What Is Hoarding Disorder?

According to the Mayo Clinic, hoarding is “a persistent difficulty discarding or parting with possessions because of a perceived need to save them.” And while this is an adequate definition, it often leads friends and loved ones to believe that treating the condition is as simple as getting rid of hoarded possessions. However, hoarding is typically a symptom of a more significant mental health condition related to anxiety disorders such as obsessive-compulsive disorder (OCD).

Individuals with hoarding disorder don’t just have a shopping problem; they experience severe anxiety at the thought of getting rid of any of their possessions. Excessive items, no matter what the monetary value, are accumulated over time. Tabletops, kitchen counters, floors, bathrooms, closets, and most surfaces are piled with random items. If the hoarder runs out of space for their items in their home, they may fill up their cars and backyard and even pay for storage units.

Some cases of hoarding can be severe, and others mild. It becomes a problem when hoarding impacts your life and affects your functioning and health.

Almost everyone knows someone who has trouble letting go of possessions they no longer use. There is no known cause for compulsive hoarding, although studies have shown that there may be links between hoarding and depression, anxiety disorders, social isolation, stress, and/or chemical dependency. The high prevalence rate of hoarders has brought attention to it as a severe mental health condition. Until the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) was released in 2013, it wasn’t a defined condition but a listed symptom of other mental health conditions, such as OCD.

Currently, estimates state that two to five percent of adults are compulsive hoarders, with most of these instances manifesting in childhood and worsening as the person ages.

Due to the link between hoarding with depression, anxiety, and attention deficit hyperactivity disorder (ADHD), there is some reason to believe that compulsive hoarding might be triggered by traumatic events such as a death in the family, loss of a job, divorce, and/or abuse. The occurrence rate in well-functioning individuals is markedly lower than in those with co-occurring psychological disorders.

Most hoarders are secretive and prefer to keep to themselves. However the conditions that they live in can be unsanitary to the extent that they are prime environments for disease, accidents, house fires, mold, and pest infestations. Many hoarders suffer from chronic respiratory dysfunction or cardiac issues due to large amounts of ammonia (from human or pet urine or feces), mold, dust, and other allergens. In addition, the increasing weight of a hoarder’s possessions can cause structural damage or even the collapse of otherwise strong structures.

Symptoms of Hoarding

Hoarding can slowly develop over time, which may be hard to see because it is a very private behavior. It has usually gotten pretty severe when others notice their loved one has a problem.

Signs of hoarding are:

Buying or taking donated items that the person doesn’t need or have space for
Having a tough time throwing away or giving away things, even if it has no monetary value
Having the compulsion to save items and becoming upset when thinking of having to give them away
Bedrooms and bathrooms are unusable due to clutter
The belief that their possessions will be needed in the future
The feeling of safety when surrounded by their things
The desire to not waste anything

Hoarders can be confused with people who collect items; however, hoarding differs from collecting. Collectors of stamps or baseball cards deliberately search for specific items and take care of their collections by organizing them. Although collections may seem to take up a lot of room, they do not appear as clutter. They also do not create health risks to the individual.

Methods Used in Therapy for Hoarding

Hoarding is a complex problem to treat. When friends and loved ones attempt to help, this is often characterized by a gentle or forceful coaxing of the hoarder to release unneeded or unwanted possessions. While this may bring temporary relief, it isn’t a permanent solution, as the hoarder will continue accumulating possessions until the problem resurfaces. In addition, this often worsens the situation by increasing anxiety levels in an individual who may already be dealing with an underlying mental health condition.

Compulsive hoarding has various types of treatment. While both medicine and therapy are vital to helping compulsive hoarders, the addition of cognitive behavioral therapy (or behavior modification therapy) to treat the underlying cause of the behavior is often the best course of action.

The treatment program is often long and relatively slow-moving, as hoarders are typically quite anxious by nature. Moving slowly and altering behaviors at a speed they are comfortable with is often the most effective way to combat compulsive hoarding.

