Compulsive Hoarding

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Hoarding Disorder is a common and potentially disabling problem, characterized by the accumulation of excessive clutter, to the point that parts of one's home can no longer be used for their intended purpose.

Hoarding Disorder is estimated to affect 2-5% of the population. The problem is characterized by attachment to objects, difficulty parting with possessions, and resulting clutter. The problem can range from mild clutter with minimal interference, to severe clutter that substantially impedes daily functioning.

Hoarding Disorder is a neurobiological disorder. Scientists do not fully understand what causes it, but it likely has some genetic component, as it tends to run in families. Not all clutter is due to Hoarding Disorder, and a diagnosis of Hoarding Disorder is typically made by a trained clinician.


Treatment for Hoarding Disorder

There is no "cure" for Hoarding Disorder, meaning there is no treatment that will make the problem go away completely and never come back at all. However, some treatments may help people to manage the symptoms more effectively.

Cognitive-Behavioral Therapy
Cognitive-behavioral therapy is a form of counseling that goes beyond "just talking." In this form of treatment, the patient practices variety of skills, including skills for sorting and discarding, organization, and time management. The program also focuses on increasing tolerance of negative emotions, maintaining motivation for decluttering, and decreasing negative thoughts that interfere with progress. The available evidence suggests that cognitive-behavioral therapy is effective for many people who hoard, generally leading to decreased clutter, improvements in functioning, and deceases in distress.

Medications
Research studies using antidepressant medications (that increase the level of serotonin activity in the brain) show that some people with hoarding may show some mild to moderate benefit from these medications; however, many do not. At this time, no medication has been proven to be effective for hoarding disorder 

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Hoarding Disorder is thought to result from problems in one or more of these areas:

Information Processing
People with hoarding disorder often have problems such as:

  • Difficulty categorizing their possessions (for example, deciding what is valuable and what is not)
  • Difficulty making decisions about what to do with possessions
  • Trouble remembering where things are (and so they often want to keep everything in sight so they don't forget)

Beliefs About Possessions
People with hoarding disorder often:

  • Feel a strong sense of emotional attachment toward their possessions (for example, an object might be felt to be very special, or a part of them)
  • Feel a need to stay in control of their possessions (and so they don't want anyone touching or moving their possessions)
  • Worry about forgetting things (and use their possessions as visual reminders)

Emotional Distress About Discarding 
People with hoarding disorder often:

  • Feel very anxious or upset when they have to make a decision about discarding things
  • Feel distressed when they see something they want and think they can't feel better until they acquire that object
  • Control their uncomfortable feelings by avoiding making the decision or putting it off until later

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Frequently Asked Questions 

Q: How does Hoarding Disorder start? What causes it?
A: We don't know exactly. People usually start hoarding during childhood or early adolescence, although the problem may not become severe until the person is in late adulthood. Like many mental health issues, it is likely due to several interacting factors, such as genetics, difficult life experiences, biological factors, and learning experiences.

Q: What is the treatment like?
A: Treatment for Hoarding Disorder at the ADC is a group-based treatment that typically lasts 4-5 months, with a group session each week. The treatment is quite class-like; it will focus on teaching skills and practicing them regularly. Group members are expected to practice sorting and parting with possessions on a regular basis as they go through the group so that they can practice applying the skills they have learned. Group members are always allowed to make their own decisions about objects; they are never forced to discard any items.

When a Loved One Hoards

In our hoarding clinic and research program, one of the most common inquiries we get is: "My [mother, father, sibling, friend, spouse, etc.] has a terrible hoarding problem. But he/she doesn't seem to recognize that it's a problem and isn't interested in doing anything about it. How can I make him/her see that this is a problem and get the help he/she so badly needs?"

In most cases, you can't. That is, assuming that your loved one is an adult who is legally competent to manage his/her own affairs (meaning he/she has not been declared incompetent by a judge and appointed a legal guardian), and the clutter is not immediately life-threatening, he/she has the right to hoard, even though the hoarding might have terrible consequences for his/her quality of life.

Even though in most cases you can't make the person do anything, you can alter your approach to minimize the likelihood of getting a defensive or "stubborn" reaction. Often, it's tempting to start arguing with the person, trying to persuade them to see things the way you do. This kind of direct confrontation rarely works.

We find that the best way to help people increase their motivation to work on the problem is to start with three key assumptions:

  • Ambivalence is normal.
  • People have a right to make their own choices.
  • Nothing will happen until the person is ready to change.

Here are some general principles to guide your conversations:

Show Empathy
Showing empathy doesn't necessarily mean that you agree with everything the person says. But it does mean you are willing to listen and to try to see things from the other person's perspective.

Respect Autonomy
Remember, most of you are dealing with an adult who has freedom of choice about his or her own possessions. Try to engage your loved one in a discussion (rather than an argument) about the home and his or her behavior. Express that you are concerned about the clutter and the related problems.

Inform them that treatment is available
Clients have often voiced to us that they would have sought treatment earlier if they had known it was available, that hoarding was a legitimate mental health issue, and that there was an effective treatment!

Be willing to help (if they ask)
Never discard objects without their consent, as this will likely just lead to arguments. Remember that even if you help or force the person to “dig out,” without effective treatment they are unlikely to develop the skills to sustain this progress. However, if possible, be supportive and willing to assist with moving objects, removing items from the home, or other tasks as long as the loved one has given you clearance to do so.

Praise efforts at change and be patient
Remember that all the clutter didn’t get there overnight, and it will take a long time for your loved one to process all of it. Treatment is usually slow going. However, over time you should see small signs of progress. Genuinely praise them for any effort you are pleased with, no matter how small, if it is an improvement on what they were already doing! Remember that they have difficulty making decisions and they may think differently than most people. In our treatment we have often found that with much repeated practice, parting with possessions leads to less distress and becomes more rapid.

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Helpful Resources 

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Anxiety Disorders Center


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