Hoarding Behavior: The Risks and How to Help
by Jan Klingberg
Joanne’s adult children were frustrated and angry because her collecting had led to her home being tagged by authorities as unfit to live in. The condition of her house had attracted attention when first responders had a difficult time entering the residence to assist her. Old newspapers and magazines were piled high. Plastic food containers littered kitchen countertops. Unopened bills, freebie brochures and mail-order boxes covered her bed; she slept on a small sofa in the living room.
Joanne rarely went out to a social or community event, and she virtually never had visitors to her home. Choosing to spend money accumulating more treasures for her collection, she also had neglected her property. Cardboard covered two broken windows. Her heating system worked irregularly at best, so Joanne used her stove as a source of heat.
What is hoarding?
Many of us are disorganized, chronically or in certain circumstances. Hoarding behavior, however, is a mental disorder that differs from chronic or situational disorganization in that the possessions become a core part of the person’s identity. They hold emotional importance, and the person feels safer being surrounded by the accumulated objects. A person with hoarding behavior often doesn’t see the reality of the situation, commented professional organizer Cathy Bock, CPO-CD of Chaos Tamers. “There is a disconnect between perception and reality. For instance, my team found dozens of savings bonds throughout one client’s cluttered house. The client claimed he had no money, but he could have used the bonds to pay for much-needed home repairs.”
The most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifies hoarding behavior as a distinct psychiatric condition.1 According to DSM-5:
- A person with hoarding behavior has irresistible urges to accumulate an excessive number of items and experiences distress or anxiety when faced with their removal
- The belongings clutter the home so much that it is nearly impossible to use rooms, furniture, or appliances for their intended purpose
- The hoarding behavior interferes with the health and well-being of the individual, e.g., unsafe living situation and inadequate self-care
Who and how?
Experts claim that 2%-5% of Americans—6 million to 19 million individuals—may meet the criteria for being hoarders.2 The disorder can be found across all ethnicities and in every economic and educational level. People with hoarding disorder also may have another mental illness, such as major depression, social phobia or generalized anxiety disorder.
Though the causes are not completely understood, scientists do know that hoarding disorder has a neurobiological origin andcan run in families.3 The behavior frequently begins in early years, and many individuals have seen the obsessive need to acquire and keep things as a normal way to live.
Often, trauma like divorce or the death of a loved one precipitates hoarding behavior. A 2012 episode of the TV reality series Hoarding, featured Michelle, a woman whose obsessive collecting escalated after her beloved sister died. They had lived together for 20 years and enjoyed shopping excursions to add to their collections. Her “partner in crime,” as she described her sister, was gone. Michelle was lonely, so she shopped and purchased even more and no longer cared about cleaning or organizing. Risks and Concerns
The person with hoarding behavior faces numerous risks, including financial difficulties and medical problems, noted Barbara Sarasin, CNA, MSW, of CJE SeniorLife. Bills are left unpaid, and money is spent impulsively to add to collections or to pay for storage for the accumulated items. “Medical problems also occur at a higher rate among people with the disorder,” she added. They neglect their health or mismanage medications. And health and medical complications—such as falls or respiratory problems—can arise from unsafe conditions in the home. Other concerns include:
- Hazards to the residence (e.g., structural damage, fire, insects and rodents)
- Threat of eviction or “tagging” of the residence as uninhabitable
- Broken relationships, such as divorce or removal of children
- Delayed discharge from a hospital or rehab center because the home is unsafe or harmful to the patient’s health
- Crowded, unhealthy conditions for hoarded animals, leading to illness and even death of pets
The community-at-large is not immune, either, to the hazards of hoarding. The repeated need for municipal services consumes community resources. Neglected house repairs or littered yards are an eyesore and can reduce nearby property values. In multifamily residential settings, bed bugs can spread from one unit to another, or water from an ignored leak can drip into the dwelling below. Collected combustibles like newspapers, magazines and cardboard provide plentiful fuel for a fire that can displace several families.
What to Do . . . or Not
If you believe your loved one might be a compulsive hoarder, take time to recognize the signs of hoarding behavior. Some of these symptoms include:
- Keeping a large number of items most people consider useless
- No longer using some rooms because they are so cluttered
- Excessive attachment to possessions and distress about parting with them
- Difficulty making day-to-day decisions and staying organized
- Shame or embarrassment
- Limited or no social interactions
“Hoarding behavior can be an intractable problem,” said Terri McHugh, LCSW, clinical supervisor of North Shore Senior Options, “and dealing with it requires patience and understanding.” Keep the person’s well-being in mind, respect his right to make his own decisions, and try to understand how important his belongings are to him.
What looks like piles of junk are precious mementos—indeed, the possessions can be so intertwined with memories that the person fears losing the memories if the objects are gone. It is never a good idea, therefore, to be judgmental or call the person’s belongings “trash” or “junk.” Don’t arrange for a complete cleanout. Unfortunately, the involvement of authorities can come as a result of a crisis, such as Joanne’s, and a cleanout becomes necessary. But unless the situation has reached that level, “a forced cleanout should not be attempted,” said Cathy, “as it can be traumatizing and often results in the person accumulating even more.”
A better approach would be to work collaboratively to create a realistic plan. Ask your loved one where and how to start and reassure her that no changes would be made without her permission. Help find creative solutions to reduce possessions. For example, you could suggest taking a photo of each precious item and putting together an album of memories that replaces the actual objects. Explore an organizational system that has worked in the past, and even engage a professional organizer for an objective perspective and assistance.
Mental Health Assistance
Recognize, however, that the best interventions are not foolproof, and the behavior usually creeps back in. Encourage evaluation and ongoing treatment by a mental health professional. Medication can be helpful in some cases, and cognitive-behavioral therapy is an accepted technique for treatment of hoarding behavior. Support groups also can be a catalyst for change.
If you are concerned that, despite your careful involvement, a housing or health crisis is imminent for your loved one, you could call Adult Protective Services. Don’t name the person but describe the situation and ask whether it’s reportable. If you do initiate a report, it would trigger a well-being check by a social worker. Some municipalities also have a multi-disciplinary hoarding task force4 that can facilitate a thoughtful and coordinated response to a hoarding situation.
Joanne wanted to return home, but that wasn’t possible until she could live safely in the house. Her family contacted North Shore Senior Center in desperation, and social workers in Senior and Family Services guided them through a process that included planning action steps with Joanne and connecting the family with resources to assist with cleanout. The Center also offered resources for ongoing therapy for both Joanne and her children in order to help avoid another crisis and to deal with the multitude of issues surrounding the hoarding behavior. Kathy Honeywell, LCSW, director of the department, commented that it’s important for family members to “appreciate that it took a long time for the loved one to get to this point. So, it’s going to take a while to clean it up. There are no magic wands for an immediate fix."
1 Diagnostic and statistical manual of mental disorders, Fifth Edition
(Arlington, VA. American Psychiatric Publishing, 2013), 247
2“Compulsive Hoarding,” Institute of Living, accessed February 9, 2018, https://instituteofliving.org/programs- services/anxiety-disorders-center/what-we-treat-at-the-adc/compulsive-hoarding
4 A hoarding task force usually includes mental health professionals, fire department personnel, environmental health experts and other necessary specialists. Local task forces include New Trier
Township Hoarding Task Force (Winnetka, Wilmette, Kenilworth, Glencoe, and parts of Glenview and Northfield); and North Suburban Hoarding Task Force (Evanston, Niles, Skokie, Morton Grove