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Hoarding is a surprisingly common problem, with millions of people in the UK believed to be hoarders. An estimated 5% of the UK population have hoarding disorder, but experts believe that the true figure is much higher.
Hoarding is much more than having belongings that we consider special, and things we want to hang on to, such as some treasured toys from our childhood, cherished ornaments, or a large record collection; these collections are usually very organised, well looked after, and have a specific place in the home. There can also be cultural beliefs and social norms which contribute to how we treat our possessions. For example, in some cultures owning possessions is a sign of wealth and status, and in some societies, there is a focus on re-using things and not wasting.
When people have problems with hoarding, this relationship that we all have with our possessions shifts and becomes a problem. Hoarding is having so many things that you cannot manage the clutter and chaos where you live, and find it difficult or impossible to throw things away.
For years, hoarders have been viewed by many as eccentrics, and the myriad of television programmes such as Britain’s Biggest Hoarders, Hoarder SOS, Hoarding: Buried Alive, whilst highlighting the phenomenon, have also added to the shame and embarrassment of people with hoarding issues.
Other people immediately relate to the extremes and stereotypes portrayed on these shows when they hear that someone is experiencing issues with hoarding, and often do not acknowledge that it is a condition that is often multifaceted and complicated, one that cannot always be solved by just decluttering. Many hoarders are so embarrassed by their situation that they hide it from the outside world so that others have little or no realisation that their lifestyle is anything unusual.
Many people do not understand that hoarding is a mental health condition that requires empathy and understanding. Raising public awareness of the disorder and its intricacies can help with understanding and supporting people who experience the condition.
In this article we will explore some of the underlying psychological factors, social influences and implications of hoarding behaviour with a view to drawing attention to a condition that can seriously affect people’s lives.
Psychological Factors of Hoarding
Hoarding is a complex condition, and its exact cause requires more research. What is known is that it can be an illness in its own right, known as hoarding disorder, or it can also be part of another health problem such as, but not limited to:
- A physical illness or physical impairment that affects motivation and energy levels, leading to tiredness, lethargy and disorganisation.
- Low self-esteem and/or loneliness – this can cause people to seek rewards or validation by buying or accumulating ‘stuff’ to such a degree that it becomes an uncontrollable desire.
- Depression – this can make a person lose interest in normal activities. It can affect motivation and make it hard to concentrate, to take action, and to make decisions. Some people excessively shop when depressed.
- Dementia – this can affect a person’s memory, and can interfere with a person’s ability to organise themselves and their possessions.
- Alcohol and substance misuse – this can affect a person’s ability to look after themselves and their living environment.
- Schizophrenia – this involves having unusual beliefs. This can lead to a lack of organisation which can lead to hoarding.
- Bipolar disorder – this can make it hard to start or finish things, even everyday chores such as tidying/decluttering. It will also interfere with a person’s ability to organise. Some people feel intensely well, energetic and optimistic, so much so that it affects their thinking and judgement which can lead to excessive shopping.
- Learning disabilities – some people can have problems with thinking, judgement and memory, which can lead to hoarding.
- Autism and related disorders – these can lead to collecting things as a source of comfort, which can get out of hand and lead to hoarding.
- Obsessive Compulsive Disorder (OCD) – about 1 in 20 people with OCD have a problem with hoarding. They often don’t feel attached to their hoarded items, but do fear what will happen if they throw them away.
- Cognitive distortions such as all or nothing thinking – the perfectionism aspect of the condition can prevent someone from starting to declutter as the results are not instantaneous and may appear worse before they get better.
- Eating disorders such as bulimia – these can include the behaviours of food hoarding, sneaking food, hiding food, eating in secret, stealing food or purchasing extreme quantities of food.
According to the World Health Organization (WHO), hoarding is a medical disorder characterised by an “accumulation of possessions due to excessive acquisition of, or difficulty discarding possessions, regardless of their actual value”. However, not everyone who is either living in a cluttered living space or who has accumulated and is hoarding an abundance of items would be diagnosed with hoarding disorder. There are very specific diagnosis criteria for the condition. DSM-5-TR is the standard classification of mental disorders used by mental health professionals, and its diagnostic criteria for hoarding disorder are as follows:
Criterion A: Persistent difficulty with discard of objects or possessions, regardless of their actual value.
Criterion B: Difficulties with discard are due to a perceived need to save the possessions and due to the distress created by discard.
Criterion C: Accumulation of clutter that congests living areas and compromises the functioning of the living area.
Criterion D: Presence of clinically significant psychological or emotional distress or impairment to social or work functioning (or any other area).
Criterion E: The hoarding is not attributable to any other medical condition.
