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Hoarding Disorder

People with hoarding disorder have persistent difficulty getting rid of or parting with possessions due to a perceived need to save the items. Attempts to part with possessions create considerable distress and lead to decisions to save them. The resulting clutter disrupts the ability to use living spaces (American Psychiatric Association, 2013).

Hoarding is not the same as collecting. Collectors typically acquire possessions in an organized, intentional, and targeted fashion. Once acquired, the items are removed from normal usage, but are subject to being organizing, admired, and displayed to others. Acquisition of objects in people who hoard is largely impulsive, with little active planning, and triggered by the sight of an object that could be owned. Objects acquired by people with hoarding lack a consistent theme, whereas those of collectors are narrowly focused on a particular topic. In contrast to the organization and display of possessions seen in collecting, disorganized clutter is a hallmark of hoarding disorder.

The overall prevalence of hoarding disorder is approximately 2.6%, with higher rates for people over 60 years old and people with other psychiatric diagnoses, especially anxiety and depression. The prevalence and features of hoarding appear to be similar across countries and cultures. The bulk of evidence suggests that hoarding occurs with equal frequency in men and women. Hoarding behavior begins relatively early in life and increases in severity with each decade.

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Expert Q&A: Hoarding Disorder

TV shows have raised awareness of the devastating impact hoarding behaviors can have on the individual and their loved ones. It is important for those affected to understand that TV shows, by their nature, may not capture all the time, effort and hard work that is a necessary part of any mental health treatment program. Hoarding, which became a new diagnostic entry in the DSM-5 in 2013, affects about 2-3 percent of individuals. People with hoarding disorder have difficulty parting with possessions, clutter that interferes with normal functioning and marked distress and impairment.

The initial start of hoarding symptoms is thought to happen in childhood or adolescence (typical onset is around age 16) and it is chronic and progressive. Hoarding is more common in older than younger age groups.

Below are some early signs that an individual may have hoarding behaviors. These behaviors are typically mild and progress over years. They may become a severe problem in adults in their 50s. However, not every person with hoarding symptoms has a hoarding disorder.

  • Difficulty letting go of things (throwing away, selling, recycling, giving away)
  • Clutter that makes it difficult to move easily throughout the home
  • Piles of items that keep tipping over (newspapers, magazines, mail)
  • Sleeping with items on the bed
  • Trouble organizing and categorizing
  • Trouble making decisions
  • Spending time moving things from pile to pile without letting go of items
  • Problems with attention
  • Excessive shopping or collecting free things
  • Not realizing the seriousness of the problem

It is difficult to watch a family member struggle with clutter; especially when they do not see how it is impacting their lives. Those who want to help can often feel helpless and overwhelmed. The first step to help a loved one is to get information. The International OCD Foundation (IOCDF) has information about hoarding and practical resources and referrals. The second step is to listen to your loved one and try to understand why they have problems with clutter. For example, letting go of possessions is difficult for a variety of reasons: sentimentality, aesthetics, or an object’s future usefulness. Those with hoarding behaviors are often highly creative individuals who can think of multiple uses for items; however, these grand ideas rarely materialize, resulting in clutter. More often than not, your loved one can recognize at least one issue (limited space, not able to have family over) that makes them unhappy, and that will serve as a good shared starting point.

In the United States, a person’s civil liberties are protected; going into someone’s house (depending on the situation) may be a civil rights violation. Because there are strong attachments to the clutter and the clutter is a result of a disorder which causes excessive acquisition and decisions to save possessions, simply removing the clutter may not help. Only changing the amount of acquisitions and decisions to save will keep the clutter manageable. Imagine treating a person with alcoholism by throwing away their wine bottles—this would not likely work as a long-term solution, and the person would likely go back to drinking if they did not get professional help to treat their underlying problems. In addition, if a family member “just went in and removed the clutter” it would most likely result in disastrous consequences, including: rupture of trust, alienating the family member, increasing the family member’s anxiety, depression/suicidality, thus potentially delaying their time to receiving care and treatment.

Yes, hoarding disorder is more common among people who have a family member who has hoarding disorder. The cause of hoarding disorder remains unknown. Genetics is likely only one part of why hoarding disorder affects a particular individual; environment plays a role as well.

Animal hoarding is a heartbreaking cycle for the pets, the individuals who keep these pets, families and the government agencies involved (animal control, social services). Many times the individual has managed to adequately care for a large number of animals, but then something happens, such as illness, loss of income, death of a spouse. This change impacts their ability to properly care for the animals; and at the same time, they are fearful, or lack the skills to seek help. In these cases, intervention in usually much easier than with hoarding of material possessions, and the individual is more cooperative. Yet in some cases, the individual may have developed a rigid set of beliefs that they are saving and protecting animals despite the fact that they are not providing adequate care. In such cases, animals in the home may be sick, dying, or dead, but the individual denies any problems.

Animal hoarding is defined in DSM-5 as the accumulation of a large number of animals and a failure to provide minimal standards of nutrition, sanitation and veterinary care and to act on the deteriorating condition of the animals (including disease, starvation or death) and the environment (e.g., severe overcrowding, extremely unsanitary conditions).

There are multiple types of help for individuals with hoarding disorder, including self-help books, support groups, individual talk therapy, medications and group therapy. New studies are underway examining internet-based treatments. Emerging evidence supports peer-facilitated group treatments.

Hoarding disorder can be treated and there is hope for returning to a normal life. Typically, individuals will continue to face challenges throughout their lives; staying in treatment may decrease chances that hoarding symptoms and clutter will return.

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About the Hoarding Experts

Carolyn Rodriguez, M.D., Ph.D.

Associate Chair and Associate Professor

Director, Stanford Hoarding Disorders Research Program

Department of  Psychiatry and Behavioral Sciences

Stanford University School of Medicine

Member, Scientific & Clinical Advisory Board, The International OCD Foundation (IOCDF)

 

Randy O. Frost, Ph.D.

Harold and Elsa Siipola Israel Professor of Psychology

Smith College

Member, Scientific & Clinical Advisory Board, The International OCD Foundation (IOCDF)

Medical leadership for mind, brain and body.

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