Psychological Conditions

Hoarding

What is hoarding?

Compulsive hoarding refers to acquiring and not being able to discard items of little value to the point that the number of items hoarded begins to make it difficult to appropriately use the living space in which the items are stored (e.g., eat on the kitchen table), and the hoarded items begin to cause a lot of distress and to disrupt the person’s day-to-day functioning.  People with compulsive hoarding are sometimes referred to as “pack rats.”  Syllogomania and disposophobia are other names used throughout the years to refer to compulsive hoarding.

How common is hoarding?

Hoarding is estimated to affect between 700,000 to 1.4 million people in the United States.  This may be an underestimate as many hoarders often do not seek help on their own.  It is most common for hoarders to be brought to treatment by a loved one.

Hoarding is quite a common symptom among people with Obsessive Compulsive Disorder (OCD).  Anywhere from 25 to 30 % of people with OCD report hoarding symptoms.

Is hoarding only a problem for old people?  

Compulsive hoarding does not discriminate.  It can affect anyone regardless of age, gender, or socio-economic status. Although hoarding is commonly thought of to occur in the elderly, hoarding symptoms actually begin between age 11 or 12 on average.  As with many other conditions, hoarding, if left untreated, will become more severe over time.   It is also important to consider that all hoarders are not the same.  Hoarding symptoms vary in severity from mild to severe.  As with most conditions, treating hoarding behavior early is the main way to derail the symptoms from becoming severe.

What do people hoard? 

Items that people hoard range from books to clothing to empty containers.  There can be many unusual items that people with hoarding keep such as used tissues and rocks, even body waste products.  The following categories cover many of the broad areas of items kept by hoarders.

  • Saving broken, irreparable, or useless things
  • Buying excessive quantities of goods (e.g. cans of tuna) beyond the amount needed for reasonable usage
  • Purchasing large amounts of useful items and storing them away for future usage, but never using them
  • Retrieving numerous materials from the trash on a regular basis
  • Having difficulty discarding anything due to a fear of accidentally throwing out something important
  • Saving excessive quantities of printed matter (newspapers, magazines, junk mail, etc.)
  • Making and keeping extensive lists or records of certain things, even after they are no longer needed
  • Saving large amounts of certain items for possible use by others or for future recycling

How can you tell if hoarding is a problem?  

Hoarding becomes a problem when it begins to interfere with a person’s day-to-day life.  Many individuals who hoard begin to isolate themselves from friends and family due to feelings of guilt and shame regarding their hoarded items.  They also begin to encounter difficulty finding items they need. In addition to these difficulties, many compulsive hoarders begin to have health problems due to dust and mold that build up on the piles of hoarded items.  The quantity of items hoarded may even become a fire hazard.  Overall, there are many heartbreaking statistics related to individuals who hoard: 6% have been fired because of hoarding, 77% report 1 or more severe health conditions, up to 1 in 55 have had a child removed from their home, 13% have been evicted or threatened with eviction from their home.

 

How is hoarding different from collecting?

One key way to distinguish a hoarder from a collector is by comparing the items hoarded or collected.  Collectors seek and maintain items that a majority of others would think of as having true value.  Collectors generally organize their items and display them in an aesthetically pleasing manner, while hoarders, on the other hand, have all their stuff in boxes and the items are not organized.  Hoarders find it difficult to determine when enough is enough.  For example, they find it very difficult to decide which items to keep as memorabilia and which to discard.  Therefore, they often end up keeping most items than discarding.  This difficulty is often caused by differences in thinking between a hoarder and a collector.  While collectors will likely acquire certain items (e.g., baseball cards, souvenir plates), hoarders tend to keep many different types of items with little rhyme or reason (maybe to them, but not to others) from random photos to gum wrappers to hair.

Is hoarding a type of OCD? 

