Hoarding Disorder: What Can You Do to Help?

As noted in an earlier post, "6 Signs of Hoarding Disorder," individuals with hoarding disorder (HD) frequently have other disorders including obsessive-compulsive disorder, clinical depression, anxiety, traumatic brain injury, and dementia. In fact, in a study of older adults, those with HD were much more likely to also suffer from other health conditions, and the severity of the disorder was directly related to the number of health problems (Ayers, Iqbal, & Strickland, 2013).

Unfortunately, HD is associated with challenges in multiple areas of functioning and compromised functioning in the areas of planning, problem-solving, spatial learning, attention, organization, and memory are often present. We can see how challenges in planning or problem-solving could lead to an unnecessary accumulation of possessions or an inability to know which items should be discarded and which should be retained. If unable to organize one’s possessions, stacks and stacks of things will accumulate. Individuals with HD also experience severely compromised insight and so are unaware of the risks their behaviors carry.

There is no cure for hoarding disorder; treatments can minimize the symptoms and help individuals gain stronger control over their lives. Commitment from the individual is essential and treatment typically includes aspects of cognitive behavioral therapy or the use of medications such as antidepressants.

Hoarding tendencies begin in late adolescence and grow worse over time. Unfortunately, hoarding isn’t just “being too lazy” to de-clutter and clean up living areas. It goes much deeper. The actual cause of HD behaviors is likely a combination of multiple factors, including genetic predisposition to the disorder, compromised neurocognitive processes, abnormal attachments to possessions, and possibly life events (Dozier & Ayers, 2017). It appears that severe adversity in childhood can contribute to the manifestation of the disorder as can traumatic victimization in adulthood.

Helping Someone With Hoarding Disorder

Individuals who hoard seldom seek out assistance for hoarding behaviors or associated problems, such as dangerous living conditions, including unsanitary conditions with even toilets no longer accessible in around 10% of cases (Tompkins, 2011). Financial problems can multiply quickly as money coming in goes back out on more “stuff” or storage unit rental fees for more space for their “stuff.” Bills may be overlooked as they get buried under newly acquired items. Family members and friends are likely to feel helpless as they watch their loved one’s home and life become buried under their acquisitions.

Instrumental, Intrinsic, and Sentimental Hoarding

It’s not easy to reason with a person with HD; their attachments to possessions are much more intense than for those who do not hoard. There are three types of attachment—instrumental, intrinsic, and sentimental hoarding (Charter, Show, & McKay, 2013).

Instrumental hoarding often arises from a sense of deprivation at some point in life. The objects may be a random collection, but they all do hold some type of functional value – buying 6 toothbrushes when they were 6 for $1; clothing items that might be great deals but are sizes too small or large may be held onto “in case” 25 pounds is gained or lost. Other items might be reading materials such as magazines, weekly sales papers, or catalogs that are seen to have information that the individual might want to access “later.” Help the individual to assess whether or not they truly will need all of the “just in case items” that they’ve collected or if there would truly be no way to get what they need in the future if they let go of the item today.

I once had a great aunt who bought multiple grand pianos in one day because of the 50% off sale she happened across. She had to be convinced that she would never really need more than one piano and she was convinced to donate the others to a school and church – both of which made promises that she could come and play them if something happened to the one she kept.

Some individuals hoard objects based on the intrinsic value or appearance of an object. Free giveaway coffee mugs may be stacked throughout the house. Old books and magazines from a library’s free shelf may be stacked feet deep and growing moldy. While others may see no true value in these items, the object has value to the person who hoards. They were “free,” so they are special; they have logos so they are unique; the books may one day be read, but they were free, so they are worth making space for. To help the hoarder let go of items like this, help the client objectively reflect on whether or not these objects are really needed or if they really are as valuable as the space they are taking up warrants. Even encouraging them to let go of duplicates or ones that are less “unique” may help in harm reduction and quantity of clutter.

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Many of us might keep souvenirs of special times or people in our lives, but sentimental hoarding results in objects being imbued with so much meaning that the person perceives the object as that time or that person. Asking someone to let go of sentimentally hoarded objects is challenging, as it feels as if parts of a person’s life are being stripped away. Help the person recognize that their memory of the event or person can sustain that positive feeling the object was bringing them.

Harm Reduction as a First Step

Until a person with hoarding disorder is ready to seek help—and their lack of understanding of the dangers their behavior is causing them keeps them from recognizing the risks—harm reduction may be a better priority than behavior cessation (Tomkins, 2011). Harm reduction is a perspective taken towards problematic behaviors/disorders that are difficult to fully eradicate and that allow for meeting people where they are at in reducing/eliminating a behavior. An example is minimizing the risk of STDs by using condoms or reducing the harm that alcohol could cause by encouraging people to limit their alcohol intake rather than strive for abstinence.

With hoarders, insight into their problem may be limited, but the risks to their health, ambulation, or independent living can be strong motivating factors for reducing their clutter.

Harm reduction often involves family members or friends or even professional de-cluttering professionals. Helping the person with HD to recognize the risk that they are facing in their holding on to their clutter can encourage more openness to at least some beginning steps in cleaning their homes.

Once the individual has been encouraged and convinced of the benefits of “doing a little bit of clearing,” agreements can be negotiated regarding what the bare minimum level of assistance will be. These goals may be as basic as removing all clutter inside and within a foot of the stove; cleaning out the fridge of all opened products; or clearing paths so that doors can all open fully to prevent tragedy in the event of the need for evacuation or entry of emergency service personnel.