Hoarding Disorder

“Hoarding: Buried Alive” is a TV series on TLC that takes an inside look at the personal lives of hoarders. Each episode examines the history of the person struggling with hoarding and the nature of their disorder. As with many reality TV shows, it shows the lives of extreme hoarders whose lives are spiraling out of control. Most of us know or have heard of someone who exhibits signs of this disorder.

What is hoarding disorder? The DSM5 provides a diagnosis containing four parts. 1. There is an excessive acquisition of stuff; 2. difficulty discarding possessions; 3. there are living spaces that can’t be used for their intended purposes because of clutter; and 4. the behavior causes significant distress or impairment.

You are likely looking around your home now and wondering if you fit the diagnosis. There is a difference between clutter, collecting and hoarding. If you have normal clutter, you can carry on normal activities in your home. Or, you may be a collector of a particular item. 70% of people collect things but the display does not impede living areas in the home. Hoarders’ possessions become unorganized piles of clutter. They are not motivated to display their collections nicely, but they are now prevented from using their rooms for normal activities.

There are many factors that contribute to hoarding. This disorder almost always co-exists with another mental health disorder such as major depression, anxiety and obsessive-compulsive disorders. 31% have an organic brain illness. Family history, genetics and social learning have contributions. There may be information processing deficits with attention, memory, categorization or decision-making skills. If facing eviction, these deficits make it especially difficult for hoarders to organize themselves and get the job done. They lack the skills to do so.

A simplistic view of a hoarding problem is to simply clean-out the mess. But a clean-out can do more harm than good. As a comparison, you don’t fix alcoholism by taking away their bottles. An initial cleaning is not sustainable and can further traumatize the individual. One study showed a rapid increase in hoarding after a clean-out.

You may ask, “don’t we all have a right to live as we please?” The problem is that hoarding presents safety and health risks. It could create fire hazards, blocked exits, structural damage to the building, risk of eviction and homelessness. It creates poor health through poor hygiene and nutrition, inattention to medical needs, and sleeping on the floor instead of a bed. There are increased health problems from mold, dust, dirt, rodents and insects, as well as animal or human feces or remains.

When treating a person with a hoarding disorder, safety issues are addressed first. Once safety is established, then the hoarder is taught skills such as emotion regulation and anxiety management. Later goals in treatment include how to acquire and discard items. Additional goals may be to help the hoarder with underlying issues of grief, loss and trauma if present.

If you are concerned about a person that demonstrates hoarding, encourage them to seek professional help. You may need to report hoarding to the authorities if there is a threat of endangerment to the health and safety of a child, older adult, person with disabilities or an animal.