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How to Help With Hoarding: Tips from an A&E 'Hoarders' Expert

August 30, 2022

Anyone who's cleaned their house knows it's not always easy to part with your possessions. But for some, it's more serious. About 19 million Americans suffer from compulsive hoarding, a condition that causes a strong need to collect things - newspapers, magazines or clothing are all common items. Hoarding disorder is more likely to affect older adults and those with other psychiatric diagnoses, including anxiety and depression. If you have a loved one who might be hoarding, is there anything you can do?

Is it affecting you?

The first question you should ask yourself is whether hoarding is affecting you - if not, it might be best to let go of the issue entirely, explained David Tolin, PhD, medical director of the Anxiety Disorders Center at the Institute of Living, part of the Hartford HealthCare Behavioral Health Network. “If it’s real safety hazard, I suggest approaching it gently, in a non-argumentative way. Say something like, ‘Mom or Dad, I’m really concerned about you and the living situation here. It makes me worry for your safety. Is there something we can do about this?’” Dr. Tolin offered. > Want more health news? Text MoreLife to 31996 to sign up for text alerts

Starts and stops

It might take more than one conversation, explained Tolin. Like other major behavioral health changes, it takes a lot of "starts and stops" - a pattern also seen in people who want to lose weight or quit smoking. But the key is to avoid being argumentative. “You can’t really force someone to get treatment or badger them into it. Arguing actually has the opposite effect - they dig in their heels, double down and get defensive,” Dr. Tolin said.

Combined causes

Hoarding disorder is a condition caused by a combination of environmental, psychological and genetic factors, said Tolin. In his experience, he said: “There are very real changes in how the brain functions when people with hoarding disorder have to make decisions, such that the regions of the brain responsible for helping you decide what’s important and what’s not are not functioning very well,” Dr. Tolin said.

Is it hoarding or are they just messy?

Hoarding, Dr. Tolin stressed, is different from messy. For a diagnosis, one of two factors must be observed: In some cases, hoarding can also pose tripping, falling or fire hazards, Dr. Tolin said. Australian researchers investigated fatal house fires over 10 years and found that hoarding caused a quarter of the deaths. Affecting more people than obsessive-compulsive disorder, schizophrenia or panic disorders, hoarding disorder overlaps with depression in half of those affected, and with Attention Deficit Hyperactivity Disorder in about 28% of people.

Retrain the brain

There is no effective medication for hoarding disorder, but Tolin's patients benefit from cognitive behavioral therapy (CBT), psychotherapy through which they learn to retrain their behaviors and resist patterns that contribute to hoarding. “CBT teaches them to think differently, practice new patterns of behavior. We’ve constructed virtual store with things people might want to acquire to help them tolerate their emotions and not pick things up,” he said. Treatment can address the layers of behavioral health issues, and CBT is highly effective in combatting hoarding, but Dr. Tolin said it will not stop completely in most people. “What is likely to happen is your home is going to be much cleaner, much safer, much easier to move around in, you’ll have full use of your home and your quality of life will improve,” he said.

Research into new treatment

Dr. Tolin and his team are launching new research into the effect of real-time neurofeedback on hoarding disorder. Study participants will participate in a functional MRI brain scan while making decisions about their possessions. The goal is to train themselves to change brain function so decision making is easier. If successful, the approach may be combined with CBT, said Tolin.