Hoarding : Ottawa-Carleton, ON : eMentalHealth.ca
Retrieved November 2013

Compulsive hoarding (aka pathological hoarding) is acquiring possessions along with the failure to discard them, even if the items are worthless, no longer useful. Hoarded items fill the person's home, and can cause severe problems with day-to-day activities and relationships, and even pose a danger to life through being a fire and safety hazard.

Mike is unable to throw out any of his newspapers, and so he has every single newspaper for his local paper going back decades... Melissa has over thirty cats in her small apartment. Dave has collected so much possessions that he is embarassed to have people over at his home... Due to public health complaints from neighbours and concerns by the fire department, all of them are in danger of losing their homes.

What is hoarding?
Especially in a materialistic society like ours, everyone collects things. But when people collect so many things that it starts causing problems, it may be hoarding?

Hoarding has been defined (Frost and Hartl, 1996) as:


  • The acquisition of, and failure to discard a large number of possessions that appear to be useless or of limited value;
  • Living spaces sufficiently cluttered so as to preclude activities for which those spaces were designed;
  • Significant distress or impairment in functioning caused by the hoarding."


Acquiring possessions and being unable to discard them. Hoarders love to acquire possessions, either by buying them or getting them free. They tend to value all objects, even things that others would view as unimportant.

Items that may be hoarded include:


  • Clothing,
  • Newspapers and magazines
  • Animals (e.g. having numerous pets such as cats)


Problems with hoarding



  • Excess clutter: Typically, a hoarder's home becomes so full of possessions that they are no longer to use parts of their home, with blocked hallways, exits and rooms. There have even been extreme cases where stacks of possessions have collapsed and crushed people to death, or simply trapped them in the home leading them to starve to death.
  • Relationship problems: Hoarding tends to cause conflicts with other people living in the home. Family members become upset at the hoarding, and may become isolated themselves, becoming too embarrassed to invite guests over.


Why do people hoard?

There are numerous reasons why people might hoard:


  • The culture of materialism and consumption (reinforced constantly in advertising and the media) that leads many people to believe that having more possessions will make one happy.
  • Hoarding is pleasurable: When you first buy or acquire something, it is pleasurable at first, though usually short-lived.
  • It?s painful to throw out things: People who hoard feel distress at the thought or act of throwing out things.


Hoarding differs from OCD

Hoarding has long been recognized as a symptom that can occur along with other anxiety conditions such as Obsessive Compulsive Disorder (OCD), Social Phobia or Generalized Anxiety Disorder.

In recent years, there has been increasing awareness of hoarding, and the belief that it may represent a condition unto itself, a condition which is similar but still separate from other conditions such as Obsessive Compulsive Disorder (Pertusa, 2008).

Ways in which hoarding differs from OCD include:


  • In OCD, individuals usually have negative, intrusive or unwanted thoughts, whereas this is rarely the case with hoarding.
  • Most people with hoarding do not have any other OCD symptoms


How common is it?

Current estimates are that hoarding occurs in 5% of the population (Samuels, 2008), generally in individuals in their 50?s. Nonetheless, it is hard to estimate how many people have problems with hoarding as many of them are able to keep their hoarding secret. However, popular shows such as "Hoarders" have increased public awareness about hoarding.

Hoarding urges occur in children and youth as well, but since they tend to live in a household (that is owned and controlled by adult caregivers), their ability to acquire and save possessions is limited compared to adults. Thus, severe hoarding does not usually begin to be a problem until adulthood, and even then, may take decades before it comes to the attention of professionals.

What can be done about it?
Like many other anxiety conditions, hoarding typically responds to:


  1. Cognitive behavioural therapy (CBT),
  2. Medication,
  3. Combination of both.


Cognitive Behavioural Therapy (CBT)


Thoughts and Behaviours. CBT looks at the person's thoughts and behaviours that lead to hoarding, and seeks to change these thoughts and behaviours to stop the hoarding.

