By the time David (not his real name) was referred for treatment, even he recognized that he had a problem — his stunningly varied collection of items had started some two decades earlier, and ranged from rocks to plastic containers and used car parts. David strongly believed all these items could one day be useful to someone, and felt incredibly stressed at the thought of parting with any of them, but he was aware things had gotten out of hand.
His house looked more like a storage unit than anything — and David was also married, so it's not hard to see how he finally ended up in treatment.
David suffered from Hoarding Disorder, and in hindsight, it all started when his son passed away. David was depressed but highly organized, and his hoarding allowed him a feeling of control over his life.
What is Hoarding Disorder?
People with Hoarding Disorder often amass an impressive amount of possessions, because the thought of letting them go can cause extreme distress. Hoarding Disorder is often triggered by high stress levels and difficult life experiences. Because it progresses gradually, many hoarders are able to accumulate items for many years before they finally enter treatment.
The current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the big handbook North American psychologists and psychiatrists use to help them make diagnoses, covers Hoarding Disorder in its chapter on Obsessive-Compulsive and Related Disorders.
Many experts, however, consider Hoarding Disorder a completely unique mental health diagnosis not linked to OCD. Research has found that hoarders have characteristic brain patterns that lead them to be especially indecisive, which could partially explain why parting with possessions can be such a challenge.
Someone ultimately diagnosed with Hoarding Disorder will meet the diagnostic criteria as laid out in the DSM-5:
- Chronically finding it extremely hard to dispose of items or part with them, even if the items in question don't have any monetary or use value.
- The difficulty in letting go of possessions is routed in the distress the mere thought of doing so causes, usually because the person feels a need to "save" the items.
- These feelings lead to a situation in which the person accumulates so many possessions that their home isn't merely cluttered, but spaces within are now rendered unusable. If a hoarder's personal space is (relatively) uncluttered, it is because someone intervened.
- The person's hoarding interferes with their daily functioning in several areas, such as socially, at work, and simply in terms of health and safety.
Other causes of the behavior will have been ruled out first. Some hoarders are aware that their relationship with their collection of items is problematic, while many are not. Anywhere between 80 and 90 percent of people diagnosed with Hoarding Disorder will continue to collect items and refuse to discard them to extreme levels — they have neither space nor any use for most of their possessions, but keep on bringing more in.
How is Hoarding Disorder Treated?
A variety of treatment and practical approaches can help people with Hoarding Disorder and their families. For David, that meant medication, talk therapy, and patience on the part of those around him — he got there in the end, and once he realized that he could let go of his collection, achieved a decluttered state and again created a home safe to live in.
Treatment will ideally be tailored to the individual hoarder's needs, and it can include:
- Cognitive behavioral therapy (CBT) — one of the most popular kinds of talk therapy today, its aim is to help people recognize unhealthy thought and behavioral patterns and change them. CBT is not as effective in treating Hoarding Disorder as it is in the treatment of many other conditions, but it can help.
- Cognitive rehabilitation plans. Designed for people who suffered traumatic brain injuries, cognitive rehab has also been shown to help people with Hoarding Disorder, and most often senior citizens. These programs help people make decisions, plan, and organize more effectively.
- Medication, typically antidepressants, and most often from the SSRI class. Antidepressants are not FDA-approved for the treatment of Hoarding Disorder, but research has shown that they can help. In some cases, like David's, treating underlying insomnia can also increase decision-making skills by eliminating sleep deprivation.
- Hoarding task forces, in which a team comes into the hoarder's home to help them discard items — gradually, or faster. This can be extremely painful for the hoarder, but can in some cases rapidly declutter the home. It may be mandated by local authorities who have identified fire hazards and other health and safety risks.
- Psychoeducation, wherein the hoarder and their family learn about Hoarding Disorder, its symptoms, its triggers, and its management in detail. This can be especially important in the case of children, who can absolutely develop Hoarding Disorder as well.
A final word
Many people have become aware of the existence of Hoarding Disorder through TV shows about hoarders — but unfortunately much still remains unknown about the disorder, and not many mental health professionals specialize in its treatment. Where such a clinicial is available, that will make treatment more effective and less distressing for a person with Hoarding Disorder.