Basically, yes.  Throughout the years, OCD has been extensively researched.  Based on this information, it is believed that obsessions (intrusive thoughts) and compulsions (repetitive behaviors or mental rituals) cluster into four groups: 1) contamination thoughts with washing and cleaning compulsions; 2) symmetry themes with ordering and arranging rituals; 3) intrusive thoughts with sexual, religious, and aggressive themes, and checking behaviors; 4) hoarding symptoms.

Although it is currently thought to be a subtype of OCD, some now theorize that compulsive hoarding may be a distinct condition.  Many researchers believe compulsive hoarding is a lot more like an Impulse Control Disorders such as gambling.  This is largely due to the function the hoarding behavior serves for the person, which is often positively reinforcing (e.g., keeping school books from elementary school onwards leads to a pleasant feeling), similar to impulsive behaviors (e.g., gambling) yet dissimilar from OC behaviors which are negatively reinforcing (e.g., washing hands temporarily takes away yucky feeling that your hands are dirty).  Because the hoarding behavior is positively reinforcing, these individuals are less likely to seek treatment, rather they are often brought for care by a loved one.  There are a couple of other reasons why some people believe hoarding is different from OCD.  First, people who hoard state that they have an impulsive urge to acquire items.  Second, hoarders with OCD also have much lower rates of response to the gold standard treatment for OCD (that is, Exposure and Response Prevention alone) as compared to OCD patients without hoarding.

Is hoarding treatable?

With comprehensive programs, 50% of participants can be expected to make mild to moderate improvements.  The key issue is to get the right type of treatment as early as possible.  Most treatment will need to address motivation as it is often very low for people who hoard at the outset of care and motivation can vary throughout the intervention.

What are some treatments of hoarding?

The best approach to treatment of compulsive hoarding is comprehensive and multimodal.  In other words, not just one type of treatment will be as helpful as multiple treatments at the same time.  Medication is often recommended for people who are hoarders.  The types of medication often prescribed for people with hoarding include tricyclic antidepressants, Selective Serotonin Reuptake Inhibitors (aka SSRIs), and psycho-stimulants.  Medication alone, however, is not the best approach.  Cognitive Behavioral Therapy (CBT) is the most effective form of psychological treatment to date.  One type of CBT is known as Exposure and Response Prevention (ERP), which is the gold standard treatment for OCD.  Traditional ERP alone, though, has not been found to be as effective for this population.  There are a few reasons that are thought to account for this discrepancy.  First, individuals who hoard often have a very strong conviction in their beliefs that requires treatment that focuses on revising these beliefs.  Hoarders are also often fearful of engaging in ERP.  They are often embarrassed and reluctant to allow others to see their cluttered spaces so a modified CBT model tailored to compulsive hoarding is used to treat this population.  Additional CBT techniques are essential for improvement to be noted in people who hoard.  Cognitive treatment that target the following areas are also essential: building motivation for treatment, disputing erroneous thoughts, increasing organizational and decision-making skills, increasing discarding skills, increasing their ability to de-clutter home, and understanding what to keep.  Effective treatment of hoarding requires sufficient intensity, duration in order to achieve desired results.  Home visits are often essential to the intervention process.

What should you do if you think that you or someone you care about has a hoarding problem?

Hoarding is often not perceived by the person who hoards to be as much of a problem (or a problem at all) as it does for their loved ones.  People who hoard often have limited awareness of how much of a problem their hoarding behavior is causing.  Forcing the person who hoards to change is not the best approach, nor is throwing all their hoarded items away.  Rather, increasing your loved one’s motivation for change is the first key step.  This can be done by finding a therapist who is familiar with treatment for hoarding, OCD, and motivational interviewing.  Treatment will need to first focus on the individual who hoards’ motivation for change.  If your loved one is unwilling to attend treatment, then it would be most helpful for you to work with a therapist on how to build your loved one’s motivation.  It would also be helpful to find a local support group for people who hoard or for people with OCD.  You will be able to obtain emotional support as well as learn from other people who understand from first-hand experience.  Most importantly, the earlier the treatment for hoarding is started, the better.  If you notice symptoms of hoarding in your loved one, begin to seek out professionals in your area who are trained to treat hoarding and OCD.