What is hoarding?
Compulsive hoarding is probably going to be classified a disorder, separate from OCD, in the next version of the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM V).
The diagnostic criteria include :
- The hoarder has ongoing difficulty throwing out or parting with possessions, even if they are useless or of limited value.
- The sufferer has difficulty disposing or parting from possessions as they believe they need to save the items and get very distressed when faced with the prospect of discarding them.
- Hoarders end up with too many possessions which cause congestion and clutter in the living areas of their home, office, car or garden and impair the effective use of these areas. If the sufferer’s living areas are uncluttered and functional it is only because other people such as family members, cleaners or authorities have intervened.
- The behaviour/s causes the person significant distress or impairs their ability to function at work or socially or to maintain a safe environment for themselves or others.
- The compulsive hoarding is not attributable to another medical condition e.g. head injury, stroke.
- Hoarding can be a symptom of other psychiatric disorders, so it is important that correct differential diagnosis is made.
Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-V) to be printed 2013. American Psychiatric Association, Washington DC.
Noelle, a Profile of a Compulsive Hoarder
Noelle, a seventy- six year old widow, is a typical compulsive hoarder. She saves the items most commonly kept: magazines, newspapers, old clothes, bags, books, mail, notes etc. At home she keeps plastic bags, paper bags and bags from clothing shops because “They might come in handy”. Noelle also hoards empty glass jars, lids to jars, boxes of recipes she likes the sound of (even though she has 100′s of them and never gets around to cooking any of them). She will not throw out old magazines “because they have good articles in them.” She also has great difficulty throwing out old clothes. Even if she considers the clothes are too dated or worn to be seen in public, she keeps multiple old tops and pants to wear around the house, yet complains she does not have enough storage and that her house is messy. There are old socks with holes in them being kept by her, as “they can be used as rags”.
Recently, her children brought a builder in to do some renovations to her house and this necessitated that her kitchen be cleared. The builder was amazed at her stash of plastic and paper bags and the vast number of skips it took to clear the house of rubbish. Noelle was very stressed and angry when the builder and her adult children disposed of her piles of useless possessions. Since the clearout, she has resumed collecting jars, plastic bags, newspapers etc. Noelle donates small amounts of money to numerous charities so receives numerous mailouts requesting donations. Her children requested that she confine her donations to one charity so as to cut down on the amount of junk mail entering the house only to add to the stacks of paper, but she refuses to do so.
Noelle lacks insight into her condition. Her children have sat with her and got her to watch programs on hoarding on television, yet she denies that she has any problem with accumulating junk. Noelle has never sought treatment for any mental health problems.
Why do Some People Have Difficulty Throwing Stuff out and Keep Acquiring More?
- fear losing things that they think will be required
- have distorted beliefs about the importance of possessions
- are excessively emotionally attached to their belongings
- throwing things away causes anxiety attacks
Hoarders tend to:
- be perfectionists,
- be indecisive,
- be procrastinators
- have difficulty organizing tasks
- engage in avoidance of : sorting mail, emptying rubbish, washing, cleaning etc.
Compulsive hoarding behaviour is caused by 4 main problem areas:
- deficits in information processing (difficulty making decisions and categorizing possessions)
- problems in forming emotional attachments
- behavioural avoidance (e.g. avoidance of sorting mail, emptying rubbish, washing)
- incorrect beliefs about the nature of belongings (e.g. believe their memory for where they put objects is poor, believe they must keep objects in order to be prepared for any eventuality, believe they cannot be wasteful or irresponsible with their belongings)
Hoarders often fear making a mistake when deciding what to throw out and what to keep, so they therefore do not discard anything. If they don’t throw anything out they avoid anxiety about making a mistake or being less prepared for some future event.
Hoarders tend to have certain beliefs about their possessions. They feel very responsible for their belongings and do not like to be wasteful or irresponsible when disposing of their objects. e.g. they might resist throwing a bit of scrap paper in the rubbish bin saying it has to go in the recycle bin. Sufferers might refuse to throw old magazines in the bin saying they wanted to give them to someone to read because there was good information to be had.
Hoarders may believe they have poor memory and think they have to keep their objects visible because they fear they would not remember where they had put them if they stored them out of sight.
Hoarders have difficulty making decisions and categorizing possessions. Many sufferers say they are easily distracted and have have difficulty remaining task focused. Sufferers avoid throwing things out and making decisions but they also may avoid sorting mail, paying bills etc. Some hoarders take a long time to execute small tasks. The may move objects from pile to pile but never throw anything out or get a functional organizational system.
Many hoarders have little insight into their condition. Given that they do not consider they have a problem they are not motivated to engage in treatment.
How to Help a Hoarder
Helping a sufferer is more complex than just walking into their house, hiring a skip and throwing out all the items they have hoarded. The hoarder most likely would experience negative emotions such as sadness, anxiety and/or anger. Even if the person would permit you to clear out their belongings, the root causes have not been addressed and you would find that the behaviour resumes immediately and the house, garden or garage are soon filled with more items.
Sufferers need to be encouraged to seek professional help and a good starting point is their general practitioner who can arrange referrals to appropriate professionals such as a psychologist experienced in treatment for the condition.
Treatment for Hoarding Disorder
Compulsive hoarders are often prescribed SSRI antidepressants but not all sufferers respond well to medication. Cognitive behavioural therapy targeting the features of the disorder has produced better results.
Cognitive Behavioural Treatment
Cognitive behavioural therapy is a commonly employed treatment for hoarding disorder.
The aims of therapy are to:
- decrease clutter
- improve the client’s decision making re their belongings
- improve the hoarder’s organizational skills re their belongings
- increase the client’s resistance to the urge to save objects
Treatment for hoarding will focus on preventing incoming junk.
Hoarders are require to keep a daily log of every time they acquire or purchase something so they can identify their triggers and patterns of acquiring.
- Hoarders may be advised to cease subscribing to magazines and newsletters and to put a “no junk mail”‘ notice on their letter box to cut down on the amount of paper coming into the house.
- Clients are also required to develop a daily routine and schedule in activities previously avoided such as cleaning,washing, emptying rubbish, sorting mail etc.
- Sufferers are taught relaxation skills as discarding belongings can trigger anxiety.
- Hoarders are going to require ongoing occasional booster visits from a psychologist or ongoing treatment in order to maintain the gains they have made.
Australians are able to receive psychological treatment subsidised by Medicare if they are assessed by their doctor as eligible for a Mental Health Care Plan.
Australians can receive ten subsidised individual psychology sessions per calendar year, as well as 10 group sessions.
Clinical Psychologist Catherine Madigan offers hoarding help and can be contact on 03 9819 3671 or 0429 88 3671 or via email at firstname.lastname@example.org
Please note, it is important to consult a qualified mental health practitioner such as e.g. a psychologist or psychiatrist to confirm any diagnosis you think you might have. You must not rely on the information on this site as a substitute for professional medical advice, diagnosis or treatment. No assurance can be given that the information on this site will always include the most recent developments or research with respect to a particular topic.