The Psychological Disorder Within Hoarding
Beneath the hoard is a debilitating illness
First known as ‘Collyer’s Sydrome’, Hoarding Disorder is named after brothers Homer and Langley Collyer, eccentric recluses who, between 1909 and 1947, slowly buried themselves alive in their Harlem mansion. Hiding from the world in the only environment they considered safe, the brothers were killed by the many booby traps they had set to deter outsiders, and sadly their bodies lay hidden under tons of rubbish for many weeks. To this day, New York City fire fighters still use the term “a Collyer’s mansion situation” as code for a fire due to hoarding.
Correctly reclassified in 2013 as a mental health condition in its own right, Hoarding Disorder is where a person acquires an excessive number of items and displays an ongoing resistance to discarding these items. Often leading to dangerous clutter, the condition can interfere with quality of life and affects family, friends and the person’s ability to work.
Once thought to be a form of Obsessive Compulsive Disorder, research has shown that people with Hoarding Disorder responded differently in comparison to those people with other types of OCD, whose hoarding was a symptom of their disorder. They were less responsive to treatment and were not as willing to accept that they had a problem.
Extremely difficult to treat, most people who hoard are reluctant to seek help mainly because the thought of getting rid of the items causes extreme levels of anxiety. They also feel humiliated, guilty or ashamed about their condition.
Causes
Hoarding Disorder usually starts in adolescence and tends to increase in severity over the years; however, it is more common in older adults. Even though the cause of Hoarding Disorder is still unknown, research has shown that there are several risk factors associated with the condition including:
Loss or Trauma
People who experience a stressful event or period in their lives may start hoarding as a coping mechanism to relieve the suffering, and in a sense feel protected by the hoard. For those who already hoard, these experiences may lead to an increase in the hoarding. Stressful events include:
· The loss of a loved one
· Feelings of intense loneliness
· The breakdown of a relationship or the divorce of parents
· Suffering abuse, either physical, psychological or sexual
· Having a terminal or severe illness such as cancer
Personality
Personality traits may also play a part as to why someone starts to hoard, as many people who have hoarding disorder tend to have an indecisive temperament, are perfectionists, or have uncontrollable buying habits with the inability to pass up free items.
Genetic
Hoarding Disorder does tend to run in families, with many people diagnosed with hoarding knowing at least one family member who also has the condition. As children we usually pick up habits, good and bad, by studying our parents; therefore, hoarding may be a learned behaviour. However, this is not always the case as from an early age some children of hoarders are extremely confused by their parents’ behaviour as they have to embrace a life without basic comforts, ultimately leaving the toxic home environment as soon as they become adults. Sadly, children of hoarders usually witness their parents slipping away one object at a time as clutter blocks pathways, invades spaces and dominates.
Mental Health Disorders
Hoarding Disorder is also linked to other mental health disorders such as: depression, bipolar, OCD, anxiety, or schizophrenia. However, research has now confirmed that hoarding in these situations is viewed as a symptom and not the main diagnosis.
Symptoms
It’s normal for a home to become untidy and cluttered from time to time; however, if you or someone you know has a home that is so cluttered it is affecting their life and health then compulsive hoarding could be the problem.
Usually stored in a chaotic manner in the person’s home, the urge to acquire more items very often results in an accumulation of unmanageable clutter. Regardless of monetary value, there is usually a deep emotional attachment to every item, and in many cases extremely valuable items are often found mixed in with items which have little value. The symptoms of Hoarding Disorder include:
· No apparent organisation to the clutter
· Some of the items may hold no value such as broken appliances, junk mail or newspapers
· The living spaces of the home become increasingly unsanitary, affecting the health of the people living there
· Becomes defensive when confronted, very often pushing away those people who offer their help
· Attempts to physically remove items from the home will be met with resistance
· As the compulsive hoarding becomes out of control, the hoarder will very often isolate themselves from family and friends. Sadly, children of hoarders cannot have friends over due to their embarrassment at the state of their home
· Will experience high levels of stress and become extremely distressed at the thought of discarding items
Commonly Hoarded Items
The reasons for hoarding particular items are personal to the hoarder and can be emotional, social, financial, or physical. However, those people who compulsively hoard believe that the quantity of their collected items sets them apart from other people. These items may include:
· Magazines and newspapers
· Books and paper
· Photographs
· Food
· Clothing
· Household supplies
· Childhood keepsakes
Even though these items are usually stored in the home, it is not unusual for the person to use other spaces such as a garage, storage unit or friend’s home.
Digital Hoarding
This term was first used in 2015 in relation to a man in Holland who took thousands of digital photos every day. Although he never looked at them, he was convinced that at some point in the future they would be of use. Even though he also hoarded objects in his home, most of his hoarding occurred in the digital realm where letting go of these digital photos affected his life in a negative way, causing him suffering and distress.
