Hoarding Behaviors and Bipolar Disorder: Examining the Comorbid Relationship

Examining the Connection Between Bipolar Disorder and Hoarding Tendencies

Bipolar disorder involves significant shifts in mood, energy, and activity levels. The condition alternates between emotional highs (mania) and lows (depression). An estimated 2.8% of U.S. adults have bipolar disorder in a given year.

In addition to emotional symptoms, some research reveals that people with bipolar disorder disproportionately grapple with problematic hoarding behaviors as well. Understanding this comorbid psychiatric relationship can help improve treatment approaches.

Defining Hoarding Disorder

Hoarding disorder refers to persistent difficulty discarding possessions due to extreme emotional attachment and perceived necessity of saving items.

Compulsive hoarding behaviors often lead to unsafe or unhealthy accumulation of items throughout living spaces. In severe cases, hoarding creates fire risks, problems with hygiene/cleanliness, and other threats to health and home safety.

An estimated 2-6% percent of the population exhibits problematic hoarding. And among people getting mental health treatment, hoarding occurs in up to 24% of cases.

Hoarding as a Standalone or Comorbid Condition

For some people struggling with hoarding disorder, these obsessive saving and collecting behaviors occur independently as the primary psychiatric issue requiring treatment.

However, hoarding also frequently manifests alongside other mental health diagnoses like major depressive disorder, anxiety disorders, and OCD. Research reveals especially strong ties between hoarding and bipolar disorder.

The Rate of Hoarding Behaviors Among Bipolar Disorder Patients

Analyzing multiple studies evaluating hoarding among bipolar patients, researchers identified an average comorbid hoarding rate of nearly 21%. This indicates that over 1 in 5 people with bipolar disorder also exhibit clinically significant hoarding.

In the general population without mental illness, only an estimated 2-5% hoard at problematic levels. So bipolar disorder coincides with a sharply elevated hoarding risk.

Key Factors Driving this Comorbid Relationship

Understanding why hoarding and bipolar disorder co-occur at such high rates requires examining potential overlapping drivers, including:

• Genetic vulnerabilities
• Family history
• Trauma history
• Impulsivity
• Emotional dysregulation

Researchers actively investigate the biological, psychological, and emotional factors interlinking complications like hoarding with mood disorders characterized by cycling manic and depressed phases.

Shared Genetic Vulnerabilities

Twin studies reveal that hoarding tendencies have around a 50% genetic heritability rate. This means that roughly half the risk traces to inherited genetics.

Bipolar disorder also carries noteworthy genetic underpinnings, with inherited DNA making up 60-80% of susceptibility. Certain genes like ANK3 and CACNA1 may heighten risks for both bipolar and hoarding.

Overlapping genetic risks likely help fuel the frequent pairing of these two conditions.

Family History Connections

Along with genetic links, researchers find that bipolar disorder and hoarding both run strongly in families. Having a first-degree relative with either condition elevates associated risks.

For example, people with hoarding parents or siblings face 2-4 times higher lifetime odds of hoarding themselves. The hereditary passage of hoarding tendencies within families parallels whats seen for mood disorders.

So inheriting a familial inclination for either bipolar or hoarding may increase susceptibility to both through interconnected genetic and environmental family components.

Shared Neurobiology

Neuroimaging studies reveal that bipolar disorder and hoarding associate with some similar brain activity patterns. Both involve abnormalities in prefrontal and anterior cingulate regions regulating executive functioning, emotion processing, reward systems, and decision-making.

Dysfunction within overlapping neural circuitry governing organization, planning, and emotion regulation may therefore help drive the clinical hoarding and mood disturbances accompanying bipolar disorder in many individuals.

Key Features of Bipolar-Associated Hoarding

While hoarding with bipolar disorder shares the core difficulty discarding items seen in general hoarding, some distinctive characteristics emerge among many bipolar hoarders.

More Severe and Longstanding Hoarding

On average, people exhibiting hoarding with bipolar disorder report more extreme, disruptive hoarding than individuals struggling with solitary hoarding problems.

Those with both conditions also tend to describe lifelong hoarding behaviors dating back to childhood or early adolescence. The hoarding patterns typically manifest years before apparent bipolar symptoms arise.

Hoarding Fluctuations Align With Mood Episodes

Many individuals describe worsening hoarding activity alongside bipolar mood episodes. Manic phases often coincide with frenzied acquiring and saving. Depressive episodes then fuel not discarding spare possessions.

So the fluctuating course of bipolar disorder creates ongoing, alternating cycles of acquisition and difficulty clearing clutter.

More Refusal to Discard

Bipolar hoarders exhibit higher levels of saving behaviors, owning far more items than typical solitary hoarders. They also report greater attachment to possessions and refusal to discard items compared to non-bipolar hoarders.

Manic states likely reinforce perceived necessity of items. And depressive phases enhance refusal to part with belonging due to fears of regret or mistake.

High Comorbid Anxiety

Worry and anxiety feature prominently among individuals struggling with both hoarding disorder and bipolar disorder. Up to 75% have an anxiety disorder diagnosis.

Anxiety seemingly fuels hoarding, while hoarded clutter sparks further anxiety. This cyclic relationship serves to worsen both hoarding behaviors and bipolar mood instability over time.

Getting Effective Treatment for Comorbid Bipolar and Hoarding

Given the distressing, impairing dual impact of simultaneous hoarding and bipolar issues, getting integrated psychiatric treatment represents a pivotal first step for management.

Cognitive-behavioral therapy (CBT) combined with medication interventions often yields the best outcomes for these co-occurring conditions.

Psychotherapy Approaches

CBT and related psychotherapy techniques help individuals work through emotional blockages preserving hoarding habits. This talk therapy also assists with improving organizational skills, decision-making abilities, and coping mechanisms.

For bipolar hoarders specifically, treatment focuses on:

• Boosting emotional regulation capacities
• Stabilizing mood fluctuations
• Diminishing acquisitiveness and accumulation

Therapists support decluttering and discarding items using evidenced systematic methods. Over time, this cognitive-behavioral approach enables maintaining tidier, safer living environments despite lingering urges to acquire and save.

Medication Options

Certain classes of psychiatric medications show promise for ameliorating both bipolar disorder and hoarding symptoms when used adjunctively with therapy.

Mood stabilizing medications like lithium, anticonvulsants, and some antipsychotics smooth out high and low mood swings. Fewer bipolar fluctuations reduce handicapping functional impacts enabling engaging more successfully in other interventions.

Antidepressant medications, particularly SSRI/SNRIs approved for OCD, may curb obsessive fixation on possessions. Some compulsive hoarding behaviors arise from underlying depression and anxiety as well.

Medications essentially set the stage for better receptiveness to CBT and related approaches actively changing thoughts and behaviors perpetuating hoarding and bipolar disability.

However, finding the right medication regimen takes patience through trial and error. Many bipolar patients try numerous medications before discovering their optimal mix. So being open to adjusting medications over time often proves important.

Consistency

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.