Literature review

Hoarding runs in families common individuals who involve in hoarding behavioral patterns have family member or relative who is also going through same problem .It means genes are the aspects that make the individuals on risk of hoarding disorder development (American Psychiatric Association, 2016). Biologists also predicted from their studies brain injuries and dysfunctioning in specific areas can be the secondary cause of this disorder (American Psychiatric Association, 2016). They also claimed that specific abnormalities of brain are also predictor of hoarding disorder and it is also distinct from other people with OCD. Several individuals with hoarding disorder too experience additional mental disorders, including depression, anxiety disorders, attention deficit/hyperactivity disorder, or alcohol use disorder. A traumatic life experience, such as the death of a valued one, can also trigger or aggravate symptoms of hoarding (American Psychiatric Association, 2016). Famiy deprivation Chen and colleagues carried French study to evaluate relationship between development of hoarding and attachments patterns with family. They collected data from hoarders that depicted insecure attachment with parents. It mean parenting styles act as a precursor of hoarding disorder or its related symptoms in children. Waters and Cummings (2000) also found that circumstances that we face in childhood like attachment affects actions all over the life phase and active childhood attachment eases the buoyant use of relationship with adults’ relational affection and dependence Moreover Medard and Kellett (2014) found from their study a positive association between insecure attachment and hoarding behaviors. They claimed that when parents doesn’t provide alliance in childhood that is considered personality development period led to growth of hoarding related issues. They also stated that negative relationship is present between secure attachment and hoarding problem. Part of literature. Herring in 2015 surveyed about hoarding construct when it was not considered it distinct from Obsessive Compulsive Disorder in DSM IV and researches were going on to consider it seaparte from OCD. He investigated about hoarding construct and found that in today society it has been legitimized as a disease that are affecting people in America with proportion of 6 to 15 million . In his research he coded the review about popular television show named Hoarders: Buried Alive Hoarders, aired in 2010 Animal Hoarding [Animal Planet, 2010] that define it like: embellished the disease with unhealthy profiles of wicked mess, untidiness, compulsive behavior, both “treated” at the end of each dramatic episode by teams of trained professionals who scrubbed up the clutter and counseled therapy for them. Mataix-col treated women with hoarding disorder. This 53 year old and physically healthy lady were referred to her mental health clinic for the symptoms of depression and anxiety. She wrote that when started to ask questions about her problem then she got a bulk of information about client habit to collect clothes, boxes, magazines etc. that had taken the whole space of her apartment and she is living in basement of her apartment building. She also reported that even she got distress and anxious due to mere thought of discarding. Service Master Pittsburgh in 2014 claimed about proportion of hoarders in America he concluded that approximately 5% of the American population are coping with this hoarding issue, but it is not considered only 5 % population are hoarders that are only disturbed, due to them family also effect. Relationship with hoarders are strained not only outside home but inside of home as well. Not only adults have problem with hoarders even its also distressing for children because if their parents are hoarders then they feel hesitant to invite their friends on home and also feel it embarrassing situation if their friend found their home messy (Service Master Pittsburgh, 2014 ). Their friend start to bully them in school due to untidiness, messy and chaotic condition of their home. The battle between children and hoarders to discard useless stuff and keep home clean sometimes it leaves behind results of battle in form of anger and misunderstanding (Service Master Pittsburgh, 2014 ). Tolin, Frostc, steketee, & Fitch (2008) carried survey on Six hundred sixty-five family informers who stated having a family member or friend with hoarding behaviors completed an internet-based survey. They reported that living with hoards during childhood was linked with higher accounts of childhood distress and family tension. Family members reported about experience of raised level of Family members reported high levels of refusal attitudes, suggesting high levels of family frustration and hostility. Literature proves Around, 3%-5% of American peoples accounts for compulsive hoarding but it also mark family members to suffer. Tompkins carried investigation in 2011 to describe how much family members experience helplessness, anger, hostility and resentment feelings when hoarders from their family refused to accept their habit of collecting stuff is problematic and refusal to accept assistance from family to discard possessions. He used harm reduction approach to help family who indirectly will arouse hoarders to accept their problem. At present, we are in abstruse condition to know about the influence that family members put on symptoms of hoarding their functioning (Vorstenbosch, 2013). Earlier exploration has recognized a substantial relationship between hoarding and relationship complications, including lower proportions of marriage and greater rates of divorce for entities with hoarding problems (Steketee & Frost, 2003). Furthermore, family members have stated experiencing burden in reaction to existing with or caring for a loved one with hoarding problems (Tolin, Frost, Steketee, & Fitch, 2008). As earlier noticed, severity of hoarding, awareness and family housing may have noteworthy negative control on family