To date, digital hoarding has received little scientific attention in identifying the characteristics and problems associated with this form of hoarding. It can be defined as the ‘over-accumulation of digital materials to the point of loss of perspective’. There is evidence to suggest that digital hoarding could become a problem as more of our lives become digitized; however, further research has to be undertaken to fully understand the consequences and effects of this form of hoarding, which has yet to be classified as a disorder. Categorising the condition as a sub-type of Hoarding Disorder would allow medical experts to diagnose and treat digital hoarding as a mental health condition.
Detrimental Effects of Life with a Hoarding Disorder
As the urge to hoard increases, the impact it has on the person’s life can become unbearable, with many facets of their daily life being affected such as:
· Cooking and eating — not being able to access their kitchen due to the clutter, making it impossible to maintain a healthy diet. Many people who hoard rely on takeaway meals, which unfortunately add to the clutter.
· Will have difficulty carrying out house repairs as even being able to answer the door becomes impossible. This in turn may lead to simple repairs becoming urgent housing problems.
· Not being able to sleep in their own bed as the clutter takes over, making it impossible to use parts of their home for their intended purpose.
· Hygiene and physical health suffers as accessing the bathroom may become impossible.
· The home may become a fire hazard due to the clutter, making it impossible to leave in an emergency.
· Feelings of shame often results in isolation and loneliness, which affects the person’s self-esteem.
· Keeping on top of bills becomes a struggle as it becomes increasingly difficult to find things.
Diagnosis
Hoarding Disorder is an extremely complicated mental health condition which may go untreated for years due to the stigma attached to hoarding and the shame that often accompanies the condition. Sadly, many people suffer in silence and, as a result, being able to lead a normal life becomes impossible.
It is worth remembering that most health professionals are now more aware of hoarding and how debilitating it can be. Visiting their GP perhaps with a family member or close friend is the first step in receiving the treatment the person needs.
In most cases the person will be referred to a mental health professional for an assessment, where they will be asked questions related to acquiring and saving items which will lead to a discussion of hoarding. They will also ascertain if the person has symptoms of other mental health disorders and, in some cases, may ask permission to talk to family members.
Treatment
It is important that the person recognises the negative impact of hoarding on their lives; therefore, a treatment plan needs to be carried out at the person’s own pace which also addresses the underlying cause of the disorder.
The primary treatment used is Cognitive Behavioural Therapy which is a talking therapy aimed at identifying and challenging negative thoughts and beliefs related to acquiring and saving items. The goal for the therapist is to ultimately ensure that the hoarder takes responsibility for clearing the clutter from their home, and the therapist will support and encourage this. Usually a team effort is needed in order to fully support the person’s treatment plan and may involve assistance from family, friends and the use of specialist agencies in the removal of clutter from the person’s home.
Medication
Research continues as to the most effective way to use medications in the treatment of Hoarding Disorder; however, at present the medication used to treat the anxiety and depression which often accompanies Hoarding Disorder is commonly used.
Self-Help
Overcoming and recovering from Hoarding Disorder can be a long and difficult journey, and it is normal to have setbacks. However, there are some steps the person can take with the support of family and friends which can make the journey easier to cope with.
Take Small Steps
Initially the whole process of de-cluttering your home can be extremely overwhelming; however, with the help of your mental health professional you will be able to tackle one area at a time, with each area tackled becoming a small win often leading to big wins.
Stick to Your Treatment Plan
This is absolutely crucial, especially in the beginning stages, as it not only provides motivation but will help you to feel better about yourself and reduce hoarding. Focusing on the goals you will have set with your mental health professional will reinforce what you have to gain by reducing clutter in your home.
“Victory is won not in miles but in inches; win a little now, hold your ground, and later, win a little more”. — Louis L’amour
Reach Out to Others
By its very nature, hoarding can lead to isolation and loneliness which often leads to more hoarding. If the thought of having visitors in your house is too much, try to visit family and friends, where you will be able to relax in a different environment. There are also various support groups for Hoarding Disorder which are a great resource tool and also lets you know that you are not alone in this battle, details of which are available through your GP or mental health professional.
Proper Nutrition
Without being able to use the kitchen, many people who suffer with Hoarding Disorder many not be eating properly. It is worth trying to clear the kitchen area in order to prepare nutritious meals which will improve your mental and physical health.
Personal Hygiene
Very often possessions are piled up in the bathroom, making it impossible to keep up with their personal hygiene. Resolving to remove these items will not only make it easier for the person to bathe, but will also improve their health.
Every person who suffers with Hoarding Disorder will have their own personal story whose events have caused such an overwhelming loss that, in order to protect their fragile vulnerability, they create their own fortress through hoarding, where they feel safe and in control. Recovery can be a slow and painful process with layers of emotional anguish to address, not made any easier by having to part with the very things they have relied on to protect them.
Sadly, research indicates that 85% of people with Hoarding Disorder acknowledge a need for treatment, yet only half will pursue help. Many refuse treatment from the outset, and those that do accept treatment may have extreme difficulty complying with the treatment, ultimately giving up. A greater understanding of the psychology of this disorder, with all its many facets, is critical in order to help these people overcome their pain and live the fulfilling lives they so deserve.