Criterion F: The hoarding is not better accounted by the symptoms of another mental health problem.
Many experts agree that without exception, hoarding is accompanied by varying levels of anxiety. Hoarding both relieves anxiety and generates it. For many hoarders, the more ‘stuff’ that they accumulate, the more insulated they feel from the world and its dangers. However, the more ‘stuff’ that a person accumulates, the more isolated they can become from the outside world, including family and friends. For some. even the thought of discarding or cleaning out hoarded items produces extreme feelings of panic and discomfort.
Despite stereotypical perceptions of hoarders hanging on to worthless rubbish such as junk mail, newspapers and magazines, or packaging and empty containers, hoarder behaviour can actually be atypical. Some people with a hoarding disorder will hoard a range of items, while others may just hoard certain types of objects; the commonality being a hoard of an excessive number of items, usually resulting in unmanageable amounts of clutter. Items that are often hoarded include:
- Paper – including newspapers and magazines, junk mail and leaflets, bills and receipts etc.
- Clothes – even if they do not fit, are no longer fashionable or have condition issues.
- Accessories – such as shoes, handbags, jewellery etc.
- Containers – such as boxes, paper and plastic bags, empty food containers etc.
- Equipment and gadgets – including broken or outdated/obsolete items, no longer used sports or exercise equipment etc.
- Food stuff – including tins, jars, bottles, packets, even rotten food.
- Toiletries – including loo paper, toothbrushes, bathing products, make-up etc.
- Furniture – both large and small items even though they may no longer be in use.
- Toys – including children’s old discarded toys and/or the hoarder’s own childhood toys.
- Animals – cats and dogs are the most common animals hoarded, although any animal could be hoarded. This is having more than the typical number of companion animals.
- Digital hoarding – this is a fairly new phenomenon associated with electronic information. Whilst the home may not be cluttered, the hoarder’s hard drives begin to run out of storage and they need to purchase additional online storage or physical hard drives, leading to difficulties finding information or the reduced ability of the computer to function, leading to further purchases. This additional hardware can add to an already cluttered environment.
Whether a person is hoarding specific items or a random accumulation of different items, there are a number of specific factors that differentiate hoarding from collecting, or just being cluttered.
Collections are usually ordered and systematic, with collectors typically keeping their possessions well-organised, and ensuring that they are carefully looked after, keeping and arranging objects in interesting and often valuable groupings. An important purpose of collecting is to display the items so that the collector and others who may appreciate them can see them. Collectors are often very social about their hobby, discussing it and sharing it with others; it gives them a sense of achievement and pleasure.
Some collectors may have a similar number of possessions as someone who hoards; however, collected objects are rarely strewn around the home, they may have a space or a room(s) dedicated to the collected items. Collectors also tend to have a theme for their collection; they seek out specific items deciding that their collection is missing a certain item and being intentional in their acquisitions, rather than haphazard.
A cluttered home environment is when possessions and objects are disorganised, out of place, often on show, and may accumulate around, but not totally overtake, living areas, although even storage areas such as cupboards, drawers and wardrobes can be cluttered. Objects do not usually have any particular emotional attachment but may be thought of as having some sort of possible future use, such as rarely worn shoes, or clothes that may fit again or may come back into fashion. In the meantime they either languish in the back of the wardrobe taking up needed space, or sit in piles on bedroom chairs, or even the floor for want of somewhere to keep them; or it could be over-spilling book shelves filled with paperbacks that will probably never be read again, but seem a shame to throw out.
Clutter may build up during busy periods of life where tidying and cleaning isn’t a high priority. However, if not addressed, clutter can transition into hoarding when it starts to take over common areas in the home and the person has extreme difficulty getting rid of items, making everyday activities hard to carry out.
Many experts cite cluttering as the lowest stage on the hoarding scale. The home is somewhat disorganised but is generally safe, and sanitary. Hoarding begins to become a serious problem when a person’s living conditions become cramped and unhealthy. It is a gradual process, but eventually the person may notice that they keep on bringing things home that they don’t need or have the space for, or that they intended as a replacement for something, only to keep both items. Every possible surface is covered in piles of ‘stuff’, and all storage facilities such as cupboards, drawers, wardrobes, sheds etc. might be filled to the brim, too.
Health professionals aren’t entirely sure what causes hoarding disorder. Different people will have different reasons for how, why and when their hoarding began, and often the cause is a combination of factors.
