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.
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