Hoarding
By Mike Hovancsek, LPCC-S
There are a couple of television shows about hoarding. They feature the extreme cases, with piles of junk stacked to the ceiling and a dramatic use of music and editing to keep things entertaining. Unfortunately, these shows earn ratings by exploiting the tragic circumstances of their subjects. In many cases, follow up on the subjects finds that they have recreated their hoard once the lights and cameras have gone away. That is why these television programs are a cruel example of profit over people.
There are many reasons people hoard and all of them are a reflection of an extremely painful struggle that a person is experiencing. Rather than turning these people’s pain into entertainment, society needs to provide them with the help they need to heal and function.
What is hoarding?
It is estimated that between 2 to 5% of the population engages in hoarding behaviors. These numbers are vague because people who struggle with these issues are less likely to ask for help and may not even realize that they have a problem. In a 1996 paper, Frost and Hartl defined hoarding as having the following four components:
- The acquisition of and failure to discard a large number of possessions that appear to be useless or of limited value.
- Living spaces sufficiently cluttered so as to preclude activities for which those spaces were designed.
- Significant distress or impairment in functioning caused by hoarding.
- Reluctance or inability to return borrowed items; as boundaries blur, impulsive acquisitiveness could sometimes lead to kleptomania.
Danger to the hoarder
Hoarders often struggle to function as their homes become more of a trap than a safe haven. In many cases their homes may become a health hazard due to molds that can form in poorly ventilated spaces and plumbing/drainage failures that a person may leave unfixed because they are too ashamed to bring a maintenance person into their homes. Their homes can be unsafe in other ways as well. For example, an overloaded house is more likely to catch fire due to items stuffed around the furnace and around delicate wiring. It is hard to evacuate a burning building where the escape route involves winding through a cluttered path, and with doors that may only partially open because of items stored behind them.
There can also be animal infestations in hoarding home, which bring their own hazards and in some cases people are trapped or crushed by piles of objects that topple over onto them.
Cost to the community
Hoarders cost a community a great deal of money. Property values can plummet in a neighborhood where one house is stuffed with clutter and where the porch and lawn become overflow storage. When the city gets involved, they often end up spending tens of thousands of dollars clearing the space. A hoarder may also struggle in other parts of life, causing issues in the workplace and in a family. This issue can be generational as well, as 80% of hoarders had a first-degree relative with similar problems. This means that the problem can be passed on to future generations.
Why do people hoard?
Hoarding can be caused by a wide variety of issues, including extreme childhood trauma, ADHD, OCD, brain injuries, chromosomal abnormalities, and psychotic disorders. Since these symptoms are caused by a variety of factors, a therapist must treat the underlying issues, and not just the immediate, observable problem.
Common mistakes that helpers make
There are a lot of mistakes that people make in an attempt to help a person with hoarding issues. One of them is to assume that all hoarding cases are the same thing and should be treated in the same way. It would be like if you went to your doctor with a persistent headache. A headache can be a symptom of a wide variety of things, including stress, allergies, high blood pressure, migraines, or a brain tumor. The doctor in that kind of case is not being very helpful if he assumes your brain tumor is a seasonal allergy. Similarly, we do not want to treat all hoarding cases by assuming that they are caused by OCD. Let’s look at a few ways professionals can pair an underlying issue to effective treatments:
- A person who has OCD is hyperfocused on small details, often to the point where they have a hard time seeing the big picture. So, a person may spend a lot of time gathering materials and information before completing a project. As things pile up, the person feels overwhelmed and sets everything aside to focus on the next project. This is treated with medications, and cognitive behavioral therapy that is focused on the obsessive and compulsive symptoms.
- A person with a chromosonal abnormailty like Prader-Willi Syndrome may obsessively gather items and struggle to organize or pair them down. This is often treated with behavioral techniques that focus on inhibiting the compulsion to gather objects.
- A person with extreme childhood trauma may not have developed a safe way to connect with people and choose to attach to objects instead. This can be treated with EMDR, medication, and cognitive behavioral therapy that challenges unhealthy beliefs about safety, attachments, and low self-esteem.
- A person who had ADHD often struggles to see the difference between important and unimportant details. This can extend into the objects in their life, where they have a hard time deciding what to keep and what to dispose of. They can also struggle with developing a plan and work their way toward accomplishing it. This can make it very difficult to declutter a home. ADHD is often treated with medication and cognitive behavioral therapy that focuses on organization, boundaries, and impulse control.
Another mistake helpers make is to show up with dumpsters and throw everything away. When this is done, the person often re-creates the hoard in a short amount of time or can become so distressed he commits suicide. Hoarding is a coping technique that people develop to deal with their struggle. If someone yanks all of those items away, it is like someone taking away your life preserver when you are drowning. Instead, it is important to collaborate with the person on a plan to undo the hoard and include him or her in the process.
It takes a village
Mild hoarding tendencies can be addressed in individual or group counseling formats. More complex cases would require a team of helpers who have clearly defined roles and who coordinate with one another on an agreed upon plan. This team can include family members, community members, health department staff, a psychiatrist, a therapist, and a social worker.
If you or someone you know needs to get this process started, feel free to call Townhall II and see what your options are for a way forward. 330-678-3006.