Spotlight on Hoarding

What is hoarding?

Hoarding is characterised by three main features, excessive acquisitionof items coupled with difficult discarding items resulting in extensive clutter.  These behaviours often lead to increased risk to the individual who hoards including fire, risk of falls and can also lead to homes becoming inhabitable due to extensive clutter.  Often those who hoard feel that hoarding is a result of lack of space and may move home or purchase additional storage to house their items.

What are the risks?

Excessive acquisition of items and difficulty discarding are not considered compulsive hoarding unless accompanied by extreme clutter.  Extreme clutter can prevent basic living such as cooking, cleaning, bathing, walking safely through the house and sleeping.  Often those who hoard retain items that increase the risk of fire such as paper and the clutter can, in turn, prevent emergency services accessing the property if a fire were to break out.  There are also increased risks of poor sanitation and infestation of rodents and insects.  Health problems can also be caused or exacerbated by hoarding.  Those who hoard can also be at risk of intimidation or threat by neighbours and can also be at increased risk of eviction by housing authorities or landlords.

Why do people hoard?

There are a number of theories as to why people hoard.  Hoarding is often related to a cycle of positive reinforcement to acquiring e.g. a sense of euphoria on acquiring items - similar to how we all might feel when we buy a coveted item or that Amazon package drops through the door! Hoarding occurs when this euphoria is accompanied by difficult getting rid of items in the usual way.  Studies have suggested that hoarders will often find value in items that others may find difficult to understand.  Usually the value of the item has either, sentimental (this item has a meaning to me e.g, reminds me of my mum), instrumental (this item has a use for me or for the future e.g. I 'might' need it some day) or an aesthetic value (e.g. this item is pretty, nice to have).  Studies have also suggested that hoarders have difficulty with decision making and therefore deciding whether or not to keep an item is time consuming and often feels overwhelming leading to the retention of items and ultimately leading to clutter.

There is also a suggestion that people who hoard are more likely to have experienced loss in their life or disruption to important relationships.  They then become more attached to their possessions and discarding can be emotionally very difficult. An example may be of someone who has experienced extreme poverty in childhood who hoards food or someone who has experienced the loss of close relatives and retains any item associated with those important people; regardless how seemingly tenuous the link.

Life choice versus psychological difficulty

Historically, hoarding has been viewed as a 'lifestyle choice' and often those who hoard were seen as choosing to live in a cluttered home.  Over the past few years there is a recognition that hoarding is a psychological condition in its own right and those with hoarding difficulties should be offered a psychological understanding and treatment of their difficulties. 

In the UK, medical professionals use a disease classification system, the International Classification of Diseases, currently in its eleventh edition (ICD 11). For the first time, in this new edition (published in 2019), hoarding disorder is classified as a mental health disorder in its own right.  Previously Hoarding was seen as a form of Obsessional Compulsive Disorder (OCD).

ICD 11 Definition of Hoarding Disorder:

How to support someone who hoards. The Dos and Don'ts!

Forget about the extreme hoarding TV programmes; clearing the house or a room forcibly will result in significant levels of distress and trauma for someone who hoards.  Can you imagine someone coming into your house and removing treasured items without your permission?  How you would feel is similar to how a person who hoards feels about the majority of their possessions; the loss they feel is exactly the same.  Forcible clearing of items is also only a temporary fix, the person, facing overwhelming distress and trauma, will return to what they know makes them feel better; acquiring more things which, through time this will inevitably lead to more difficulties hoarding.  They will also be terrified of the same thing happening again and will struggle to trust those who try to help them in the future.

Insight

One of the difficulties often faced by those who try to support someone who hoards is a lack of insight into how problematic their hoarding is and the risks they may be facing.  There may also be a family history of hoarding which has normalised these behaviours and their beliefs about their belongings are long held and therefore quite fixed.  Furthermore, by the time those with difficulties come to the attention of services, hoarding has often been a life long issue and it is the lifetime of possessions that have accumulated to cause the current issues.  Changing any life long behaviours is extremely difficult.

Shame

There may also be a significant element of shame involved that prevent those who hoard asking for or accepting help.  They may not want anyone to see their home because of how it appears and they may well have had experience of negativity or hostility about their hoarding in the past.

Top tips for supporting those who hoard

• Be kind and compassionate towards the situation. Don't pass judgement on the current state of a property and be aware of your facial expressions!
• Discuss the risks associated with the continued retention of items; usually there will be an acknowledgement that risks exist
• Start small; support them in making a plan of discarding items that cause the least distress and support a plan for choosing whether to discard, donate or recycle an item. 
• Do NOT touch any of their items without permission to ensure they feel in control of the process
• Create small, daily goals for decluttering and retain focus on one area or room so that gains made are noticeable.  Gains made can provide a sense of accomplishment, pride and an increase in well being.
• Support them to reduce the acquisition of new items in parallel with the discarding.
• Talk to them about what the room/house might be like and how life might be improved if there wasn't so much clutter
• Support and encourage and praise any achievements no matter how minor
• Decluttering can take time and can be frustrating but it is very important to work at the pace of the person who hoards as much as possible.

Further information on hoarding can be found on the MIND website:

https://www.mind.org.uk/information-support/types-of-mental-health-problems/hoarding/about-hoarding/

Support organisations:

https://helpforhoarders.co.uk/

https://hoardinguk.org/