functioning. Though case studies and anecdotal evidence have proposed a evident disturbance inside families of compulsive hoarders, even systematic also proved association of compulsive disorder with family pressure (Tolin, Frost, Steketee, & Fitch, 2008; Wilbram, et al., 2008). In an internet survey of 665 family members (i.e., children, significant others, siblings) and friends of hoarders, informants reported increased negative attitudes towards the hoarder (Tolin, Frost, Steketee, & Fitch, 2008), such as frustration, rejection, and hostility. Though, a smaller amount of is known about the effects that close significant others‟ (CSOs‟) behavioural responses have on individuals‟ hoarding symptoms, functional impairment, and wellbeing. Beside with the adverse influence on the individual, earlier literature have showed that involvement in compulsive hoarding is not merely marring and considerably troublesome for family members, on the other hand also related to disturbances in family functioning (Jennifer, 2014). The path model analysis was used to check association between hoarding family functioning and parent child relationship. Outcomes exposed that family functioning facilitated the association between hoarding sternness and parent-adult child relationship. Reduced awareness into hoarding symptoms was openly related with diminished value of parent-adult child relationships, which was intervened by family functioning. They found that family impair functioning of hoarders due to their excess accommodation for hoarders. Hoarding disorder is associated with significant impairment for the individual such as lower rates of employment and social isolation. However, less is known about the impact of this condition on the children of people with hoarding disorder (HD). No qualitative research to date has focussed exclusively on the experiences of adult offspring of parents with hoarding difficulties. The present qualitative study set out to investigate the experiences of adult offspring of parents with hoarding difficulties, exploring the present, and longer‐term impacts of parental hoarding. Differential diagnosis: A clinical practioner in field of mental health before diagnosis of hoarding disorder assess neurological condition (traumatic brain abnormality, injury) or other mental disorders like autism spectrum disorder because individuals with this problem have habit to store things in a huge volume (Mataix, 2014). They supposed hoarding can develop in outcome of typical signs of obsessive compulsive disorder (contamination fear, feeling of incompleteness) so in this case OCD should be diagnosed (Pertusa, Frost & Mataix, 2010). Diogenes condition is the mixture of severe self-neglect, internal dirtiness, social withdrawal, hoarding, and denial of assistance, in elderly patients is comorbid with psychiatric/somatic disorders and even Depression and dementia are considered risk factors for self-neglect ( Lahera, Saiz-González, Pérez-Rodrígue,&  Baca-García, .2006). Literature has predicted that hoarders live in unsanitary condition, untidiness they show from their behavior because they can’t arrange stuff in an organized form and clean it. It has been found full criteria or picture of other mental disorders (OCD, dementia) are shown by person who live in place filled with rotten food, trash or excrement (Snowdon, Pertusa, Mataix-ColS, 2012). Some authors recommend that Diogenes is associated with neglect of self-care that is also symptom of hoarding (abrams, lachs , mcavay, keohane & bruce, 2002). Ayers, Thorp & Wetherel in 2012 carried study on adults to see the difference between anxiety and hoarding disorder. Because anxiety is also experienced by hoarders because of having alliance with possessions they feel anxious when thought about discarding. They concluded that before going to diagnose this disorder we need to assess it on anxiety disorder also. Hoarding signs have been defined in individuals with autism spectrum disorders (ASD). Moreover, individuals with hoarding disorder (HD) may show some ASD-like features. Two hundred and twenty-one participants of assessed. It has been concluded that individuals with HD do not show more autistic traits. So it mean person with hoarders are not diagnosed with Autism Spectrum disorder (Pertusa, Eriksson, Bejerto & Ferna Collecting and hoarding possibly seem alike, but there are discrete individualities between hoarders and collectors that established them independent terms. Collecting often includes the targeted exploration and gaining of definite items that practice a greater gratitude, deeper understanding, or increased value when joint with further related items. In contrast Hoarding seems jumbled and involves the general acquiring of common items that especially not meaningful for person who collects in a large quantities (Neziroglu, Fuge, 2014). Collector keeps things that are valuable for them but it is not for hoarders. Most of hoarders are messy, and their living spaces are congested and in jumbled form but its not with collectors who keep stuff in systematic form and can afford room to lay their collections (APA, 2014).   Prevalence and Course of Hoarding In general population the proportion of hoarding disorder estimated to be between 2 and 5%(Iervolino et al., 2009; Samuels et al., 2008). The studies of various researchers proved the chronic course of this illness and found the onset of hoarding in childhood poor adolescence period. (Grisham, Frost, Steketee, Kim, & Hood, 2006; Tolin, Meunier, Frost, & Steketee, 2010). Before the study of Tolin, Meunier, and colleagues (2010) the exact onset of hoarding was unknown but they reported age of onset between 11 to 15 years and proposed major population of hoarders engage in this pattern from early 20s. These symptoms get worsen in severity over time (Grisham et al., 2006). Thus, it should not be astonishing that incidence proportions for challenging hoarding have found to increase over age; individuals with age of 55 years or more old are more vulnerable to experience hoarding