The complications when treating compulsive hoarders are often magnified by the hoarder not believing that the behavior is a problem. Therapists typically work to address the problem by earning the patient’s trust, then slowly working to make them realize how hoarding is harmful before ultimately working out a step-by-step program to modify the behaviors at its core. Addressing the issue and then slowly working to address the behavior, instead of just getting rid of the hoarded possessions, helps to keep it from happening again once the patient is finally ready to discard items.

Post Pandemic Impact

The COVID-19 pandemic has resulted in high levels of stress and fear within people and communities. According to different studies, anxiety and the idea of a threat were the most frequent reasons for stockpiling during the pandemic. Recent research has shown that those with pre-existing mental health problems have experienced more significant distress and negative psychological consequences as a result of COVID-19. For people who suffer from hoarding disorder, the use of the word “hoarding” casually during the COVID-19 pandemic triggered emotions and an array of responses. In fear and preparation for long-term quarantine, many people began storing large quantities of essential supplies such as hand sanitizer, cleaning products, toilet paper, and bottled water. These behaviors, collectively called “hoarding” by the press, were a result of greed, and in many cases, it was panic buying by people afraid of getting sick or having to live without essential items in the event of a long-term quarantine.

Like many of us, people suffering from hoarding disorder have responded to the pandemic, leading to the immediate quarantine and social isolation of people worldwide. People who hoard items have felt justified in their desire to save them and felt more prepared for the quarantine. Some people have stocked up on specific foods that are important to them, just in case they become unavailable. However, others have benefited from the isolation, using their alone time to go through their belongings and de-clutter. Although there are common themes, there is no one response from people with hoarding disorder to the COVID-19 pandemic. During the pandemic, the most significant threat to people with hoarding disorder is increased misunderstanding and stigmatization of this already misunderstood psychiatric illness.

Why Hire a Therapist?

Hoarding is a compulsion that primarily affects individuals that don’t necessarily see it as a problem. Cleaning a hoarder’s house or forcing them to remove particular objects often causes undue stress and ultimately becomes counterproductive. Once hoarded items are gone, the behavior or underlying psychological condition can remain unaddressed, making ongoing therapy sessions more critical.

Hoarders are often unaware that they have a problem until loved ones discover what kind of conditions they are living in. Once this happens, it’s best to contact a mental health professional – with experience in compulsive hoarding – for help. Only they can properly help your loved one with any underlying psychological conditions and understand the root of the behavior instead of just addressing the visible symptoms. Remember, removing extraneous items doesn’t relieve the underlying problem.

What to Look for When Finding a Therapist.

When looking for a therapist, finding one with experience in hoarding is ideal, but since this is a relatively new condition, a therapist with expertise in obsessive-compulsive behavior, or anxiety disorders, is often qualified to handle most hoarding cases. Search TherapyTribe.com to find a qualified therapist today – don’t wait to get the help you need.

References

Benatti B., Albert U., Maina G., Fiorillo A., Celebre L., Girone N.…Dell’Osso B. What happened to patients with obsessive compulsive disorder during the COVID-19 pandemic? A multicentre report from tertiary clinics in Northern Italy. Front. Psychiatr. 2020;11:720. doi: 10.3389/fpsyt.2020.00720. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

Fontenelle L.F., Muhlbauer J.E., Albertella L., Eppingstall J. Traumatic and stressful life events in hoarding – the role of loss and deprivation. Eur. J. Psychotraumatol. 2020 (in press), (in press) [PMC free article] [PubMed] [Google Scholar]

Mayo Clinic Staff (2018). Hoarding Disorder. Retrieved on June 13, 2019 from https://www.mayoclinic.org/diseases-conditions/hoarding-disorder/symptoms-causes/syc-20356056

Hoarding disorder. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. http://www.psychiatryonline.org. Accessed June 13, 2019.

Tolin DF, et al (2015). Cognitive behavioral therapy for hoarding disorder: A meta-analysis. Depression and Anxiety. 32:158.