Hoarding Disorder ~ Facts Not Fiction

 

In a recent online seminar with hoarding expert Dr. Catherine Ayres, I gained insights about hoarding among older adults, as this has only been identified as a diagnostic disorder five years ago. Before that, hoarding was classified as a type of “obsessive compulsive disorder (OCD).” However, during the past few years, scientists and therapists have gained a clearer understanding of identification and treatment approaches. HGTV is now on their thirteenth season of “Hoarders,” a documentary featuring people with hoarding disorders. I have watched all of them. For the record, I am not in favor of hoarding as entertainment and some of their approaches are appalling because they harm people. The show has brought attention to hoarding but has created a plethora of misunderstandings and draconian solutions, especially apparent in the earlier seasons. Hoarding is not just “collecting stuff.” A critical element of hoarding disorder is severe distress and impairment if items are taken away. Bringing in a “clutter management” or “cleaning” expert is not a compassionate approach: It only makes the condition worse.

What exactly is hoarding? It is the accumulation of items, many of which have no value such as paper, food, donated or discarded clothing, or disposable containers. It is excessive acquisition which means buying markdowns or going out and picking up free discards, such as items left on the curb for donation. Disposable flatware, paper plates, napkins, or packets of condiments, for example, are commonly hoarded. 

When asked why they accumulate things, hoarders have justified it as avoiding waste, acquiring information, aesthetic reasons, or emotional connection to the objects. Comorbid conditions (these are conditions that coincide with hoarding disorder) include Major Depressive Disorder, anxiety, social anxiety, PTST, and OCD. Although it is assumed that a traumatic event precedes the onset of hoarding, there is no significant evidence to suggest that is the case. Hoarders have often experienced trauma, stressful life events, and childhood adversities, but then so have non-hoarders. The majority of hoarders are women. It has been shown that hoarding leads to marital and family discord and the majority are socially isolated. The demographics of hoarding disorder are shown below:

        66.1%            Reside in single-family homes without partners

        32.3%            Live in an apartments

        1.5%              Rent rooms

Is hoarding a disorder only applicable to older people? Certainly not, but the severity of hoarding increases over the lifespan. It is estimated that about two percent to seven percent of adults (representing all age groups) have hoarding disorder. According to Dr. Ayres, most people begin hoarding before age twenty and late-onset hoarding is rare. It increases over the lifespan and becomes worse in old age. The acquisition, saving, and disorganization are all part of the hoarding process. The majority of older adults with hoarding disorder exhibit dysfunction of executive thinking skills which includes impulse management, self-control, problem solving, organization, categorizing, and sequencing.

The consequences of hoarding are devastating, impacting physical well-being, and placing themselves and others at risk. Entrances and exits are often blocked, creating a fire risk: Fire hazards exist in 58% of homes with hoarding. Piles of collected items result in 63% of hoarders falling inside their homes. Their major appliances are not usable and that often includes the stove, oven, washer/dryer, refrigerator, kitchen sink, and toilet. Other consequences include food poisoning, loss of social support, lack of basic hygiene, rodents, bed bug infestation, and roaches. Hoarders are not usually welcoming to code enforcement representatives, and long-range consequences include fines, eviction, relocation, jail time, and even death. A contributing factor is that 35% of hoarders have dietary and medication mismanagement issues. The community also suffers. Hoarding creates sanitation problems, impacting landlords and neighbors. Property values plummet, and hoarding may create flooding and structural issues in addition to blighting the surrounding community.

While there is no “cure” for hoarding disorder, there are novel approaches including improving executive functioning skills. The CREST approach used by Dr. Ayres has been shown to be effective in treating the disorder.  https://www.usnews.com/news/healthiest-communities/articles/2019-10-15/older-hoarding-patients-get-help-healing-through-in-home-program

 The Mayo Clinic has adopted a Cognitive Behavioral Therapy approach (CBT), focusing on changing behaviors that trigger the urge to hoard. https://www.mayoclinic.org/diseases-conditions/hoarding-disorder/diagnosis-treatment/drc-20356062

Therapists use several assessment tools for diagnosing and treatment of hoarding disorder and I recommend finding a specialist. Dr. Ayres’ site has numerous resources and I recommend starting there. I have deliberately omitted the assessments from this publication, as there is a tendency for family members and well-meaning friends to lay diagnose in an effort to help someone who hoards.