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Hoarding

Hoarding is the excessive collection and retention of objects. To make it a disorder, the person concerned would have to be suffering a significant reduction in the quality of his or her life. This might involve an inability to go out for fear of experiencing the compulsion to pick up 'valuables' or 'useful' items, or 'recyclables'. Or it might make the home virtually uninhabitable or even dangerous via rooms stacked with hoarded items.

There doesn't seem to be any really useful research available at the moment concerning the 'who' and 'why' of hoarding. However, the consensus seems to be that hoarders often have other symptoms that would be classed as part of Obsessive/compulsive Disorder (OCD). Those suffering from anorexia also sometimes exhibit hoarding symptoms as do people with dementia and some people with psychotic illnesses and children with attention deficit and/or hyperactive problems. Those who exhibit no other mental disorders apart from hoarding are harder (or impossible) to classify. It might be suggested that those that don't fit into a comfortable category have a genetic tendency this way or that, if the hoarders parents suffered from the same thing, they modelled themselves on the parent. In the latter situation this, again, could mean that the sufferer inherited some genetic tendency towards the problem from one or other of the parents. 

There does seem to be some relationship between depression and hoarding. When the depression came first, the symptoms might have involved an inability to organise life, general indifference to the outside world and an allied drop in motivation towards tidiness and order, that resulted in useless things not getting thrown away. Charity home visitors have encountered clients with this lack of order problem: suitcases still not unpacked from a house move years earlier; food rotting in the cupboards; a year's newspapers piled up on the floor. However none of these people exhibited any resistance to others tidying up the place and there are no documented cases within the charity of such clients become very anxious when demonstrably useless items were thrown out by charity workers on their behalf. 

There is some research that suggests that perfectionists are heavily represented among hoarders. Again, this would be much to do with the definition of the term. Some people coming to Anxiety Care have exhibited perfectionist tendencies in a few areas of life but not in others. That is, a young person may do the same piece of homework over and over again, or the home improver might paint the same table for a week, but this need to 'get it right' may have little 'carry over' effect on others areas: The young person only experiences this need where school work is concerned and is slapdash everywhere else; and the table painter works only as hard in his or her occupation as is absolutely necessary. And, where hoarded items such as newspapers and magazines are concerned, Anxiety Care has encountered people whose drive is not towards personal growth: to make them totally up to date with current affairs or their career, but involves fear of missing something that might have a detrimental affect on their lives, such as new rules and laws they may get into trouble for not observing. Another aspect of written work hoarding has been guilt: people afraid that they have inadvertently written something about themselves in newspapers and magazines that carry stories that triggered this guilt (often sexual). When this obsessive response is involved, 'written' might involve fear of indentations on the paper or even excessive finger marks around a story that 'prove' that this person is interested in a forbidden or shameful subject. In such a situation, allowing the newspaper or magazine out of the house would involve fear of it being seen by others and this person then being 'found out'. In this case, a hoarder might well admit to being a perfectionist when questioned by a therapist about a hoard of newspapers, rather than admitting to being someone with a guilty secret (as he or she perceives it). This might significantly alter statistics gathered by questioning hoarders.

Hoarders who have had a deprived childhood: lack of love, toys or even food are obviously prime targets for 'armchair psychiatrists' and might then be viewed by such people as making up for this deprivation through their hoarding. There doesn't seem to be any good scientific evidence for this. However, in Anxiety Care's experience, people easily persuade themselves that their childhood was a time of emotional starvation if they are looking for a villain to blame their problems on, and it is likely that many hoarders are encouraged to go in this direction by less able therapists.

Hoarding seems to be a problem in all cultures so it is unlikely that a cultural tendency this way has much to do with the problem. That is, in cultures that value personal property a good deal and tend to grade people's worth on how much they own, there does not seem to be a greater incidence of hoarding than in less property orientated cultures. Hoarding usually seems to involve psychological rather than social attachment to items. This might be a perceived sentimental value; the possibility of it (like magazines and newspapers) containing valuable information; that the item might gain value later and become a collectable or useful to future generations; or that discarding the item might have family repercussions (aunty will hate me if I chuck her ugly vase out). And this latter case will be coloured by how the hoarder perceives upsetting people: they won't be able to stand the emotional pain, they will, as mentioned, hate him/her for ever etc.


Treatment

The normal medication of choice for OCD: serotonin reuptake inhibitors (SRI's) do not seem to be as effective with hoarders. However it has been suggested that, as with other resistant anxiety disorders, some kind of 'medication mix' might work better and this would have to be worked out with a doctor. One charity client with these problems found that an anti-depressant augmented by a major tranquilliser was effective.

