How Do Mental Images Affect People With Hoarding Disorder When They Try to Discard Items?

What you need to know

• People with hoarding disorder experience frequent intrusive mental images in daily life that are more negative and disruptive compared to people without the disorder
• When trying to discard valued possessions, people with hoarding disorder experience positive mental images that make it harder to let go of items
• Understanding these mental images could lead to new treatment approaches for hoarding disorder

Understanding Mental Images in Hoarding

Hoarding disorder affects about 1.5% of people and causes significant problems in their lives. People with hoarding disorder have extreme difficulty discarding possessions and accumulate so many items that their living spaces become unusable. This can lead to serious consequences like family conflicts, eviction, and safety hazards.

While we know that difficult life experiences and trauma are common in people who hoard, researchers hadn’t previously studied how mental images might play a role in the condition. Mental images are like pictures or movies that play in our mind - they can be memories of past events or imagined scenarios. These kinds of intrusive mental images are known to be important in other mental health conditions like post-traumatic stress disorder and social anxiety.

The Research Findings

Researchers interviewed 27 people with hoarding disorder and 28 people without the condition about their experiences with mental images, both in everyday life and when trying to discard possessions.

Everyday Mental Images

The study found that people with hoarding disorder experienced mental images that were:

• More frequent throughout the week
• More negative in emotional tone
• More disruptive to daily life
• More likely to be actively avoided

The content of these everyday mental images often involved themes like:

• Illness or death of others
• Positive memories from the past
• Personal danger or illness
• Clutter in their environment
• Environmental waste and damage

Images When Discarding Items

An especially interesting finding emerged when participants tried to discard possessions:

For items of low personal value:

• People with hoarding disorder experienced more negative mental images compared to the control group
• These negative images made discarding more difficult

For highly valued items:

• Both groups experienced mental images, but people with hoarding experienced particularly positive and vivid images
• These positive images were often memories connected to the object
• The images made it harder for people with hoarding to let go of items
• Unlike the control group, people with hoarding didn’t try to avoid these positive images

Why This Matters for Treatment

Current treatments for hoarding disorder, while helpful, often don’t lead to complete recovery. The discovery that mental images play an important role suggests new possibilities for treatment.

Therapists could:

1. Assess what kinds of mental images come up when someone tries to discard items
2. Help develop alternative mental images that support letting go rather than keeping items
3. Address negative images using established techniques from other disorders
4. Help people manage positive images that make it hard to discard items

For example, if someone experiences positive memories when trying to discard an item, they could be helped to create a competing positive image of the benefits of letting go - like imagining family members enjoying a cleared dining table together.

Conclusions

• Mental images are an important but previously overlooked aspect of hoarding disorder
• Both negative everyday images and positive images related to possessions may help maintain hoarding behaviors
• New treatments targeting these mental images could help people who haven’t fully recovered with current approaches