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How to help someone with a hoarding disorder

How to help someone with a hoarding disorder

Hoarding disorder is getting worse for some, experts warn, as the rising cost-of-living and the pandemic trigger a mental health crisis

Clutter. Acquisition. Compulsion. Marie Kondo. Hoarding has many popular connotations, but hoarding disorder itself is far more complex than is often acknowledged and is frequently misunderstood.

Hoarding disorder can be hard to identify, not least because its manifestations evolve in response to changing external stimuli.

Common perceptions of hoarding range from jokes about having "shopping problems" to dragons encircling treasure on the silver screen. However, such simplistic understandings and representations of this behaviour do an injustice to those living with hoarding disorder.

This is especially so in 2023 as individuals worldwide grapple with challenges like climate anxiety, the coronavirus pandemic, and the cost-of-living crisis.

So, what is hoarding disorder, and how are current global events impacting the ways individuals understand and experience it?

What is hoarding disorder?

Man with hoarding disorder sitting on chair surrounded by stuffHoarders collect so many items around them that it starts to negatively affect their life

Hoarding is a disorder where a person accumulates items and stores them in a typically chaotic manner, often to the extent that their environment grows cluttered and overwhelming or begins to impede the person’s ability to live their life.

Imagine a house so filled with objects that inhabitants can no longer access certain rooms; or alternatively, collections of items, physical and digital, so extensive that even when out of sight, their presence and sheer volume provoke stress in their owner.

The hoarded items will not necessarily have monetary value. This is because hoarding behaviour is more often a manifestation of other preoccupations and anxieties in a person’s life than it is a reflection of the value of the actual items that are being hoarded.

How is hoarding disorder different from being messy?

Identifying hoarding disorder can be challenging for various reasons. These include the fact that people experiencing hoarding disorder might be skilled at hiding this behaviour, such as by avoiding inviting guests into cluttered living spaces.

Diagnosing hoarding disorder is also complicated by factors like finances, classism and cultural background.

For example, class and financial resources can influence how hoarding is perceived and addressed. If someone can pay for storage spaces or lives isolated in their own property filled with clutter, they may be dismissed as benignly eccentric and avoid public scrutiny.

Those individuals with fewer resources, who may live close to others or in public housing, often draw far more public approbation due to the risks posed by clutter, including fire-related risks, sanitation issues, and unsightliness and inconvenience for others living around them.

"Class and financial resources can influence how hoarding is perceived and addressed"

Consequently, whether one is perceived as a messy eccentric or a hoarder sometimes hinges on wealth as opposed to mental wellness.

Attitudes towards possessions, disposal of possessions, recycling, and the value of older goods also vary across different social and cultural groups.

Nevertheless, health practitioners can identify hoarding disorder with substantial accuracy based on the evidence of certain diagnostic criteria. The accumulation of clutter is one such criterion, alongside difficulty discarding items due to a perceived need to save them.

Academic clinical psychologist, Professor Jessica Grisham of UNSW Sydney, notes that hoarding disorder’s diagnostic criteria are unusual among other psychological disorder criteria because they include indicators located externally to the person who is experiencing the disorder.

“Clutter is an external manifestation of the disorder, but not actually a symptom experienced by the individual him or herself,” says Grisham.

“With depression or anxiety disorders, diagnostic criteria all pertain to the experience and behaviour of the individual.

"In the case of hoarding disorder, however, the clutter criterion allows practitioners to distinguish those with the disorder from those who may be messy or disorganised, but manage to have a liveable or somewhat uncluttered living space.”

Hoarders retain items for different reasons

Woman with hoarding disorder looking at messy roomHoarding is not about people being lazy or messy—often it is linked to emotional distress

Hoarding is complicated, not least because the underlying triggers for compulsive collecting vary from person to person. Some hoarders save items because they can imagine future uses for them, whereas others resist discarding objects for reasons rooted in grief or fear.

Miriam, for example, developed hoarding disorder following the death of her husband.

“I didn’t used to have a problem with getting rid of things,” she explains. “Since my husband’s passing, however, I have found it extremely hard to part with anything that belonged to him, or even just with miscellaneous items from our shared life.”