Some research has found that hoarding disorder is more common in males, but that more females seek support; however, hoarding isn’t restricted to age, gender or socio-economic status; although, according to Hoarding UK, potentially only 5% of hoarders come to the attention of professionals. This may be because of the shame attached to hoarding, and to the stigma that mental healthcare treatment can have, which prevents people from seeking medical attention. Some researchers believe that hoarding can relate to childhood experiences such as:
- Childhood trauma such as the loss of a parent or sibling, or abandonment, or physical or emotional neglect.
- Family money worries, living in poverty in childhood, or being denied or deprived of personal possessions for whatever reasons.
- A lack of respect for a child’s things, such as parents who throw or give the child’s possessions away randomly.
- Being part of a large family where objects were shared, rather than being someone’s own processions, or where siblings took things from each other without being reprimanded by parents.
Although hoarding behaviours often begin during the teenage years, and grow stronger into adulthood, they can start at any time of life, and may have been triggered by an experience of some recent form of trauma such as the death of a partner, loss of a job etc. Problems with hoarding gradually develop over time, and the excessive acquirement and hoarding of objects, and even animals, appear to fill some sort of void in the person’s life. Some people feel safe and comforted when surrounded by things.
There can also be an element of not wanting to waste anything. Hoarders may feel that if they have paid good money for something, or been given something, then they should keep hold of it, especially if it reminds them of happier times or of a departed friend or family member.
Cuts in council rubbish collection can exacerbate hoarding, as disposing of items can be difficult or expensive for people, so they just hang on to them thereby adding to the clutter.
Some hoarders may experience compulsive urges to acquire things that others might consider rubbish, such as things found in skips, rubbish bins or car boot sales. They might believe that they are rescuing things that may still have some use or value.
Once acquired, a hoarder finds it extremely challenging to part with anything, irrespective of its usefulness or value. Almost everything has some sort of emotional or sentimental value with a hoarder, and even thinking about giving up any items, whether they hold value or not, can cause extreme anxiety and stress.
Social Influences on Hoarding
Recognising a hoarder can often be very difficult. There are hoarders whose personal appearance is unkempt and even dirty, who rarely leave their home and become more withdrawn over time, leading to a further decline in their mental health and well-being. Then there are others who, to the world outside their home, don’t display any of the stereotypical traits of a hoarder. They may be smartly turned out, appear to be organised, even having traits of perfectionism and over attention to detail. However, their home life may be very different; they may avoid inviting people into their homes, preferring to visit others or to socialise outside the home.
However a person portrays themselves to the outside world, the common factor that most hoarders share is creating a distance between friends, family and/or social support and their home often due to the embarrassment or shame of their living conditions, or in order to avoid or neutralise others’ attempts to manage the clutter. This can have the long-term effect of people ‘falling off the radar’, and losing access to social support as they grow older, often a time when a person may need additional support.
It can be hard to make and maintain relationships for someone with hoarding disorder. It is common for them to have conflicts with family and friends because they are unable to prioritise relationships over their belongings. Children of people with a hoarding disorder may experience depression or another mental condition because of the cluttered and overwhelming environment that they live in. Some may avoid inviting their friends or relatives to their house out of embarrassment of a hoarding parent, they may also resent their parent(s) for the unhealthy lifestyle the hoarding creates. This can add to a withdrawal from society in general for the hoarder.
Hoarders’ homes can in some circumstances impact others outside the home such as neighbours, and even the wider community. Homes can fall into disrepair particularly if the person doesn’t allow anyone into the property. Hoarding does not always take place inside someone’s home. The hoarding may be in a garage, garden, communal area or drive, or may be an overspill from the house into these areas. Where this occurs it can affect the look of the property and can become a blight on the neighbourhood. It is possible if complaints have been received from neighbouring properties that the hoarding-related behaviours could be classed as antisocial behaviour, in which case proceedings can be brought against an individual in this manner.
Hoarding animals, particularly dogs, can lead to excessive noise for neighbours, and animal sanitary problems can result in strong odours being omitted from the property, and could lead to potential animal welfare legal issues for the individual if the neighbours’ complaints are reported to the local council and/or to animal welfare organisations.
All of these issues can decrease home values in the vicinity.
Implications of Hoarding Behaviour
Hoarding affects the quality of a person’s life in a number of ways. A hoarder not only has a mental health condition but their issues can bring on further health problems. Clutter makes cleaning challenging for someone living in these conditions, leading to excessive dust, overflowing rubbish, and mould and mildew in kitchens and bathrooms, all of which can lead to respiratory problems and a decline in health over time.
Those with an excessive number of pets may live in unsanitary conditions with pet hair, urine and even faeces throughout the property. The smell can often be unbearable and there is also the potential for fleas and tics. In some cases, hoarding can lead to infestations such as mice, rats or other pests and these may impact neighbouring properties too.
