Everything you need to know about Hoarding Disorder

What is hoarding?

Hoarding is clinically considered a disorder that exists when someone accumulates a large number of items and finds it difficult to get rid of things regardless of their actual value.

According to the World Health Organization (WHO) “Hoarding disorder is characterised by accumulation of possessions that results in living spaces becoming cluttered to the point that their use or safety is compromised. Accumulation occurs due to both repetitive urges or behaviours related to amassing items and difficulty discarding possessions due to a perceived need to save items and distress associated with discarding them”.

Why do people hoard? Is hoarding genetic or learned?

The exact cause of hoarding is not known. Researchers found that it is often the combination of genetic, environmental and psychological components.

Genetic component

Indecisive people are more likely to develop a hoarding disorder due to the difficulty in deciding what items to keep and which ones to discard.

Environmental component

Hoarding has been found to be more common in people with relatives who have the disorder.

Psychological component

Psychologists agree that hoarding disorder can be connected to stressful life events and can worsen if the individual does not deal with the trauma.

Hoarding can be the psychological reaction to a deprived childhood and can be connected to other mental illnesses.

What are the signs of a hoarding disorder?

Hoarding signs and symptoms may include:

• Compulsive buying and acquisition of free items and the following accumulation.
• Experiencing anxiety while attempting to discard possessions because of the perception that everything is valuable and might be needed in the future.
• Congested living space and embarrassment associated with it that can lead to isolating behaviour.

The Institute for Challenging Disorganization created a model of five progressive levels of hoarding to determine the severity of hoarding disorder.

While level 1 hoarders can still enjoy the view from their window and can freely walk through their doors, level 5 is the most severe hoarding level and involves extreme clutter, safety concerns and unhygienic conditions.

Some studies found some common traits on hoarders:

• They usually live alone.
• Hoarding is more common in elderly individuals (though it may begin to develop in adolescence).
• Hoarders are three times more likely to be obese compared to the average person (food hoarding is often linked to eating disorders).
• They are perfectionists.
• They have at least one family member who is also a hoarder.

Do I have a hoarding disorder?

Considering that people have very different ideas of what it means to have a cluttered home, the OCD Foundation has created a tool that everyone can use to establish what level of cluttering they are at and determine if they can be considered hoarders.

The tool is called Clutter Image and provides a series of pictures of rooms in various stages of clutter:  from completely clutter-free to very severely cluttered.

People can just pick out the picture in each sequence that comes closest to the clutter in their own living room, kitchen and bedroom.

In general, clutter that reaches the level of picture number 4, or higher, impacts people’s lives to a point that the OCD Foundation would encourage the individuals to get help for their hoarding problem.

Is hoarding a mental illness?

Hoarding used to be considered a form of Obsessive Compulsive Disorder (OCD); however, recently it has been recognised as an illness in its own right.

According to the Royal College of Psychiatrists hoarding can also be part of another health problem:

• Physical illness which can lead to tiredness and disorganisation.
• Dementia: memory problems can interfere with someone’s ability to organise themselves and their belongings.
• Depression can make someone lose interest in normal activities, make it hard to concentrate and make it hard to make decisions.
• Alcohol and drug misuse can affect someone’s ability to look after themselves.
• Schizophrenia: unusual beliefs and a lack of organisation can lead to hoarding.
• Bipolar disorder can make someone shop too much, and it can interfere with their organisation.
• Learning disability can lead to problems with thinking and memory.
• Autism and related disorders: where collecting things can be a source of comfort.
• Obsessive Compulsive Disorder (OCD): individuals do not feel attached to their hoarded items, but fear what would happen if they were parted from them. About 1 in 20 people with OCD have a problem with hoarding. You can learn more about the signs and symptoms of OCD in our knowledge base.

A person without a hoarding disorder could confuse hoarding with laziness or simply being disorganised.

That is not accurate.

• Laziness and being disorganised do not qualify as mental disorders.
• Laziness implies a conscious choice not to do something that should be done. Hoarders are not able to discern what is necessary to hold on to and what they should let go of, and as a consequence, they are not able to tackle their own mess.
• Everyone is disorganised at times and this state can be resolved by cleaning up, organising items and discarding what is not needed. A hoarder’s personal space is disorganised as a consequence of the accumulated clutter they are unable to part with.
• Hoarders are unable to let go of possessions out of guilt, fear of needing the items in the future or anxiety. For them everything is useful.

The difference between hoarding and collecting

When asked about their “mess” hoarders often call it a “collection”, but compulsive hoarding and collections are two different things.

• Collectors focus on one type of item and accumulate different versions of it. For example, stamps and coins.
  These items are usually displayed and shown (with pride) to others.
  Collectors can part from unnecessary items: a coins collector with two copies of the same coin is likely to be open to sell or exchange one of them.
• Hoarders accumulate a large number of random items that do not necessarily have value, without organisation. The possessions are usually inaccessible.
  Hoarders are not proud . They are often embarrassed about their accumulation to the point that they might decide not to let anyone into their home.
  The number of possessions can slowly take over their living space, become a safety hazard and potentially attract pests.

How might hoarding affect someone’s life?

Hoarding disorder can affect an individual mentally and physically as well as financially.