Talking treatments such as cognitive behavioural therapy seem to be reasonably effective for hoarding. This will usually involve working through any inappropriate beliefs about the process of, and reasons for, hoarding and beginning a hierarchy of practical steps to begin disposing of hoarded objects; starting with the easiest thing to throw away and gradually working up to higher levels of difficulty. When a hoarder has accumulated vast amounts of objects, the thought of beginning the process of disposing them can be overwhelming: there is simply too much work involved. Devising ways to make this happen, possibly with the support of family and friends, might need to be an integral part of a recovery programme. Here, treatment might also involve analysing space cluttered against space needed, in rooms where the hoarding has reached health and fire hazard proportions, and working out plans to 'de-clutter'. However, there are difficulties if a practical approach is considered without looking at the reasons for hoarding. This is not the 'deep psychological' stuff of early childhood that we are all tempted to dig in to, but the current reasons.

A problem encountered by Anxiety Care is that, as mentioned above, reasons for hoarding can vary a great deal. Here, persuading somebody to dispose of items would need to involve the reasons for hoarding so that a practical programme can be properly aligned. For example, the magazine hoarder might be doing this from a vague feeling that something 'valuable' might be lost if the item is disposed of; or from guilt as described above; or from depression and an inability to organise this area of life; or for some variation within these. Anxiety Care has encountered people who hoard hand written information because of doubt about personal abilities to remember things if they are not written down; also beliefs that information only exists if it can be seen to be written down as in: 'if I can't find the piece of paper that says I visited mum on Sunday, I probably didn't'. In the latter case, this has never been believed to a delusional level but has been more to do with self-doubt. That is, the person who seeks reassurance from others might begin to believe that he/she did not ask the right questions or did not hear the answer properly unless the actual conversation is written down in detail at the time it happened. So a therapeutic approach here would need to involve challenging poor thought processing and irrational beliefs in a fairly specific area.

Where 'precious' objects are involved, the idea of value might need to be part of therapy, or the perceptions about other people's responses to the hoarder disposing of something. For example, with aunty's vase above: how rational is it to believe she would be heart broken? If there is a sentimental value involved, how far is it reasonable for this to extend? If the vase is damaged, immense or just immensely ugly, why does it still have to sit on the mantelpiece? If it is a question of what happens to the disposed-of item, how responsible is the sufferer to ensure that it goes to a 'good home'? There may be many areas of erroneous thinking that need to be looked at and this will be particularly hard if the hoarder genuinely believes that he or she is doping the right thing. Forced disposal, if this is achieved, besides upsetting this person, will probably mean that he or she will start doing it again later if the reasons for hoarding are not dealt with.

Thoughts and beliefs will often have to be challenged before any practical steps are taken in many areas of hoarding, as otherwise the approach may be aimed at the wrong area. For example, when a person has a strong social content to the problem or harbours misperceptions about the level of unhappiness involved among other people (notably the giver with unwanted gifts) when items are disposed of, this has to be taken into account. The hoarder might also have very different beliefs about response levels in different people. That is, the hoarder might keep aunty's hateful vase because she is very frail and he/she believes a shock might kill her; because the hoarder has a specially close relationship with the old lady; because the hoarder is afraid of her; because aunty might be heartbroken. The same vase given by a different person would be viewed differently and this would colour the reasons it was hoarded. A therapist or helper approaching the vase simply as an ugly and eminently disposable object, would be missing the reasons for hoarding entirely and might be starting at a level of practical activity that was far from the first and easiest step. That is, the vase might have such an emotional weight to it that getting rid of the thing might be a dozen or more steps away from the first reasonable activity. Picking on it because of its ugliness rather than what it means to the sufferer is an arbitrary response that says more about the helper or the therapist than the hoarder, and will probably result in a failure to comply.

Someone helping a hoarder, particularly when this is a family member, must be ready to work within the hoarder's reality not his/her own. That is, trying to apply normal logic endlessly, assuming that this person will 'see the light' if one simply keeps saying the same thing often enough, is likely simply to upset this person and prove, yet again that he or she is, at best, misunderstood, and at worst a hopeless freak.

The hoarder might well agree that certain objects of groups of items are useless to most people, but the reality is that this person does not throw them away. And it is reality that has to be worked with, not what this person says he or she is doing or planning to do. A good general rule for a family member working with an intelligent and articulate hoarder ((as with any anxiety disorder that restricts life) is to 'switch off the volume': not listen to what is being said, but watch what is actually being done. If the end result of promises and agreements is that, a week or a month or a year later, the clutter is still there, than that is what the hoarder wants. Then, something else has to be considered; and this might well be medication and/or psychotherapy.

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