Hoarding Disorder (aka Pathologic Hoarding)

Summary: Hoarding disorder (aka compulsive hoarding or pathological hoarding) is acquiring possessions along with the failure to discard them, even if the items are worthless, no longer useful. Hoarded items fill the person's home, and can cause severe problems with day-to-day activities and relationships, and even pose a danger to life through being a fire and safety hazard.
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Introduction

Mike is unable to throw out any of his newspapers, and so he has every single newspaper for his local paper going back decades... Melissa has over thirty cats in her small apartment. Dave has collected so much possessions that he is embarassed to have people over at his home... Due to public health complaints from neighbours and concerns by the fire department, all of them are in danger of losing their homes.

What is Hoarding Disorder?

Especially in a materialistic society like ours, everyone collects things. But when people collect so many things that it starts causing problems, it may be hoarding disorder, also known as pathologic hoarding…

 

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), hoarding disorder is characterized by persistent difficulty discarding or parting with possessions, regardless of their actual value, to the point that it causes harmful effects for the person, or to those around the person (e.g. family members or landlords).
 
Common items that are hoarded may include:
  • Clothing,
  • Newspapers and magazines, 
  • Animals (e.g. having numerous pets such as cats). 

In people with hoarding disorder, their hoarding is to such an extent that it causes serious problems such as:

  • Excess clutter: Typically, a hoarder's home becomes so full of possessions that they are no longer to use parts of their home, with blocked hallways, exits and rooms. There have even been extreme cases where stacks of possessions have collapsed and crushed people to death, or simply trapped them in the home leading them to starve to death.
  • Relationship problems: Hoarding tends to cause conflicts with other people living in the home. Family members become upset at the hoarding, and may become isolated themselves, becoming too embarrassed to invite guests over.

How Common Is It?

Hoarding occurs in 2-5% of the population (Samuels, 2008), generally in individuals in their 50’s. Although popular shows such as "Hoarders" have increased public awareness about hoarding, it is still difficult to estimate how many people have problems with hoarding as hoarders usually keep their hoarding secret.

 

Hoarding urges occur in children and youth as well, but since they tend to live in a household (that is owned and controlled by adult caregivers), their ability to acquire and save possessions is limited compared to adults. Thus, severe hoarding does not usually begin to be a problem until adulthood, and even then, may take decades before it comes to the attention of professionals.

Why Do People Hoard?

Human beings are a social species, and in general, need to feel connected to people and activities that give a sense of purpose, hope and meaning.  

 

However, in people that hoard, their connections with possessions have often replaced their connections to meaningful people and activities. 

 

There are numerous reasons why this might happen:

  • They may have experienced life experiences (such as trauma or abuse) that have made it difficult for them to trust or connect to people, and as a result, connecting to possessions is safer than connecting to people.
  • The culture of materialism reinforced constantly in advertising and popular culture tricks many people into believing that possessions will make you happy.
  • Hoarding is pleasurable: When you first acquire something, it is pleasurable at first. Unfortunately, this pleasure is short-lived..
  • It’s painful to throw out things: People who hoard feel distress at the thought or act of throwing out things. In many cases, people who hoard may have had problems grieving and dealing with loss. 
  • They may have problems with organizational skills and other mental abilities which makes it hard to get rid of things. 

What Treatments Are There?

Typical treatments given by professionals may include:

  1. Cognitive behavioural therapy (CBT),
  2. Medication,
  3. Combination of both.

Cognitive Behavioural Therapy (CBT)

Thoughts and Behaviours

 

CBT looks at the person's thoughts and behaviours that lead to hoarding, and seeks to change these thoughts and behaviours to stop the hoarding.

 

Hoarding Thought

Solution

I can't throw out this old newspaper because I (or someone else) might need it…

These newspapers can be thrown out because they’re all online nowadays.

I can't throw out these old books because I (or someone else) might want to read them.

Whoever needs these books can just borrow them from the library.

I can't throw out my old school notes, because I (or someone else) might need them.

These notes are out of date and I haven’t reviewed them in over 10-years, so I might as well throw them out.

I don’t want to throw out these newspapers and waste all that paper.

I can put these in the recycling, and let it be re-used.

 

Behavioural Hierarchy

 

A behavioural hierarchy is about coming up with a step-by-step plan where one gradually de-clutters. It involves:

  • Make a list of what things to throw out
  • Start with the easiest things
  • Gradually progress to the more difficult things to throw out

Self-Help for Hoarding

Whether or not you seek professional help or not, there are a lot of things that you can do to help with hoarding.

 

Ultimately, dealing with hoarding involves:

 

1.     Reconnecting (or connecting) to people and activities that give a sense of belonging, purpose, hope and meaning.

 

Consider some of the following ways to build your connections:

  • Spend time with people
  • Spend time with nature
  • Spend time with animals
  • Join a club
  • Take a course, even if it is an online course
  • Volunteer somewhere
  • Join a church, or spiritual activity

2. Disconnecting from possessions as a way to meet your needs. 

 

Before you acquiring something, ask yourself the following questions:  

  • Do I have an immediate use for this?
  • Do I need it? How many do I already have?
  • Can I get by without it?
  • Do I feel compelled to have it?
  • Can I afford it comfortably?
  • Do I have time to deal with it appropriately? maintain it?

If the answer is no to any of these questions, then don’t acquire it!

