Hoarding—sometimes called compulsive hoarding—is a mental health condition that causes people to collect large quantities of objects. This clutter often interferes with healthy functioning and normal use of one's home and can have a negative impact on one's quality of life and/or relationships with others. When a person who hoards is ready to de-clutter, a mental health professional may be able to offer support and assistance.
People who hoard may collect a wide variety of things. They do not only collect junk or garbage; in fact, some of those who hoard may intentionally buy items to collect, sometimes finding themselves in debt as a result. Sometimes the hoarding is limited to a specific type of object such as dolls, baseball cards, old computer parts, or clothing. In other cases, those who hoard might collect random items they come into contact with, valuable items such as jewelry, items they think may be useful in the future, or items that have sentimental value. Even when the hoarded items are things that most would consider to be garbage—plastic bags, scraps of paper, or broken knickknacks—the person hoarding them may experience significant mental distress at the thought of throwing them away. Between 2 and 5% of the population meets the criteria for compulsive hoarding, and up to 40% of those who hoard objects also hoard animals.
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The public awareness of hoarding greatly increased due the popularity of the TLC television show Hoarding: Buried Alive. The show features people who hoard and follows them as they explore their past in order to determine the cause of the hoarding behavior, attempt to clean their homes, and work to improve their emotional states.
A person who hoards might begin to show symptoms as early as their teen years, and these symptoms typically persist throughout life unless they are treated. Someone who hoards generally has a house that is extremely cluttered with extraneous possessions, an inability to resist taking free items, and a tendency to buy multiple items before they are needed, to the point of excess. The person may often lose things in the clutter and avoid inviting anyone into the cluttered space, feeling embarrassed or ashamed at the clutter and lack of space, and thus become socially isolated.
People who hoard often experience positive feelings when obtaining items and negative feelings when thinking of giving them away. They may become attached to the objects and believe that the objects have feelings. Though they may make an effort to organize their living spaces, they are generally prevented from doing so by the amount of possessions in their home, and this can lead to distress and guilt, especially when the clutter affects others. Many of those who hoard do not find the hoarding to be a problem in their lives, but others are ashamed of their tendency to hoard items because of the clutter that results.
Hoarding can be caused by a number of factors. People with a family history of hoarding have been shown to be more likely to hoard. One study diagnosed hoarding in 12% of the first-degree relatives of people who hoarded. In the past, hoarding was thought to be a type of obsessions and compulsions, but the fifth edition of the Diagnostic and Statistical Manual lists compulsive hoarding as a separate condition, as research has shown that the two conditions are distinct, although there can be some symptom overlap and the conditions do occasionally co-occur (research shows that nearly one in five of those who hoar may have non-hoarding OCD symptoms).
Hoarding symptoms might also be triggered by a traumatic event, such as the death of a parent or partner. Substance abuse is correlated with hoarding, and some have also been shown to hoard in order to relieve symptoms of anxiety or depression: Fifty percent of those who hoard also experience depression, and 48% of those who hoard experience anxiety or social phobia. The condition might also develop with another mental health condition, such as dementia or schizophrenia.
Symptoms of hoarding typically worsen as time passes. Even when those who hoard are aware of the distress caused by the hoarding, they are often still compelled to continue collecting items without getting rid of anything.
Talking to a loved one about their hoarding behavior can be challenging, and many people react to criticism with defensiveness. However, many people who hoard do not seek help until they realize the effects of their behavior on others. Hoarding does not always lead to mental distress, but it may be harmful because it can leave a house too cluttered to be used, lead to safety concerns in the event of fire or disaster, and cause strained relationships with one's friends and family members. Forcing a person who hoards to de-clutter may not be the best solution, but discussing the effects of hoarding behavior may help the person realize how the hoarding affects others. When discussing a person's hoarding, it may be best to:
- Avoid judging or criticizing the hoarding behavior.
- Emphasize concern for the well-being of the person and others in the person's life.
- Discuss the effects that hoarding may have on others.