People with severe hoarding difficulties are likely to be at risk of neglecting their own physical healthcare needs and have greater difficulty accessing health services. Increasing isolation increases the likelihood that the person may not be known to local GPs, creating further risk that their physical health is compromised. People with hoarding difficulties have been shown to be nearly three times more likely to be overweight or obese, and significantly more likely to report a wide range of chronic and severe medical problems, with the most common conditions including:
- Diabetes
- Seizures
- Head injury
- Sleep apnoea
- Cardiovascular
- Arthritic
- Haematological
- Lung conditions
There is an increased risk of trips, falls, other injuries or being trapped by shifting or falling items in an excessively cluttered home. The risks for older adults are even greater as mobility and balance decreases; what once may have been manageable living conditions can become increasingly dangerous. In addition, if someone is taken seriously ill or sustains an injury and calls for an ambulance, difficulties can arise with access if the home is extensively cluttered and entry proves difficult. If access for the ambulance service or fire service, which may assist in certain circumstances, is compromised, there is a potential risk that the person lying ill or injured might not be rescued and taken to hospital in good time. This leaves the person particularly vulnerable in cases of emergency.
If the person is unable to access hot water or a bathroom or simply the sink, self-care becomes increasingly unlikely and difficult. The person may find it difficult to wash clothes or keep themselves clean. This can exacerbate difficulties with isolation if the person increasingly avoids contact with other people because of embarrassment or shame of their neglected appearance. Alternatively, they may engage in more acquisition behaviours, buying new clothes in the absence of any readily available clean clothes in the home, with the worn clothing just piling up and adding to the clutter.
Difficulties accessing the kitchen may lead to problems with eating and drinking. This can range from people who are unable to heat any food up or keep anything used for eating clean, to storing food in unusual places where it may rapidly deteriorate, be forgotten, or be eaten when well past its best. Alternatively, they may resort to takeaways, which are often not a healthy eating option and can prove to be expensive.
Hoarding may pose a significant fire risk to the hoarder’s property and neighbouring properties, particularly in blocks of flats. It also significantly increases the severity of risks if a fire were to occur. Due to a possible increased load risk, ceilings can collapse as a result of the weight of stored possessions, doorways can be damaged and walls weakened. Potentially combustible materials in the property can heighten the intensity of a fire. There may also be a lack of escape routes due to hoarding. Hoarding behaviour that compromises the ability of gas/electric services to be inspected or maintained leads to a higher risk of faults developing, house fires starting and/or dangerous gas leaks.
Growing up in a hoarding property can put a child at risk by affecting their development and, in some cases, lead to the neglect of a child, which is a safeguarding issue. Safeguarding children refers to protecting children from maltreatment, preventing the impairment of their health or development and ensuring that they are growing up in circumstances consistent with the provision of safe and effective care. Children may in extreme circumstances be removed from the home to escape health hazards.
Treatment and Intervention Strategies
If you recognise hoarding behaviours in yourself, and you don’t want to live like that anymore, there are strategies that you can apply to help you to deal with the situation. It is not unusual to feel overwhelmed at the prospect, and there are common obstacles we can put in our own way such as “I am too tired”, “I don’t have the time”, “There is too much to do and I don’t know where to start”. The key is to make a start. Break the task into smaller segments to make it more manageable. If you can bear it, take photos of your home at your starting point, then take regular photos to compare and show your progress, as this can be quite motivating to see that you are actually making an impact.
Before you begin, identify an area that you are going to concentrate on first. This might be the bedroom or kitchen, and it helps if it is an area that is particularly important to you, such as having a clear tranquil area to relax and sleep in. Start with items with no value or emotional attachments such as packaging, junk mail, magazines etc. as these are the easiest to part with. You can then move on to other perhaps more significant items. You may find it easier to part with them by donating these to charity rather than just dumping them. Work consistently in this area before moving on to another area, and don’t feel dejected if you only achieve a little at a time; it is normal to have good and bad days, just keep going back whenever you can make the time. By maintaining your focus on this area, you will find that as it clears, you will notice the difference and this will in turn motivate you to keep working on your hoarding issues in other areas.
Remember that out of sight, out of mind is not a solution to dealing with hoarding; moving items to cupboards or storage boxes is not really addressing the issue. If selecting items to get rid of is causing you stress, ask for help. You may have someone close to you who could help you, or who could act as a sounding board for your feelings as you clear; just having someone to talk to can be helpful.
Managing your hoarding can make you feel emotionally drained, so seek support either from a close friend or family member, or if you prefer from a help service such as Hoarding Support, who can provide help, tips and even recommendations to professional declutters. You can also talk to your GP who may recommend treatment such as cognitive behavioural therapy (CBT), which is a talking therapy that teaches you coping skills that can help you manage your problems by changing the way you think and behave.