 

Strategies for Getting Rid of Clutter

  • Start with one area at a time
  • 1st priority is fire safety
  • Declutter so that you have free routes in and out of the residence
  • Declutter so that you have entrance and exits from each room.
  • Declutter around heat and ignition sources, i.e. furnaces, stoves, portable heaters, baseboard heaters, water heaters or uncovered light bulbs,
  • Make sure smoke detectors are functioning.
  • Spend as many future work periods as needed to complete your goal for this area.
  • Sort possessions into categories:
    • 1) Keep
    • 2) Discard & Recycle
    • 3) Re-gift piles
  • How do I know what category something goes into? Ask yourself the following questions in order to decide whether to
    • 1) Keep or to
    • 2) Discard & Recycle or
    • 3) Re-gift it
  • Questions to ask yourself about possessions that you have:
    • Do I need it?
    • Do I have a plan to use this?
    • Have I used this in the last year?
    • Can I get it elsewhere? i.e. library, or online
    • Do I have enough space for it already clear and available?
    • Do I love it?

If the answer is no to any of these questions, then either Discard/Recycle, or Re-gift (give it to someone else!)

 

Self-Help content copied with permission from Ottawa Public Health, 2011

Supporting a loved one with hoarding

If you have a loved one who has problems with hoarding, here are some tips that may be helpful:

 

Do's

  • Do help your loved one get help. E.g. "I'm worried about you." "How can I be helpful?" "If there is anything I can do to help, let me know. If you want me to come with you to any doctor or counseling appointments or anything like that, let me know."
  • Do praise and reinforce any positives. E.g. "I notice that you've cleared your couch. That's amazing! How did you manage to do that?" "I notice that its more cleared near your front door. That's great!"
  • If your loved one is sensitive or uncomfortable with praise, then just use gratitude instead. E.g. "Thank you for doing that. It means a lot to me."
  • Do acknowledge the emotions behind some of the possessions, and validate those feelings. E.g. “I can see that your high school possessions mean a lot to you. What did high school mean to you? What were those times like for you? Sounds like a very meaningful time in your life.”

Don'ts

  • Don't use negative comments to try to shame or embarrass the other person into stopping hoarding, as this tends to make the person defensive and less likely to listen to you. For example, if you say, “How can you live in such a mess!”, then it tends to lead the other person to come up with reasons why s/he hoards, which then strengthens the hoarding.
  • Don't lecture or tell the person what to do, unless you have build up enough trust. If the person who hoards is actively asking, “Please help me to stop hoarding”, then its probably okay to give advice. But if the person hoarding is not, then its best to avoid giving unsolicited advice. Avoid critical statements such as "You really should throw out all these newspapers." Is professional help required?

Medications

When everything has been tried, but hoarding continues to be a problem, there are medications that may be helpful, and that can be prescribed by a physician.
 
Examples include specific serotonin reuptake inhibitors (SRIs) such as Fluoxetine (Prozac), Sertraline (Zoloft), Fluvoxamine (Luvox), Citalopram (Celexa), and Escitalopram (Cipralex).

References

Ottawa Public Health. Helpful Questions & Strategies for Hoarding Situations [Brochure]. 


Metcalf E: Harmless Pack Rat or Compulsive Hoarder? Retrieved Sep 28 2010 from http://www.webmd.com/mental-health/features/harmless-pack-rat-or-compulsive-hoarder?ecd=wnl_emw_031908&print=true 

 
Pertusa et al.: Compulsive hoarding: OCD symptoms, distinct clinical syndrome, or both? Am J Psychiatry. 2008 Oct; 165(10):1229-33.

 

Sansone RA et al.: Hoarding: obsessive symptom or syndrome? Psychiatry. 2010 Feb;7(2):24-7.

 

Samuels JF et al.: Prevalence and correlates of hoarding behaviour in a community-based sample. Behav Res Ther. 2008 Jul; 46(7): 836-44. Retrieved Sep 28, 2010 from http://www.ncbi.nlm.nih.gov/pubmed/18495084

 

For More Information

Hoarding Center of the International OCD Foundation

http://www.ocfoundation.org/hoarding/welcome.aspx

 

Documentary on Vimeo

http://metropolitanorganizing.com/blogs/geralin/2009/10/help-hoarders

About this Document

Written by members of the eMentalHealth.ca team.

 

For the section on Self-Help Strategies for Hoarding, we graciously acknowledge Ottawa Public Health’s permission to reproduce their questions and strategies for hoarding, to which the following applies: “All rights reserved by Ottawa Public Health, City of Ottawa. Permission is granted to print and copy this document for educational and non-commercial purposes. No part of this information may be reproduced for any other purpose without the prior written permission of Ottawa Public Health, City of Ottawa.”

Disclaimer

Information in this pamphlet is offered ‘as is' and is meant only to provide general information that supplements, but does not replace the information from your health provider. Always contact a qualified health professional for further information in your specific situation or circumstance.

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You are free to copy and distribute this material in its entirety as long as 1) this material is not used in any way that suggests we endorse you or your use of the material, 2) this material is not used for commercial purposes (non-commercial), 3) this material is not altered in any way (no derivative works). View full license at http://creativecommons.org/licenses/by-nc-nd/2.5/ca/

 

Date Posted: Jul 19, 2011
Date of Last Revision: Dec 1, 2016

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