Many people have treasured collections, gathering items to display that reflect their interests. Others just have too much stuff and live in a disorganized mess. A smaller segment of folks have a hoarding disorder, a mental health condition that drives them to save items in extreme numbers and conditions, often rendering them unable to leave their homes or live safely.
What Hoarding Disorder Is – and What It Isn’t
Hoarding is more than clutter or collecting. Homes or storage areas with clutter are disorganized, but the items don’t impair household functioning. People with clutter don’t acquire excessive amounts of items and may feel minor distress in discarding what they have.
Collectors are usually selective with their chosen items, organizing them together and often creating displays. Some have a focus like comic books or trading cards, while other collectors save sentimental items like family heirlooms.
Collectors typically have a purpose for their collections, such as investing 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 or acquire possessions 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 cannot care for. Their homes become unhygienic and unsafe, filled with tripping hazards, risks of stacks falling on people and the potential for fires.
Those with HD 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 heavily affects relationships with close friends and family, causing social isolation.
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, as do physical limitations and age. Research is ongoing.
Signs of hoarding usually start early in life, typically in adolescence, and start causing problems by age 30. People over 60 may have a lifetime of accumulating or start hoarding in response to life events. Often, a hoarding problem is only discovered when older people require home support, their homes become unsafe, or loved ones ask for help.
It’s difficult to assess the number of people with HD as many are ashamed and hide their problems. Research shows that two to six percent of North Americans experience HD. According to Dr. Murray Anderson, approximately 600 households on the Sunshine Coast and 15,000 households in Great Victoria were identified in 2019 as occupied by people with HD.
Hoarding: Self-Neglect and Abuse
Hoarding is a form of self-neglect and can lead to instances of abuse. The person with HD may be abusive to those who try to help them or share the same home. They may also be vulnerable to abuse by others who try to take advantage of their vulnerability,
Problems with safely staying in their homes as they age or maintaining tenancy may arise.
Help for Hoarding: Diagnosis to Treatment
- Get An Assessment
Assessment is the first step toward understanding what’s going on and making a plan. For a full diagnosis, contact Adult Mental Health Services or the local health authority.
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 has 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
- Start Cognitive Behavioural Therapy (CBT)
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 worsen the problem and may cause the person to sever relationships.
CBT examines a person’s behaviours and thoughts, helping them develop solutions with a step-by-step action plan. The therapist helps the person gradually shift their attachment from objects to community, such as reconnecting with family and friends, taking a class, volunteering, or joining a community or spiritual group.
Referrals for CBT can be made through Adult Mental Health or with a private counsellor.
- CRNs and Community Support Groups
Helping vulnerable adults with hoarding disorder crosses professional scopes of practice. A comprehensive, far-reaching approach is needed. CRNs do not intervene but may help connect the individual with the appropriate team community support groups.
Community support workers are encouraged to contact their local government or health authority to learn if a local hoarding response team exists (see Resources at the end of this article). The service is collaborative, and participation in the process must be voluntary; participants must consent and participate. The team may include a combination of a case worker, a mental health worker, a fire inspector, RCMP, landlords, the SPCA, a family member and others.
- Medications
In some cases, medication is helpful, especially if an underlying condition is diagnosed. The family doctor will determine this, often in consultation with the psychologist. Medication may be indicated, especially if an underlying condition is diagnosed. A combination of medication and CBT is frequently successful.
- Professional Organizers
If the person agrees, they can work with a professional organizer who would be available for a fee. Accredited organizers are often adept at understanding and assisting people with HD.
- Self-Help
Some people can work independently or with a family member to clear up. That can be very difficult if the situation has moved beyond clutter and into compulsive hoarding.
For tips on helping a family member declutter, see the helpful pointers on eMentalHealth.ca. The book Buried in Treasures is another good resource.
Learning and Research Continue
It’s important to know that recovery from a hoarding disorder may be a months- or lifelong struggle. Like any other illness, those dealing with it need empathy and support.
BC CRN has a new program that is now part of our regular training activities. This program will be presented on a rotating basis with our other webinars and offers more detail and research than we can offer here.
Resources for 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.