• The joy felt after purchasing an item is quickly replaced by shame and sadness.
• Hoarders often feel embarrassed and tend to isolate for fear of judgement.
• On one hand, the number of material possessions causes distress to hoarders but, on the other hand, the thought of parting from them causes them anxiety.
• In serious cases of hoarding, material possessions obstruct windows, doors and even kitchens and bathrooms, making it impossible to perform simple tasks such as cooking a meal or taking a shower.
• The poor housekeeping and the number of items stacked all over the place can become a safety hazard (such as fire hazard, slips trips and falls, piles of items collapsing) and attract pests.
• Hoarders often accumulate debts as they keep purchasing items compulsively.
• Hoarders can find themselves in awkward situations where they do not get access to important information such as bills or letters, which can easily get lost in the mess, adding further problems to their lives.
• Hoarding is also a problem that can sneak into the workplace, leading to health and safety concerns, and financial and productivity issues.

What things do people hoard?

Commonly hoarded items include books, newspapers, magazines, paper and plastic bags, cardboard boxes, photographs, household supplies, food, clothing and even animals.

Book hoarding

Very often people get inspired and purchase more books that they can actually read. This is not enough to make someone a hoarder. A book hoarder will not let go of those books at any cost as they believe they might want to read them at some point in the future.

Book hoarders tend to accumulate old magazines and newspapers as well.

Paper hoarding

Similar to book hoarding, paper hoarding involves keeping any bill, letter, document, card, invoice or receipt due to worrying that it might be needed in the future.

Shopping hoarding

Compulsive shopping and compulsive acquisition of free stuff is common among hoarders. For them everything is valuable, so they will buy and keep items even if they do not use them, “just in case”.

Hoarders will hold on to clothes, accessories, photos, furniture, kitchenware, tech, gadgets etcetera.

In some cases, these purchases remain unopened with their price tag still attached; in other cases, they are kept despite not being suitable any more (for example, clothes that do not fit any more or old phones).

Food hoarding

Food hoarders purchase excessive amounts of food for fear of running out despite having their fridge and cupboard full. Hoarders will hold on to it even after the expiry dates have past, and in serious hoarding cases even if the food is rotten.

Animal hoarding

Someone hoarding animals is keeping more animals than they can properly take care of. It is mostly common with cats and dogs.

Trash hoarding

In some serious cases hoarders do not let go of their rubbish, which keeps piling up and attracting pests. Hoarders at this stage often go through other people’s bins and bring home whatever is useful to them.

How to treat a hoarding disorder

Potentially only 5% of hoarders come to the attention of professionals.

It is important to remember that hoarding may not be a choice someone makes. Instead, it could be deeply rooted in a psychological condition that is difficult to overcome.

Every person’s situation is different. There are different levels of hoarding, and some hoarders might know they need help and some others might be unaware and uninterested.

One thing is sure. For a hoarder to look for help, or accept help, he or she needs to become aware of the problem and needs to want to make the changes required.

Self help

Hoarding UK has developed a guide to support people wanting to overcome hoarding behaviour, with tips and potential obstacles to overcome.

This guidance recommends to follow the steps below:

• Take a photograph of the living space as it is.
• Identify an area to work on, as it is within human nature to move from one area to the next when clearing. It is more effective to commit to one room only, for example.
• Keep a record of progress.
• Stay with the feeling and keep the momentum going.
• Elicit support. Family and friends can provide support in many different ways, from emotional support to actually physically helping with getting rid of things.
• Put things into practice.
• Be creative with solutions.
• Celebrate each inch of space regained.

According to the same guidance it is also important to remember that the process can take some time. Taking small steps to begin with will boost confidence and individuals will be more able to deal with larger spaces and work through them.

Seeking support

Sometimes hoarders cannot overcome the disorder on their own and seek medical attention. It usually starts by visiting the GP.

Hoarders often tend to feel too embarrassed or stigmatised to talk about their disorder and how it is affecting them and their life and don’t know anyone they feel they can trust to discuss it with.

To overcome this, Hoarding Practitioner Cherry Rudge (founder of Rainbow Red) has developed an “Ice-Breaker form” to help hoarders to start a conversation with their GP (or other medical professional) if they’re embarrassed or aren’t sure what to say.

When someone is willing to accept hoarding treatment the focus of the treatment is usually on behaviour modification and identity work (“who am I without my stuff?”).

Support may include various therapies such as cognitive behavioural therapy (CBT) and emotional freedom technique (EFT).

In the UK there are several charities dedicated to supporting people affected by hoarding behaviours as well as their families, friends, neighbours and carers, through helplines and free resources:

• Hoarding UK.
• Help for Hoarders.
• Hoarding Disorders UK.

Helping someone with a hoarding disorder

To help someone with a hoarding disorder it is vital to understand what hoarding is and how it works. Often friends and family with good intentions want to get involved and help declutter, but this is not always what a hoarder needs in the first instance.

Hoarders often isolate from others because they feel embarrassed about their disorders and struggle to open up for fear of judgement. The first step to approach a hoarder is to listen to them without making assumptions.

It is also important to understand that the disorder is not about the stuff but the way possessions are perceived by the hoarder.

Friends and family can offer their support in the process of clearing, without doing it for them, but with them.

The London Fire Brigade has also developed some guidelines for families and friends of hoarders on how to help reduce the fire hazards in their homes.

When needed, families and friends can encourage hoarders to seek medical attention.

How to deal with a hoarder in the office

After ruling out that the employee’s behaviour is down to laziness or disorganisation, the employer should approach the employee with the aim of trying to understand the cause by listening without judgement, offering resources of support and working on finding a solution that in some cases may involve seeking medical attention.

Conclusion

Hoarding is a clinical disorder that if left untreated can seriously impact a person’s health, safety and wellbeing.

Hoarding is not treated by simply clearing the space.

Friends, family, employers and colleagues can play a key role in encouraging a hoarder to overcome the disorder, provided they are educated on what hoarding is and how it works.

Support will help hoarders to deal with some of the obstacles they will experience on the route to reclaiming their space and their life.