditions, anxiety is otherwise normal and healthy. But for some people, the response is triggered by inappropriate situations that do not actually pose any sort of threat. When anxiety becomes a near constant concern, to the point where life becomes centered around managing fears, worries, and it negatively affects daily life and activities, then it becomes a serious mental health condition.

There are several different types of anxiety disorders. Studies have estimated the prevalence of anxiety disorders in older adults is between three and fourteen percent, with specific phobias and generalized anxiety disorder being the most common. However, psychiatric disorders are widely underdiagnosed and undertreated, especially among the senior age group. And research suggests that there are many adults who do not necessarily meet the full criteria to have a psychiatric diagnosis, but the problems they face are still clinically significant enough to interfere with their functional abilities.

Anxiety disorders typically develop early and late onset is relatively infrequent. However, many different factors can affect the manifestation and severity of one’s symptoms. Because late adulthood is frequently characterized by considerable changes in health, independence, cognition, and social support, it can be different to accurately diagnose psychiatric disorders in older adults. What further complicates things is there is considerable overlap between the symptoms of many common health disorders to older adults, and anxiety disorders.

Obsessive-compulsive disorder, or OCD, is characterized by persistent, upsetting thoughts, along with repetitive behaviors used as a method of control for the anxiety these thoughts produce. While OCD was originally listed as an anxiety disorder, as of late the two have been thought of as separate conditions. One study identified four major OCD symptom dimensions, which were symmetry obsessions (counting or ordering), forbidden thoughts, cleaning, and hoarding.

Hoarding is the excessive collection of items and difficulty parting with them. Hoarding often creates cramped, dangerous, and unsanitary living conditions, with homes that may be filled to capacity with only narrow footpaths winding through stacks of clutter.

People who hoard frequently consider their possessions essential to their identities. Losing or disposing of a possession may produce extreme anxiety or even a sense of loss and grief. Hoarding frequently demonstrates a need for comfort due to the deep fears and anxiety the sufferer experiences. Others hold on to items because of the fear their memories will be lost without tangible evidence of the past.

The American Psychiatric Association has said that individuals with pathological hoarding behaviors could receive either a diagnosis of OCD, an anxiety disorder, or no disorder at all since many severe cases of hoarding are not accompanied by obsessive or compulsive behavior. Research suggests that Alzheimer’s and other forms of dementia may contribute to hoarding behaviors by magnifying existing personality characteristics and behavior patterns in older adults.