- Offer help, resources, and support without attempting to control or change behavior by, for example, throwing items away.
- Respect the person's right to collect things and keep possessions, while encouraging steps that may make a living environment more safe and/or habitable.
Therapy has been shown to be an effective way to treat compulsive hoarding, when an individual enters treatment willingly. Simply cleaning out a house affected by hoarding without treating the underlying issues that led an individual to begin hoarding will generally always result in repeated hoarding behavior. If family members or friends clean the house without the consent of the person who hoards, the person may become angry and refuse further help.
Treatment for hoarding generally occurs in two parts. People who hoard often need help to clean their living space and dispose of old collections, and homes often need significant cleaning and repair. People who hoard animals might need assistance disposing of toxic waste. Strategies to prevent further hoarding will typically also need to be explored, often with the help of a mental health professional. Some who have hoarded in the past suggest that developing strategies to resist acquiring new items should be the first step, because if a home is simply cleared of items, those who hoard will often want to acquire new items to fill the space.
Hoarding was often treated in the past with the same techniques used to treat OCD, but those techniques have been shown to be less effective at treating compulsive hoarding. Cognitive behavioral therapy, however, has been shown to be helpful in reducing hoarding behavior. In CBT, people learn ways to decrease the distress they feel when discarding possessions and explore organization and decision-making techniques. Therapy frequently focuses on understanding the compulsion to hoard, finding alternative strategies when the compulsion is experienced, and alleviating any anxiety and depression, which often worsen hoarding behavior. Antidepressant and antianxiety medication can also help treat those conditions when they occur.
Peer-organized support groups have also developed as a method of treatment for hoarding. Known as Buried in Treasures workshops—from the book of the same name that was written by leading experts on hoarding—these groups are free workshops that follow the treatment program of the type of CBT that treats hoarding. These workshops have been shown to be effective, reducing symptoms of hoarding by up to 27% in trials and even more in some cases.
- Therapy after compulsive hoarding leads to injury: Sarah, 41, enters therapy somewhat reluctantly after falling down the stairs and breaking both legs. She admits to the therapist that the excessive clutter in her house is what caused her to trip and fall and that she cannot seem to keep herself from acquiring more possessions even though she has no place to put them, but she firmly states that she cannot give away or otherwise dispose of any of her possessions. Sarah tells the therapist that her belongings would be sad if she threw them away and that she could never forgive herself. The therapist asks Sarah about her family and friends, and Sarah reports that she has not seen many people lately, as there is no room in her house to entertain people. She also says that she does not go out often, since she feels anxious when she is separated from her things. Sarah does say that she wishes she could see her friends and family more often, and the therapist begins to work with her, helping Sarah see that the people in her life have been pushed aside by her possessions. After several sessions with the therapist, who helps Sarah learn ways to resist impulses to acquire new things and reduce the upset she feels when giving things away, Sarah begins to de-clutter by asking her sisters for help in sorting through and disposing of her possessions. The therapist continues to work with Sarah, who reports distress each time she sees a box of her belongings leave the house, but Sarah continues in treatment, reporting improvement in each session.
- Animal Hoarding FAQ. (n.d.). Retrieved from https://www.aspca.org/fight-cruelty/animal-hoarding/animal-hoarding-faq.
- Bratiotis, C., Otte, S., Steketee, G., Muroff, J., & Frost, R. (n.d.). Hoarding Fact Sheet. Retrieved from https://iocdf.org/wp-content/uploads/2014/10/Hoarding-Fact-Sheet.pdf.
- Hoarding - School of Social Work. (n.d.). Retrieved June 15, 2015, from http://www.bu.edu/ssw/research/hoarding.
- Jabr, F. (2013, February 25). Step Inside the Real World of Compulsive Hoarders. Retrieved from http://www.scientificamerican.com/article/real-world-hoarding.
- Tolin, D. F. (n.d.). When a loved one hoards. Oprah.com. Retrieved from http://www.oprah.com/home/How-to-Talk-to-a-Loved-One-Who-Hoards.
Last updated: 07-28-2015
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