Hoarding

Hoarding is the compulsive purchasing, acquiring, searching, and saving of items that have little or no value. People with this disorder have persistent difficulty in discarding or parting with possessions. This difficulty is due to the strong urges to save items and/or distress associated with discarding. When these behaviors lead to enough clutter and disorganization to affect someone’s health or safety, or they lead to significant distress, then hoarding becomes a “disorder”. The symptoms result in the accumulation of a large number of possessions that fill up and clutter active living areas of the home or workplace to the extent that their intended use is no longer possible such as:

• Beds that cannot be slept in
• Kitchens that cannot be used for food preparation
• Tables that cannot be used for dining
• Tubs, showers, and sinks filled with items such that they cannot be used for washing or bathing

Hoarding is particularly dangerous for older individuals who may have physical and cognitive limitations. Basic functioning in the home is impaired which has serious consequences for older adults. One investigation found that 45% could not use their refrigerators, 42% could not use their kitchen sink, 42% could not use their bathtub, 20% could not use their bathroom sink and 10% could not use their toilet. In addition, hoarding was viewed as a physical health threat due to fires, falling, unsanitary conditions, and inability to prepare food.

The most frequent reason people hoard is that they do not want to waste things. They believe these items will be needed or have value in the future. A person may also hoard items that they feel have important emotional significance. In fact, people who hoard typically report feeling safer when surrounded by the things they save. Often people who hoard believe that an object may still be useable or of interest or value to someone. Thinking about whether to discard leads them to feel guilty about wasting it.

The second most frequent reason for saving is the fear of losing important information. Many hoarders describe themselves as “information junkies” who save newspapers, magazines, brochures, and other information-laden papers. They keep large quantities of these items so that when they have time, they will be able to read and digest all the useful information they imagine to be there. Each of these items (in the hoarder’s mind) contains a wealth of opportunities and discarding them would mean losing those opportunities.

The third reason for saving is that the object has an emotional meaning. This takes many forms, including the sentimental association of things with important persons, places, or events. Hoarders often feel that getting rid of the item feels like losing part of oneself.

Some risk factors that researchers have found are:

Age – hoarding usually starts in early adolescence, around age 13 or 14, and it tends to get worse with age. Younger children may start saving items such as broken toys; pencil numbs, and outdated school papers.

Family history – there is a very strong association between having a family member who is a compulsive hoarder and becoming a hoarder yourself

Stressful life events – some people develop hoarding after experiencing a stressful life event that they had difficulty coping with, such as the death of a loved one, divorce, eviction, or losing possessions in a fire.

A history of alcohol abuse – about 50% of hoarders have a history of alcohol dependence

Social isolation – people who hoard are typically socially withdrawn and isolated. In many cases, hoarding leads to social isolation. Because of the distinctiveness of hoarding symptoms, the DSM-V diagnostic workgroup on Obsessive Compulsive Disorder has recommended that hoarding is included in the DSM-V. The proposed diagnostic criteria are:

1. Persistent difficulty discarding or parting with personal possessions, even those of apparently useless or limited value, due to strong urges to save items, distress, and/or indecision associated with discarding.
2. The symptoms result in the accumulation of a large number of possessions that fill up and clutter the active living areas of the home, workplace, or other personal surroundings and prevent normal use of the space.
3. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others).
4. The hoarding symptoms are not due to a general medical condition (brain injury or cerebrovascular disease)
5. The hoarding symptoms are not restricted to the symptoms of another mental disorder (hoarding due to obsessive-compulsive disorder, lack of motivation in major depressive disorder, delusions in schizophrenia or another psychotic disorder, cognitive defects in dementia, restricted interested in autistic disorder)

There are two main types of treatment that help people with hoarding disorder. They are:

• Cognitive-behavioral therapy (CBT)
• Medication

During cognitive-behavioral therapy, individuals gradually learn to discard unnecessary possessions with less distress, diminishing their exaggerated perceived need or desire to save for these possessions. They also learn to improve skills such as organization, decision-making, and relaxation. For many people, certain anti-depressant medications may be helpful and may produce more rapid improvement.

A Case Manager can be an integral piece in helping a family work through a hoarding disorder. To speak with us about this condition or any other troubling health issue, call 877.538.5425. All calls are strictly confidential and you may choose to remain anonymous.