Hoarding is more than collecting or having extra stuff. Hoarding disorder is a mental health condition that makes people feel the need to save items in extreme numbers and conditions, often rendering them unable to leave their homes or live safely. There is help! Compassion, therapy and medication are helping people with hoarding disorder (HD) live happier lives.
What Hoarding Disorder Is – and What It Isn’t
Hoarding is more than collections. Collectors are usually selective with the items they choose, organizing them together and often creating displays. Collectors usually have a purpose for their collections such as investments for future sales, a focus such as stamps or comic books, or things of sentimental value like personal awards or family heirlooms.
Hoarding is an excessive need to collect what others perceive as random, useless items. A person with HD often lives in chaos. Stacks of newspapers, magazines, clothing and household goods may fill their homes. Entire rooms, hallways, toilets and even kitchen appliances may be inaccessible. Some people with this disorder accumulate large numbers of pets they are unable to care for. Their homes become unhygienic and unsafe, filled with tripping hazards, risks of stacks falling on people and the potential for fires.
Hoarders experience extreme distress at the thought of throwing items out. If items or pets are removed from their homes, they often quickly replace them to feel comforted.
Hoarding also takes a heavy toll on relationships with close friends and family.
Causes of Hoarding
Around 75% of individuals who have HD have a co-occurring mental health condition, according to the International Obsessive-Compulsive Disorder Foundation Hoarding Centre.
The most common are depression and anxiety disorders, obsessive-compulsive disorder (OCD) and attention-deficit/hyperactivity-disorder (ADHD). Some researchers believe genetics, brain function and stressful life events underlie the condition. Research is ongoing.
Signs of hoarding usually start early in life, typically in adolescence, and start causing problems by age 30. People over age 60 may have a lifetime of accumulating, or they start hoarding in response to life events.
Research shows that 1.5 to 6 percent of North Americans experience HD. It’s difficult to assess as many people are ashamed and hide their problems. Often a hoarding problem is only discovered when older people require home support, their homes become unsafe, or loved ones ask for help.
How Hoarding is Diagnosed
The current Diagnostic and Statistical Manual of Mental Disorders (DSM 5-TR) lists four primary criteria for the diagnosis of hoarding disorder:
- Persistent difficulty parting with possessions regardless of value
- A perceived need to save items
- An accumulation of items that resulted in significant clutter
- The behaviour and/or clutter are time-consuming or cause significant distress or impairment in various areas of functioning, including work, school, or social life
There is a simple, five-question hoarding disorder screening tool on the eMentalHealth.ca website that may be a good place to start assessment.
Help for Hoarding
- Self-Help
Hoarding is a challenge that needs to be approached compassionately and gently. People with HD often feel shame and fear; critical family members or support workers will only make the problem worse and may cause the person to sever relationships.
Some people can work on their own or with a family member to clear up. That can be very difficult if the situation has moved beyond clutter and into the realm of compulsive hoarding. For tips on helping a family member declutter, see the helpful pointers on eMentalHealth.ca.
- Community Support
Community support workers are encouraged to contact their local government or health authority to learn if there is a hoarding response team in their area. The service is collaborative and participants must be voluntary; they must give consent and participate in the process. The team may include a combination of a case worker, a mental health worker, a fire inspector and/or a family member. Professional organizers are also available for a fee.
If the person with HD still cannot move forward, they may require the assistance of a mental health professional specializing in hoarding disorders.
- Mental Health Treatments for Hoarding Disorder
There are three recognized ways to treat HD:
- Cognitive behavioural therapy (CBT), provided by a specialized psychologist, psychotherapist or social worker
- Medication, prescribed by a doctor
- Combination of CBT and medication
CBT will look at the person’s behaviours and thoughts, helping them develop solutions with a step-by-step action plan. The therapist will help the person gradually move their attachment from objects to community, such as reconnecting with family and friends, taking a class, volunteering, or joining a community or spiritual group.
Medication may be indicated, especially if an underlying condition is diagnosed. A combination of the two is often successful.
Learning and Research Continue
It’s important to know that dealing with their disorder may be a months- or lifelong struggle for hoarders. Like any other illness, those dealing with it need empathy and support.
BC CRN is developing a new program that will become part of our regular training activities. Watch our website for more information!
Resources on Hoarding Disorder
- Hoarding Disorder – HealthLink BC
- Hoarding Disorder (aka Pathological Hoarding) – eMentalHealth
- Hoarding Education & Action Team (HEAT) – Greater Victoria
- Hoarding Action Response Team (HART) – City of Vancouver
- Centre for Collaborative Research on Hoarding – UBC
- International Obsessive-Compulsive Disorder Foundation Hoarding Centre
- Assessment and Inspection Tools
Explore our website to learn more about BC CRN or connect with your local CRN for more information or resources.
