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Answers to common questions about hoarding

15 August 2023 16:00

Satwant Singh, Margaret Hooper and Colin Jones, authors of Overcoming Hoarding, here help us to understand commonly asked questions about the nature of hoarding disorder.

What is hoarding disorder?

People with hoarding disorder save and collect things to excess and find it very difficult to get rid of items. They often have a cluttered living space at home or elsewhere and experience distress and find it hard to function fully within their personal or work environment when it no longer functions for its intended purpose. For example, a bedroom may not be useable for sleeping or a kitchen may not have space in which to prepare and cook meals.

Hoarding becomes a problem when it starts affecting the ability of a person to live in the comfort and safety of their own home. Additionally, clutter becomes a health and safety issue not only to them, but also to those living with them and their neighbours. Fire poses the greatest risk, followed by the possibility of infestation by vermin. Injuries from tripping and falls are common and, in the extreme, people have been reported to have died after being buried under their clutter.

Often people become very distressed when they come under the scrutiny of statutory authorities such as environmental health, housing departments and emergency services. Officials view excessive clutter as something with the potential to endanger the hoarder and this can lead to prosecution. Furthermore, legal action can result in an individual’s home being forcefully cleared and increases emotional distress, stigmatisation and discrimination.

Who is affected by hoarding disorder?

Hoarding can affect anyone. It does not discriminate in terms of occupation, education status, religion, gender, sexual orientation or age. Hoarding disorder does not only have an impact on the individual who shows the symptoms but also on their family members, carers and friends. Often sufferers do not allow family or friends to visit their home. When family members share living space with those affected they can find it extremely difficult to cope with the restricted environment and the reaction to moving or handling items that have been hoarded.

Why do people hoard?

There is no single reason why people hoard. Research has shown that experiencing some form of traumatic event can contribute towards hoarding behaviour. Others use hoarding behaviours as a way of coping with emotional distress.

For some, it may be strong emotional and sentimental attachment of values to objects. Some people have strong beliefs about the value of knowledge and tend to hoard related materials such as books, magazines and newspapers. For others, hoarding can be a learned behaviour. Perhaps they have grown up in an environment where items were saved and the significance of keeping and not wasting things was considered vitally important. This could play a part in the development of the disorder.

Other factors that may contribute to the problem include ingrained perfectionistic tendencies, high standards, difficulty making decisions, need for control, strong beliefs about the significance of items saved and also deprivation – those who may have once been denied objects can hoard as a way of compensating. Moreover, a lack of significant personal relationships can lead to the development of an attachment to objects as a replacement. For these people, the objects represent stability, remaining a constant feature in their environment and life. Saved items may provide a link to positive memories and good times, so they help create an environment of safety and comfort.

How common is hoarding disorder?

Hoarding disorder is a common condition but because many people feel embarrassment and shame about it, exact figures about its prevalence are difficult to obtain. In reality, almost everyone has hoarding traits but these may not manifest as a problem. It is estimated that between 4–6 per cent of the population have difficulties with the condition and the number of people accessing help has increased with recent media attention as more sufferers are beginning to recognise that they may have a problem. Many others only realise that they have a hoarding problem when their homes require maintenance or when they receive complaints from neighbours or visits from housing support teams, family and friends or the emergency services.

What objects make up a hoard?

Anything and everything can be hoarded. As each person is individual so are the items they choose to hang on to. Common objects include clothes, photographs, crockery, furniture and even animals. A hoard tends to have some personal significance, value or perceived usefulness although, in extreme cases, people keep apparently bizarre items such as faeces and urine – but even these will have personal relevance.

Items can have direct or indirect significance. Direct significance might be ascribed to an item bought or acquired in person, perhaps received as a gift or inherited. Indirect significance can be tied to an object by association and has no direct link to the individual. A concert programme can be collected as a reminder or memory of someone having mentioned the event.

Where do people hoard?

The home is the most common environment for a hoard, although they can be found anywhere that a person with the disorder has access. Garages, storage facilities and offices can be used. Often, friends and family are implicated in hoarding behaviours by providing the temporary relief of additional storage space, resulting in their own environment becoming cluttered.

What do we know from research?

Recent research has shown that hoarding is a disorder in its own right. Encouragingly, this work also shows that treatment is effective for those who engage in therapy and are motivated to change. Over the years, therapy has developed and improved to target hoarding beliefs and behaviours.

Treatment for hoarding disorder

The early research undertaken into the treatment of hoarding disorder offered treatment based on the CBT treatment protocol for OCD. This was a result of the fact that most individuals with hoarding disorder seeking help were also showing signs of OCD. The outcome of these studies was poor and participants did not make much improvement. Treatment did not specifically target the hoarding disorder as it was assumed that hoarding was a symptom of OCD. Therefore it was difficult to identify which specific condition was being treated.

However, over the last few years, outcome studies have concentrated on providing therapy and treatment based on the CBT model for hoarding disorder. The results of these studies have been more favourable. These therapies range from individual to group, web-based to consulting room-based and include some home-based sessions. Studies have demonstrated that for treatment to be effective there needs to be a mixture of consulting room and home-based sessions.