"Hoarding disorder can be a form of self-neglect, and people experiencing it deserve support and empathy"

Experiences like Miriam’s are common among hoarders. Jo Cooke, author and director of the community interest company Hoarding Disorders UK, emphasised the need for the general public to understand that hoarding behaviour is an expression of an emotional state, as opposed to some kind of personal shortcoming.   

“Hoarding is not about people being lazy or dirty,” says Cooke. “Rather, it is often linked to anxiety, low mood, depression, or bereavement.

“When we are emotionally vulnerable or overwhelmed, people don’t always have the energy for looking after themselves, let alone their homes. In response to grief and loss, too, people sometimes turn to items—compulsive acquiring—which can trigger shame and lead to people isolating themselves.

"In this sense, hoarding disorder can be a form of self-neglect, and people experiencing it deserve support and empathy.”

How might external factors impact hoarding in 2023?

Complexities particular to this day and age are impacting triggers for, and development of, hoarding disorder, as well as people’s experiences of living with it.

The cost-of-living crisis, for example, has amplified fears of scarcity and anxieties about the future worldwide. For many people who are either experiencing hoarding disorder already or are on the cusp of developing the condition, external pressures like this tend to exacerbate their hoarding tendencies.

Dr Satwant Singh RN MSc DPsych, nurse consultant in cognitive behavioural therapy and facilitator of the London Hoarding Treatment Group, has noted the effects of the current economic crisis on individuals.

“The cost-of-living crisis has impacted people by increasing their stress and sense of uncertainty, which is likely to increase levels of clutter as individuals with hoarding disorder cope by acquiring more items,” says Dr Singh.

“Many individuals remain undiagnosed, hidden, and disengaged from services. The lack of mental health and support services specialising in hoarding disorders has also posed a challenge in terms of individuals being formally diagnosed and accessing treatment and support.”

"The cost-of-living crisis has impacted people by increasing their stress and sense of uncertainty"

Anxiety and grief related to the coronavirus pandemic, and stress regarding lockdowns and the lifting of restrictions, have also exacerbated hoarding tendencies among some individuals. Professional organiser and declutterer, Heather Tingle, who specialises in supporting clients with hoarding behaviours, has observed this in her own practice.

“Hoarding disorder is a mental health disorder, and so at a time when the public’s mental health was under pressure, for those with hoarding disorder, this was amplified,” says Tingle.

“For my clients, worry over scarcity of food, medicines and household items meant that when they could buy items, they would bulk buy.

"Coupled with more leisure time for online ordering, and with working from home becoming the norm, many found that during lockdowns in particular, their hoarding tendencies grew and exerted an even stronger, more constant impact over their lives than usual.”

Moving forward in addressing hoarding

Donation boxes for helping to treat hoarding disorderEvery hoarding disorder case is different, so compassion is key when addressing it

Compassion is an important part of seeking to understand hoarding disorder. Especially in difficult times, safeguarding items might be, to some extent, advisable, which is why it can be easy for some individuals to tip into hoarding behaviour.

Cooke describes how she sees an overrepresentation of engineers, artists and teachers among hoarders, for instance, because people in these professions tend to be resourceful and quick to see uses for every object.

Tingle, meanwhile, highlighted how hoarding tendencies can be a learned behaviour passed down through family ethos.

“My grandfather kept everything,” she explains, “as growing up during the Depression, his family impressed on him the need to keep anything that could come in useful one day. This emphasis on preserving resources and avoiding being wasteful was passed down to me.”

Addressing hoarding, especially when such behaviour is an extension of otherwise rational beliefs, is difficult. Every case is unique.

However, putting systems and steps in place around item management can make everyday life easier for those experiencing hoarding disorder, and can lessen such tendencies over time.

What is important, especially in present circumstances, is to be aware of and compassionate towards the way that external stresses may be pushing vulnerable individuals to develop or deepen hoarding behaviours.

No socioeconomic era lasts forever, and help is available. Some things one does not have to keep.

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