Hoarding Disorder and Suicide

Hoarding Disorder (HD), classified under the category of Obsessive-Compulsive and Related Disorders (OCRDs) in the DSM-5, has gained significant attention due to its association with heightened suicidality. Here, we explore the relationship between HD and suicidal behaviors, drawing on the recent meta-analysis by Pellegrini et al. (2021). A meta-analysis can generate more robust conclusions than a single study because it includes more subjects and accumulated results. Pellegrini et al. revealed critical insights into the prevalence and risk factors associated with suicide in patients with HD, emphasizing the need for enhanced suicide risk assessment and intervention strategies tailored to this population.

Prevalence of Suicidality in Hoarding Disorder

A desperate hoarder contemplating suicide

Source: CHATGPT / OpenAI

Pellegrini et al.'s (2021) meta-analysis systematically examined the prevalence of suicide attempts and ideation across different OCRDs, including HD. The findings indicate that individuals with HD exhibit a significant lifetime prevalence of suicide attempts (24.1%), a rate notably higher than those without the disorder and approximating rates seen in some other OCRDs. Furthermore, the prevalence of current and lifetime suicidal ideation in individuals with HD was estimated at 18.4% and 38.3%, respectively. These figures suggest that nearly one in four individuals with HD may attempt suicide at some point in their lives, underscoring the severe psychological burden associated with this disorder.

Factors Contributing to Increased Suicide Risk in Hoarding Disorder

Several factors may contribute to the elevated suicidality observed in individuals with HD. According to Pellegrini et al. (2021), poor educational attainment emerged as a significant factor associated with increased suicide attempt rates in patients with HD. This finding aligns with broader research indicating that lower educational achievement often correlates with various adverse health outcomes, including mental health issues and suicidality. The authors also highlighted that HD is frequently comorbid with other psychiatric conditions, such as major depressive disorder and anxiety disorders, which are well-established risk factors for suicide.

Additionally, the chronic and progressively impairing nature of HD may contribute to suicidal thoughts and behaviors. HD often leads to significant functional impairment, social isolation, and deterioration in the quality of life, which can exacerbate feelings of hopelessness and despair, common precursors to suicidal ideation and attempts. The distress caused by the clutter and inability to discard items, coupled with a perceived loss of control over one's environment, may further aggravate these psychological burdens, increasing the risk of suicidality.

Comparisons With Other OCRDs

While the prevalence of suicide attempts in HD is concerning, it remains lower than that observed in Body Dysmorphic Disorder (BDD), another disorder within the OCRD category. Pellegrini et al. (2021) reported a lifetime suicide attempt rate of 35.2% in individuals with BDD, significantly higher than the rate found in HD. This discrepancy could be partially attributed to the different psychopathological mechanisms underlying these disorders. BDD is characterized by intense preoccupation with perceived physical flaws, often leading to severe distress, social withdrawal, and impulsive behaviors such as substance abuse, which can elevate suicide risk. In contrast, the compulsive acquisition and difficulty discarding possessions seen in HD may be less directly associated with impulsivity but more strongly linked with chronic psychological distress and comorbid psychiatric conditions.

The lower rate of suicidality in HD compared to BDD and other OCRDs like OCD (obsessive-compulsive disorder) and Grooming Disorders may also reflect the unique cognitive and behavioral characteristics of HD. Unlike OCD, where intrusive and distressing obsessions often drive the compulsions, the behaviors in HD may be perceived by the individual as less immediately threatening despite their long-term impact on well-being. This difference might explain the comparatively lower—but still significant—prevalence of suicidal behaviors in HD.

Clinical Implications and Recommendations

The findings from Pellegrini et al.'s (2021) meta-analysis highlight the need for heightened awareness and targeted interventions for suicidality among those with HD. Given the relatively high prevalence of suicidal behavior in this population, clinicians should incorporate routine suicide risk assessments into the standard care of individuals with HD. These assessments should consider not only the direct symptoms of HD but also comorbid psychiatric conditions, such as depression and anxiety, that can exacerbate suicide risk.

Furthermore, the study suggests that addressing socio-demographic factors like poor educational attainment and social isolation may be vital components of a comprehensive approach to managing suicidality in HD. Interventions aimed at improving social support networks and access to education or vocational opportunities could mitigate some of the risk factors linked with suicidality.

In addition to psychosocial interventions, pharmacological treatment of comorbid depression or anxiety disorders may also be necessary to reduce suicide risk. Cognitive-behavioral therapy (CBT), particularly hoarding-specific CBT, has shown promise in reducing hoarding symptoms and associated distress. Incorporating modules that address suicidality directly, such as safety planning and coping strategies, could further enhance the effectiveness of these treatments.

Hoarding Essential Reads

What Distinguishes a Hoarder From a Collector?

5 Warning Signs You’re a Digital Hoarder

Conclusion

The meta-analysis by Pellegrini et al. (2021) provides compelling evidence that suicidality is a significant concern in patients with Hoarding Disorder. The lifetime prevalence rates of suicide attempts and ideation highlight the severe psychological burden associated with HD and the need for tailored assessment and intervention strategies. Clinicians should be vigilant in identifying and addressing risk factors for suicide in this population, including comorbid psychiatric conditions, poor educational attainment, and social isolation. By adopting a multifaceted approach to treatment that incorporates both psychosocial and pharmacological strategies, it may be possible to reduce the risk of suicide and improve the overall quality of life for individuals living with HD.

If you or someone you love is contemplating suicide, seek help immediately. For help 24/7 dial 988 for the National Suicide Prevention Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist near you, visit the Psychology Today Therapy Directory.