Dealing with a friend or family member’s hoarding can be frustrating and stressful, but when sharing a living space with the hoarder, things can feel even worse. While no one should have to live in cramped or unsanitary conditions, it is important to remember that the person hasn’t chosen to become a hoarder, it is a complex mental health condition.
Don’t be judgemental or argue with the person. They are likely to feel guilt and shame about their situation and trying to take control, or force them to act in a certain way, will only foster anger and resentment. Ask the person what they think will be helpful. This will give them more control over the situation and shows that you care about what they want. They might feel really anxious about visitors, so it is important not to take it personally if at times they don’t invite you in. Let them know that you are there when they need support.
Cleaning out their clutter for them is not a solution to the issue. Neither is offering to store items for the hoarder or pay for extra storage space. In the long term this will just make the problem worse, as you will be unconsciously enabling the hoarder rather than helping them. Clearing up for a hoarder takes away the motivation to address the problem themselves and to tackle the real issue, the beliefs and behaviours that fuel their hoarding.
Encouraging them to seek treatment at the first sign of a problem may help prevent hoarding from getting worse, but it is never too late for them to seek help. You can offer to go with them to the GP or to research therapists, support groups and treatment programmes in your area such as cognitive behavioural therapy (CBT), which is the recommended treatment of choice for hoarding disorder. CBT will make an assessment of the psychological factors that have predisposed, triggered and maintained hoarding behaviours and address underlying beliefs and thinking patterns about the importance of items, fear of loss, sentimental attachment, the need to remember and future usefulness. It will teach the person skills and techniques to use to manage strong urges to acquire or collect more items or clutter. Working with a therapist can bolster their motivation to declutter and prevent relapse into negative patterns of coping.
At the end of treatment, the person may not have cleared all their clutter, but they will have gained a better understanding of their problem. The person gradually becomes better at throwing things away, learning that nothing terrible happens when they do, and becomes better at organising items they insist on keeping.
Antidepressant medicines called selective serotonin reuptake inhibitors (SSRIs) have also been shown to help some people with hoarding disorders. The GP may decide that it is appropriate to prescribe these usually in addition to therapy as they are not a solution to hoarding; they help to manage symptoms of hoarding such as depression and anxiety.
If hoarding has become so bad, it may be an adult safeguarding issue. Safeguarding adults means protecting an adult’s right to live in safety, free from abuse and neglect. It is about people and organisations working together to prevent and stop both the risks and experience of abuse or neglect, while at the same time making sure that the adult’s well-being is promoted including, where appropriate, having regard to their views, wishes, feelings and beliefs in deciding on any action. This must recognise that adults sometimes have complex interpersonal relationships and may be ambivalent, unclear or unrealistic about their personal circumstances. Hoarding may become a reason to make safeguarding enquiries with the local authority when:
- The level of hoard poses a serious health risk to the person or neighbours.
- There is a high risk of fire or infestations by insects or animals.
- Hoarding is connected with other concerns of self-neglect, such as neglect, physical health, or lack of adequate nutrition
- Hoarding may be linked to serious cognitive decline and lack of capacity to self-care and care for the environment.
- Hoarding is threatening a person’s tenancy and they are at risk of being made homeless through closure orders or possession orders.
The local authority often works in a multi-agency approach in response to the challenges posed by hoarding. This may include, for example, mental health services and social services. Their priority will be to risk assess and put in place strategies to eliminate or reduce any potential immediate hazards to health.
It is a big decision to involve outside agencies, so if you can, involve the person in making that decision. Talk to them about your concerns and about the benefits of eliciting outside help, and get their agreement that this is the best course of action. Reassure them that you will continue to support them through the process. If they do not agree, you should only go against their wishes if they are at risk of harm.
Conclusion
As we have seen, hoarding and hoarding disorder are complex conditions that can take years to build up, and often months and years to overcome. People affected by the disorder deserve empathy, compassion and support rather than stigma and ridicule.
There are a variety of organisations that can provide help, information, advice and support to people who hoard and to those supporting someone with their condition. These include, but are not limited to:
Hoarding UK – whose services include advocacy and support for people who are hoarding themselves and also for their friends and family.
Hoarding Support – who provide self-help advice and advice for friends and family.
Hoarding Disorders UK – help and support people who are affected not only by hoarding and clutter but also by chronic disorganisation.
Mind – provides information and support.
PETA – advice for animal hoarding.
RSPCA – animal advice and welfare.
Hoarding Awareness
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