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Differential Diagnosis

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Differential Diagnosis

Hoarding Disorder: ICD-10 code: F42.3

Hoarding Disorder is defined by specific criteria, including the inability to discard items regardless of their lack of utility, as noted by Bratiotis et al. (2021). This behavior is driven by a strong compulsion to keep possessions and the distress associated with getting rid of them. In Sam’s case, this is evident by his extreme emotional distress and anger when his wife throws away items, he values even though they are useless. Despite his wife’s concerns, his tendency to accumulate magazines, cooking supplies, and tissue rolls in various parts of the house supports this diagnosis. Additionally, Sam’s behavior meets another key criterion of hoarding: it negatively impacts essential areas of his life, particularly his relationship with his wife. This illustrates the interpersonal, emotional, and functional impairments characteristic of Hoarding Disorder.

Obsessive-Compulsive Disorder (OCD): ICD-10 code: F42

Another potential diagnosis could be obsessive-compulsive disorder (OCD), which is characterized by persistent, unwanted thoughts (obsessions) and repetitive behaviors (compulsions) performed to alleviate anxiety linked to these obsessions (Brock & Hany, 2023). While Sam did not exhibit compulsive behaviors, his intense attachment to possessions and the distress caused by the idea of losing them hint at obsessive tendencies. However, since there are no compulsive actions to counterbalance these thoughts, OCD seems less likely. Sam’s case appears more focused on his attachment to belongings rather than the ritualistic behaviors typically associated with OCD.

Generalized Anxiety Disorder (GAD): ICD-10- F41. 1

Another contribution to Sam’s presentation could be Generalized Anxiety Disorder. GAD involves excessive concern over multiple aspects of life, such as work, relationships, and health (Munir & Takov, 2022). Sam has been dealing with GAD for 15 years, and this almost certainly plays a different contributor to his symptomatology at the current moment. The loss of his possessions is, in and of itself, an anxious preoccupation for him and one that is most likely part of a general pattern of excessive worrying typical of those with GAD. It is clear, however, that the anxiety seems to be related explicitly to possessions in Sam’s case, lending additional support for Hoarding Disorder as the principal diagnosis.

Case Analysis

The most likely diagnosis for Sam is Hoarding Disorder, according to the DSM-5-TR. Inability to reject or discard possessions, feeling the need to save items, and emotional distress brought on by throwing away items are significant factors for the diagnostic criteria of hoarding disorder, as stated by Lin et al. (2022). His attachment to plainly unimportant objects, such as magazines and snacks, points to this diagnosis. Other evidence of functional impairment includes the clutter in his home and the strain on his relationship with his wife. Since Hoarding Disorder tends to worsen over time without treatment, Sam’s symptoms have also gotten progressively worse over the last year. These behaviors, if not kept under control, have caused severe problems in his personal life and highly stressed his wife due to the clutter that is taking over their living space.

Whereas obsessive thoughts are also common symptoms in more classic forms of OCD, behaviors that are compulsive and typically accompany such obsessive thoughts are not present in Sam. Consequently, while GAD might have a somewhat subsidiary role in enhancing the anxiety Sam feels about losing some possessions, emphasis on the hoarding behaviors points more strongly to Hoarding Disorder as the principal diagnosis from an analyst’s perspective.

Treatment Plan

Pharmacologic Treatment

Selective serotonin reuptake inhibitors (SSRIs), such as Sertraline (Zoloft), are often considered first-line treatments for Hoarding Disorder. In Sam’s case, initiating Sertraline at 50 mg daily would be appropriate, as this medication is effective in managing anxiety and hoarding-related behaviors. According to Singh and Saadabadi (2023), Sertraline has been shown to reduce symptoms of anxiety and distress associated with hoarding, particularly when comorbid conditions like Generalized Anxiety Disorder (GAD) are present. The rationale for using Sertraline is that it can help alleviate the core anxiety and emotional attachment to possessions, making the thought of losing items less overwhelming for Sam. Also, SSRIs like Sertraline are used off-label for Hoarding Disorder, with many reports showing they reduce distress associated with the condition.

Non-Pharmacologic Treatment

Just as important as Sam’s medication is non-pharmacologic treatment, CBT is the gold standard for Hoarding Disorder. CBT helps people challenge their beliefs about the value of their possessions and develop coping strategies for the anxiety that comes with getting rid of stuff; as noted by Rodgers et al. (2021), for Sam, CBT would involve gradual exposure to situations where he would be encouraged to get rid of items in a controlled way so he could emotionally detach from them over time.

Through therapy, Sam can learn to make more rational decisions about what to keep and what to get rid of. Family therapy would also help address the relational strain between Sam and his wife due to his hoarding behaviors. Family therapy sessions can help his wife develop empathy and understanding for him, easing the tension in their relationship. Together, they can work on the home environment in a way that doesn’t trigger Sam’s anxiety.

Notably, the second part of treatment is educating Sam and his wife about Hoarding Disorder. Both must understand that hoarding is a mental illness requiring patience and a structured treatment plan. Educating Sam will help him see the need for change, and educating his wife will help her support his recovery.

Referrals and Follow-Up

Sam should also be referred to a psychiatrist or therapist experienced in treating Hoarding Disorder, particularly in CBT and other therapies. Since his symptoms are psychiatric, no labs or imaging studies are needed at this time. Follow up in 4-6 weeks to see how he is responding to Sertraline and therapy; at this visit, focus on reassessing Sam’s hoarding behaviors, anxiety, and overall mood to determine if the current treatment plan should continue. If he is improving on medication and therapy, the treatment plan can stay the same; if not, he may need adjustments.

References

Bratiotis, C., Muroff, J., & Lin, N. X. Y. (2021). Hoarding Disorder: Development in Conceptualization, Intervention, and Evaluation. FOCUS, 19(4), 392–404. https://doi.org/10.1176/appi.focus.20210016

Brock, H., & Hany, M. (2023). Obsessive-Compulsive Disorder (OCD). PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK553162/

Lin, N., Bacala, L., Martin, S., Bratiotis, C., & Muroff, J. (2022). Hoarding Disorder. Psychiatric Clinics of North America, 23(2). https://doi.org/10.1016/j.psc.2022.10.007

Munir, S., & Takov, V. (2022, October 17). Generalized anxiety disorder. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK441870/

Rodgers, N., McDonald, S., & Wootton, B. M. (2021). Cognitive behavioral therapy for hoarding disorder: An updated meta-analysis. Journal of Affective Disorders, 290(3), 128–135. https://doi.org/10.1016/j.jad.2021.04.067

Singh, H. K., & Saadabadi, A. (2023, February 13). Sertraline. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK547689/

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Question 

This section should contain possible differential diagnoses applicable to the case presentation that was reviewed.

Differential Diagnosis #1

Differential Diagnosis #2

Differential Diagnosis #3

Case Analysis

This section should include a discussion of the likely diagnosis with rational and citation

Treatment Plan

The treatment plan should include:

References

References should be in APA 7th edition format; must provide scholarly support for all provided information.

References need to be on a separate page

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