related traits than individuals with 34 or more than it. (Samuels et al., 2008). Furthermore, although the assessed incidence proportion for problematic hoarding was not known to change with education level, Patterns of living, or ethnicity, inversely relationship was found with household income,such that middle class individuals with a lower income experienced hoarding five times more likely than individuals with a upper class status(Samuels et al., 2008). Effect of Hoarding Symptoms on Family Members As mentioned previously, it has been identified hoarding disorder chas caused significant deterioration inn individuals who is going through this pain. Nonetheless, as it is putting the life of haorders on verge of pity in addition to it research has identified its detrimental effect on family members or others living around them (Vorstenbosch, 2013). Frost and Gross (1993) interviewed hoarders and intended to explore about effect of hoarders on family dynamic. They found that 63% of entities with hoarding problems account that their family supporters outlook their hoarding-related behaviors as difficult or troublesome. Moreover, hoarders were frequent in reporting about family conflicts or spouse conflict about clutter which proposes that hoarding may put adverse influence on functioning of individuals‟ relationship Frost & Gross, 1993). To support association between hoarding and meagre relationship functioning was examined by Frost, Steketee, and Williams (2000), who seen that hoarders experience withdrawal from society and they depend on others to complete their any task related to home e.g., cooking, cleaning, paying bills. In an experimental study Frost, Steketee, Williams, and Warren (2000) used Sheehan Disability Scale (SDS; Sheehan, 1983) to assess the impact of hoading across various domains of their life. The results showed the detrimental impacts of hoarders on work, social life, leisure activities, relationship with family and their own responsibilities. Results of this study was compared with non-hoarders with OCD and individuals with anxiety and other disorders (Frost, Steketee, Williams, & Warren, 2000). Particularly their research depicted hoarding with OCD put moderate detrimental influence on family relationship and responsibilities than individuals with other disorders. For better comprehension of hoarding effects on family dynamic Wilbram, Kellett, and Beail (2008) conducted interviews from 10 hoarders families and their interviews were analyzed qualitatively. Five interconnecting themes emerged from these interviews, including: 1) loss of normal family life; 2) need for understanding; 3) coping with the situation; 4) impact on relationships; and 5) marginalization (Wilbram et al., 2008). Numerous participants in their study reported that their normal family had diminished like hoarders didn’t leave space for other family members due to family social life get reduce. For instance it is reported by one participants he claimed they had several rooms in home but all are inaccessible for them due to hoarder’s bulk of possessions (Wilbram et al., 2008, p. 63), and another participant 12 detailed that they have limited their social circle because they know that they can’t invite their friends at home so they don’t stride hard to keep up their (Wilbram et al., 2008, p. 64). Additionally, it has been stated from family members, there is need to develop understanding about severity of problems in hoarders then they can be able to bring change, they reported unfortunately hoarders lack this insight so they can’t be compelled to bring change. Therefore, family members frustrated and required to make various efforts to manage this intense situation through implementation of various methods like negotiation with hoarders on discarding or adapting modeling behavior to reduce clutter at home. But these strategies results in failure (Wilbram et al., 2008, p. 63). They claimed that family relationships strained due to frustration, anger feelings, developed interpersonal conflicts with hoarders when they could not facilitate change and shrink clutter feelings of anger and frustration, as well as interpersonal conflict with the individual with the hoarding problem. To end with, physically, emotionally and socially freeze out feelings are reported by many family members. Like physically demoted mean they are pressurized to live in limit, socially marginalized mean friends, family members relative nosedived to recognize the hoarding and bear the situation in their lives in the last emotional detachment in their relationship with hoarders. Inclusive, outcomes of this survey put forward that hoarding is considered systematic problem that create problems for only hoarders but also family dynamic in wide form (Wilbram et al., 2008). Prolonging investigation in hoarding, Tolin, Frost, Steketee, and Fitch (2008) bring into being that there are some problematic situations come upon by hoarders that make them prone to develop affiliation with possessed stuff like their childhood experiences underpinned with distress feelings, reduced happiness, lack of social circle or peer group, trouble in to make friends, conflicting relationship with family and embarrassment in front of others due to parents hoarding habit. Moreover, they used Patient Rejecting Scale to measure patient relation with family and found that family members or relatives pose rejecting attitude and hostile behaviors towards hoarders (PRS; Kreisman, Simmens, & Joy, 1979). During childhood hoarders received negative, rejecting and hostile attitude from family that leads to severity of problem, lack of insight and excess in clutter (Tolin, Frost, Steketee, & Fitch, 2008). While equated with other mental health issues, Tolin, Frost, Steketee, and Fitch (2008) found that score on Patient Rejecting Scale of family members were greater (M = 20.48, SD = 4.57) than those found from family members of treatment-seeking OCD patients (M = 16.81; SD = 3.84; Amir, Freshman, & Foa, 2000) Though the sequential association among