Hoarding Thought Solution
I can't throw out this old newspaper because I (or someone else) might need it? These newspapers can be thrown out because they?re all online nowadays.
I can't throw out these old books because I (or someone else) might want to read them. Whoever needs these books can just borrow them from the library.
I can't throw out my old school notes, because I (or someone else) might need them. These notes are out of date and I haven?t reviewed them in over 10-years, so I might as well throw them out.
I don?t want to throw out these newspapers and waste all that paper. I can put these in the recycling, and let it be re-used.

Behavioural Hierarchy
A behavioural hierarchy is about coming up with a step-by-step plan where one gradually de-clutters. It involves:


  • Make a list of what things to throw out
  • Start with the easiest things
  • Gradually progress to the more difficult things to throw out


Self-Help for Hoarding

This section of self-help questions and strategies for hoarding is adapted from Ottawa Public Health?s brochure entitled Helpful Questions & Strategies for Hoarding Situations.

Before you acquiring something, ask yourself the following questions:


  • Do I have an immediate use for this?
  • Do I need it? How many do I already have?
  • Can I get by without it?
  • Do I feel compelled to have it?
  • Can I afford it comfortably?
  • Do I have time to deal with it appropriately? maintain it?


If the answer is no to any of these questions, then don?t acquire it!

Strategies for Getting Rid of Clutter


  • Start with one area at a time
  • 1st priority is fire safety
  • Declutter so that you have free routes in and out of the residence
  • Declutter so that you have entrance and exits from each room.
  • Declutter around heat and ignition sources, i.e. furnaces, stoves, portable heaters, baseboard heaters, water heaters or uncovered light bulbs,
  • Make sure smoke detectors are functioning.
  • Spend as many future work periods as needed to complete your goal for this area.
  • Sort possessions into categories:
    • 1) Keep
    • 2) Discard & Recycle
    • 3) Re-gift piles



  • How do I know what category something goes into? Ask yourself the following questions in order to decide whether to
    • 1) Keep or to
    • 2) Discard & Recycle or
    • 3) Re-gift it



  • Questions to ask yourself about possessions that you have:
    • Do I need it?
    • Do I have a plan to use this?
    • Have I used this in the last year?
    • Can I get it elsewhere? i.e. library, or online
    • Do I have enough space for it already clear and available?
    • Do I love it?



If the answer is no to any of these questions, then either Discard/Recycle, or Re-gift (give it to someone else!)

Self-Help content copied with permission from Ottawa Public Health, 2011

Supporting a loved one with hoarding
If you have a loved one who has problems with hoarding, here are some tips that may be helpful:

Do's


  • Do help your loved one get help. E.g. "I'm worried about you." "How can I be helpful?" "If there is anything I can do to help, let me know. If you want me to come with you to any doctor or counseling appointments or anything like that, let me know."
  • Do praise and reinforce any positives. E.g. "I notice that you've cleared your couch. That's amazing! How did you manage to do that?" "I notice that its more cleared near your front door. That's great!"


  • Do acknowledge the emotions behind some of the possessions, and validate those feelings. E.g. ?I can see that your high school possessions mean a lot to you. What did high school mean to you? What were those times like for you? Sounds like a very meaningful time in your life.?


Don'ts



  • Don't use negative comments to try to shame or embarrass the other person into stopping hoarding, as this tends to make the person defensive and less likely to listen to you. For example, if you say, ?How can you live in such a mess!?, then it tends to lead the other person to come up with reasons why s/he hoards, which then strengthens the hoarding.
  • Don't lecture or tell the person what to do, unless you have build up enough trust. If the person who hoards is actively asking, ?Please help me to stop hoarding?, then its probably okay to give advice. But if the person hoarding is not, then its best to avoid giving unsolicited advice. Avoid critical statements such as "You really should throw out all these newspapers." Is professional help required?


Medications

When everything has been tried, but hoarding continues to be a problem, there are medications that may be effective, such as Specific Serotonin Reuptake Inhibitors (SSRIs). Common examples include Fluoxetine (Prozac), Sertraline (Zoloft), Fluvoxamine (Luvox), Citalopram (Celexa), and Escitalopram (Cipralex).

References



For More Information
Hoarding Center of the International OCD Foundation: International OCD Foundation (IOCDF) - Hoarding Center

Documentary on Vimeo: http://metropolitanorganizing.com/bl.../help-hoarders