Hoarding: The Basics

I’ve always had trouble throwing things away. Magazines, newspapers, old clothes… What if I need them one day? I don’t want to risk throwing something out that might be valuable. The large piles of stuff in our house keep growing so it’s difficult to move around and sit or eat together as a family. My husband is upset and embarrassed, and we get into horrible fights. I’m scared when he threatens to leave me. My children won’t invite friends over, and I feel guilty that the clutter makes them cry. But I get so anxious when I try to throw anything away. I don’t know what’s wrong with me, and I don’t know what to do. This example is typical of someone who suffers from hoarding. Read on to learn more, including the differences between hoarding and collecting.

Understanding Hoarding

Hoarding is the persistent difficulty discarding or parting with possessions, regardless of their actual value. The behavior usually has deleterious effects—emotional, physical, social, financial, and even legal—for a hoarder and family members. For those who hoard, the quantity of their collected items sets them apart from other people. Commonly hoarded items may be newspapers, magazines, paper and plastic bags, cardboard boxes, photographs, household supplies, food, and clothing.

Hoarding can be related to compulsive buying (such as never passing up a bargain), the compulsive acquisition of free items (such as collecting flyers), or the compulsive search for perfect or unique items (which may not appear to others as unique, such as an old container).

Symptoms and Behavior

Someone who hoards may exhibit the following:

Inability to throw away possessions

Severe anxiety when attempting to discard items

Great difficulty categorizing or organizing possessions

Indecision about what to keep or where to put things

Distress, such as feeling overwhelmed or embarrassed by possessions

Suspicion of other people touching items

Obsessive thoughts and actions: fear of running out of an item or of

needing it in the future;checking the trash for accidentally discarded objects

Functional impairments, including loss of living space, social isolation, family or marital

discord, financial difficulties, health hazards

Reasons for Hoarding

People hoard because they believe that an item will be useful or valuable in the future. Or they feel it has sentimental value, is unique and irreplaceable, or too big a bargain to throw away. They may also consider an item a reminder that will jog their memory, thinking that without it they won’t remember an important person or event. Or because they can’t decide where something belongs, it’s better just to keep it. Hoarding is a disorder that may be present on its own or as a symptom of another disorder. Those most often associated with hoarding are obsessive-compulsive personality disorder (OCPD), obsessive-compulsive disorder (OCD), attention-deficit/hyperactivity disorder (ADHD), and depression. Although less often, hoarding may be associated with an eating disorder, pica (eating non-food materials), Prader-Willi syndrome (a genetic disorder), psychosis, or dementia.

Diminished Quality of Life

A lack of functional living space is common among hoarders, who may also live in unhealthy or dangerous conditions. Hoarders often live with broken appliances and without heat or other necessary comforts. They cope with malfunctioning systems rather than allow a qualified person into their home to fix a problem. Hoarding also causes anger, resentment, and depression among family members, and it can affect the social development of children. Unlivable conditions may lead to separation or divorce, eviction, and even loss of child custody. Hoarding may lead to serious financial problems, as well.

Hoarding vs. Collecting

Hoarding is not the same as collecting. In general, collectors have a sense of pride about their possessions and they experience joy in displaying and talking about them. They usually keep their collection organized, feel satisfaction when adding to it, and budget their time and money. Those who hoard usually experience embarrassment about their possessions and feel uncomfortable when others see them. They have clutter, often at the expense of livable space, feel sad or ashamed after acquiring additional items, and they are often in debt.

Staging an Intervention

Lisa loves to entertain, but she’s married to Mike, who is a hoarder. Newspapers and magazines cover every room in their house so they can barely get to the kitchen and can never reach the couch. Lisa hasn’t invited company in eight years because she is too embarrassed by the clutter. Their 8-year-old daughter begs to visit her friends because she isn’t allowed to have anyone over—and even if she were, they wouldn’t have enough room to play. Lisa tries to clean up when Mike isn’t home, but her efforts are fruitless. When he discovers what she has done, he becomes very upset and angry. He grows even more possessive and his hoarding gets worse. Despite Lisa’s desperate pleas and threats, Mike refuses to get help. Barbara has been living alone in her big house since her husband passed away three years ago. She has three grown daughters who love her very much, but she doesn’t let them inside. Although she has always had a tendency to hold onto things, her behavior became extreme after she lost her husband. Her hoarding got so bad that the entire floor is covered, only one chair can be used, and she has hardly any space to cook in the kitchen. Her daughters are very worried about her, but she shrugs them off when they try to convince her to get help. They would invite her to live with one of them, but they know that the clutter will follow. They are exasperated and at a complete loss about what to do. After her mother passed away, Annie moved in with her elderly father when his health began to decline. She always called her father a pack rat because he kept lots of pencils, rubber bands, bags, and papers. But his hoarding grew worse after his wife’s death. Although Annie wants to help out her father, she feels agitated and frustrated at the mess. Having lived alone for a long time, she has difficulty adjusting to the lack of space in the house, and she’s worried about her father’s safety. Although he admits he has a problem, her father refuses to let Annie clean the house, and he claims he is too old for treatment. Each of these cases illustrates a hoarder’s resistance to treatment and how it affects family members. When a hoarder resists the idea of getting help, a family member may contact a therapist about staging an intervention. Intervention Guidelines

First, family members meet with a therapist to learn more about hoarding and treatment options, who should be involved and what to say at an intervention, and how to prepare for what may become an ordeal. They must have the conviction that they are doing the right thing because a hoarder cannot be helped if the family fears anger or consequences of an intervention. Often family members attend a practice session before the intervention takes place. The goal is to have the hoarder make one visit to an experienced therapist. Arrangements for treatment are usually made before an intervention takes place; ideally a session follows immediately. At a prearranged time, family members approach the hoarder to talk about the effect of clutter on their lives and explain that help and support are available. Each person explains in a non-confrontational and nonjudgmental manner why he or she is concerned. It is important that all participants make it clear that treatment is mandatory. Details of an intervention can vary: The consulting professional may or may not be present; it may take place in an office or a home; and the hoarder may or may not be made aware of the upcoming event. Facing a cohesive group, a hoarder cannot hide or minimize the problem. Intervention is a big step in the right direction, but the hoarder and those involved have much work to do. The hoarder must commit to treatment, and family members must address personal issues and learn to handle issues that may come up as the treatment progresses. Elements of Treatment During the initial visit, the therapist reassures the hoarder that family members want to help and that no possessions will be thrown away without permission. The client will learn organizational and decision-making skills while trying to understand the reason for hoarding. The therapist discusses the pros and cons of hoarding, reasons to give up some of the behavior and to discard items, as well as how the behavior interferes with the client’s goals and values. In collaboration with family members, the therapist works to get the client to subsequent sessions and on the path to a safer, more fulfilling life. Fugen Neziroglu, PhD, ABBP, ABPP, is Director of the Bio-Behavioral Institute, in Great Neck, New York Learn more Overcoming Compulsive Hoarding: Why You Save and How You Can Stop, by Fugen Neziroglu, Jerome Bubrick, Jose A. Yaryura-Tobias, (New Harbinger Publications, July 2004)

http://www.adaa.org/understanding-anxiety/obsessive-compulsive-disorder-ocd/hoarding-basics/staging-intervention


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