concerning hoarding and domestic distress or impairment has not determined until now, outcomes of these studies put forward that hoarding is connected with substantial distress and loss of good alliance with family members. Effect of Family Members on Hoarding Symptoms Specified the general sound effects that have been detected among individuals with hoarding problem and the multifaceted relations that expected to ensue among hoarders and family members. it is essential to recognize means in which family members or relatives play role in development of hoarding problem or if it is present how they exacerbate it. Presently, however, slight research has explored the influence of family behaviors on hoarding symptoms. One important and significant construct that has received little consideration among hoarder’s family members but it has been investigated in detail in family of OCD individuals (Lebowitz, Panza, Su, & Bloch, 2012) that is family accommodation. Family accommodation is defined as the manner by which family members contribute to reduce and amend their individual or family rituals for the reason that of the individual’s psychological well-being signs (Calvocoressi et al., 1995). Struggles with the hoarder concerning clutter was commonly reported; in some cases these conflicts consequently lead to the collapse of relations with caregivers while noticing hatred and anger feelings towards individuals with hoarderding (Jennifer, 2014). In the same way, Black et al. (1998) had seen excessive disturbances in family relations, lack of communication, and absence of emotional involvement in families of OCD patients than normal people of family. Caregivers and spouses of individuals with OCD in this data also identified suffering disturbed family and social life, annoyance and frustration concerning the hoarder, domestic clashes, depression, tiredness and disturbed personal life (Black, Gaffney, Schlosser, & Gabel, 1998). They concluded that family functioning possibly will function as a facilitator among elements related with hoarding (i.e., hoarding sternness, family accommodation and vision) Medard and Kellet in 2014 carried study to examine whether hoarders practice less societal backing and more challenging relations, the point to which attachment and l support from society causes hoarding and whether attachment moderates the relationship between social support and hoarding. They used Savings Inventory–Revised (SI-R) to collect data from 380 hoarders for their outcomes. They found that insecure attachment with parents or other family members and lack of social support seems challenging for hoarders. Danet and secouet (2017) collected data from two hundred and nineteen non-clinical adults who accomplished two self-report measures for attachment and hoarding behaviors. The consequences show a connection between insecure attachments that is worried about loss rejection feelings. Thy thought that hoarders to overcome or cope with fear they show excess involvement in in collection of objects and Possession Therefore, insecure attachment seems to be a susceptibility cause in hoarding behaviors. Alonso and colleagues (2004) proposed that individuals with hoarding problem involve in acquisition of large bulk of objects may be related to their need to compensate their deprived parental attachment in childhood. There are studies related to OCD and parental attachment patterns. Alonso et al. (2004) did not find a marked difference in parents rearing style of OCD patients and healthy people. But hoarding that is symptom of OCD was inversely related to parent’s warmth. Family accommodation in hoarding. To period, two investigation have inspected family accommodation in hoarding. The role of family accommodation in hoarding problem has been investigated by qualitative study, Wilbram and colleagues (2008) found that family members of individuals with hoarding problem accommodate them to modify and manage it. Specially, the interviews of family members revealed that they try hard to accommodate hoarders in their cluttering behavior like they tolerate their excessive involvement in acquisition of things and avoid distress and conflicting reaction from not showing involvement in discarding of clutter (Wilbram et al., 2008). Researches not only restrict themselves to qualitative study they carried recently quantitative study by Steketee, Ayers, Umbach, Tolin, and Frost (2013) examined the construct of family accommodation of family members of individuals with hoarding problems in a large Internet sample. For measuring of accommodation the 16 item self-report Family Response to Hoarding Scale was used (FRHS; Steketee et al., 2013), particularly for this study it was adapted from the FAS for OCD. The FRHS contains two subscales, including the family behavior changes subscale, which evaluates the degree to which family members amend their behaviors concerning the individual with the hoarding problem, and the Family consequences subscale, which gauges the hostile influence that an individual’s hoarding behaviors have on family members. Generally, it was found accommodation had a strong impact on severity of hoarding problem; however, the family consequences subscale was found toward be more intensely associated with hoarding symptom severity than the family behavior changes subscale. These findings were also correlated with the findings of OCD severity with family accommodation. Moreover, in the Steketee et al. (2013) study, family members were more prospective to bring conversion in their manners in the direction of the individual with the hoarding problem and encountered contrary consequences due to loved ones hoarding issue. The outcomes of these two exploration suggest that accommodation is existing among relatives of individuals with hoarding problems; on the other hand, no research up to the present time has inspected the relationship between family accommodation and satisfaction from relationship, impairment in functioning, or wellbeing in a sample of individuals with hoarding problems.