Hoarding Disorder

Hoarding Disorder

People with Hoarding Disorder often feel shame and isolation in their condition. However, experts report that up to 6% of the adult population in the United States experiences Hoarding Disorder. People with this disorder often experience the burden of hoarding along with the embarrassment of the condition of their environment. This may lead them to retreat to their homes and resist social invitations for fear of having to reciprocate. It is often referred to as among the loneliest of psychiatric conditions.

Both men and women may have this disorder, but women are more likely to seek treatment than men. Although the onset may occur in adolescence or young adulthood, the symptoms may escalate in older people, particularly among those ages 55 years and older and who are not married or have a partner.

Hoarding often accompanies other conditions

Sometimes one condition is the result of the other, left untreated. For example, individuals with Hoarding Disorder have a higher likelihood of experiencing symptoms of ADHD, anxiety, or depression. As a result, in most cases we recommend treating one condition first, determining if those symptoms resolve, and if they do not, proceed to the next condition.

Specifically, we see that when patients struggle with Hoarding Disorder in addition to ADHD, treating the ADHD first may lead to reduction in symptoms of hoarding. The reason for this is that patients with ADHD may struggle with procrastination in decision making, organizing and sorting. If the ADHD is treated first, this may lead to greater clarity in resolving the typical obstacles associated with hoarding. On the other hand, when depression or anxiety accompanies hoarding, treating the underlying Hoarding Disorder tends to improve all other symptoms. The exception is when a person’s depression or anxiety is so severe that they need immediate relief, and at that point, other interventions must be considered.

Often confused with OCD

Many people believe that Hoarding Disorder is the same as, or similar to, Obsessive Compulsive Disorder (OCD). However, although some people with OCD are hoarders, most hoarders do not have OCD. OCD is characterized as intrusive, unpleasant thoughts (obsessions) often followed by burdensome rituals (compulsions) meant to neutralize that unwanted thought. While people that hoard may have rules around what they can and cannot discard, those rules are not usually guided by accompanying rituals. Furthermore, their thoughts regarding their hoarding behavior are usually intentional, not spontaneous.

In contrast to people with OCD, who often realize that their obsessions are irrational, the person with Hoarding Disorder may not realize or acknowledge that he or she has a problem. They usually reject help from others unless threatened with dire consequences, such as losing custody of their children or losing their home. The embarrassment of exposing one’s home to the scrutiny of others is often an impediment to receiving help.

Impact of hoarding on families

In addition to the shame and embarrassment associated with hoarding behaviors, those who suffer the symptoms of this disorder may face hazardous living conditions. They may live in extremely cluttered or dirty conditions that threaten their health. Sometimes the county or state Health Department may threaten to condemn the home because of severe health conditions. Some studies show that hoarders are more likely than others to have diabetes, high cholesterol, and other serious health conditions. The person who is a hoarder is also at risk for falls because of the excessive clutter within the home. As the individual ages, the health risks increase greatly.

In extreme circumstances when living conditions become untenable, people with Hoarding Disorder may face the prospect of losing custody of their children, severely disrupting the family unit. The person with Hoarding Disorder is generally advised that the children will be returned if the conditions in the home improve. Without professional help, however, the hoarder is usually unable to clean the home to a level considered acceptable by child welfare authorities.

What it looks like

Many people with Hoarding Disorder amass specific types of items, such as papers, mail, clothes, bags, and other types of items. Studies have found the most common reasons people hoard are: procrastinating making decisions re: what to keep and what to discard; trouble processing, organizing and remembering the content of what they have accumulated; emotionally attaching to the items and experiencing guilt and regret at the prospect of discarding; and feeling beholden to keep the item (i.e ”I may need this one day”) and therefore fearing a catastrophic outcome should they part with them.

Some hoarders even amass large numbers of animals but they fail to provide adequate food and care for them. They often insist (and believe) that they are providing good care to their animals and that they love their pets. In some studies of animal hoarders, most of the animals were malnourished and needed urgent medical attention

Researchers report that people with Hoarding Disorder have difficulty managing negative emotions; however, most can learn to better tolerate this distress with professional help. For example, the person can learn that throwing away an item that they consider valuable (although the average person would not agree) is uncomfortable yet tolerable. This change in thinking is reinforced if they see that that no negative consequence comes of it. This process would need to be slow and deliberate and mindful of the myriad of complicated emotions associated with it.

Most hoarders of objects label themselves collectors, but research comparing actual collectors to hoarders has not found that to be the case. While collectors highly valued their items as much as the hoarders did, the homes of the collectors were not cluttered and disorganized. The accompanying potential health problems and social isolation associated with hoarders is also not associated with collectors.

When a person with Hoarding Disorder tries to discard items, they are frequently distraught. They may find it difficult or impossible to rid their home of any items, despite pressure from family and friends. Oftentimes, well meaning loved ones try to enlist the help of a professional organizer. In theory, this sounds like a great idea: have a skilled professional purge the unnecessary items from the home and finally put the remaining belongings in a newfound, uncluttered space. While the intention is to help, this effort to circumvent the complicated emotions associated with hoarding will likely lead to repetition of the unhealthy behavior.

Furthermore, without understanding the cognitive challenges associated with hoarding– organizing, prioritizing, remembering placement– this effort will be circumvented by old habits of accumulating without order. Instead, the assistance of a trained and compassionate therapist would better serve a person with Hoarding Disorder.

Having hoarding disorder is nobody's fault

People who struggle with Hoarding Disorder may have experienced the disorder for years because they have been unable to control their compulsions. But, Hoarding Disorder is no one’s fault, and it is an extremely difficult disorder to control without therapy. Most evidence does not support a “cause” for the disorder. Instead, it looks to biology, genetics, and the likelihood that others within the family tree experience the same symptoms.

Outlook

Without treatment, the problematic behavior of hoarding will continue. But, with treatment, many individuals with Hoarding Disorder can learn to control their symptoms.

In good company

Many prominent people reportedly have/had Hoarding Disorder, such as the late business mogul Howard Hughes, singer/actress Kristen Chenoweth, and actress Delta Burke. There was even a popular TV show called “Hoarders.”

The current thinking on what causes hoarding disorder

There are several hypotheses about what causes Hoarding Disorder. Researchers believe the disorder is largely genetic, although in some cases, the person with Hoarding Disorder has suffered a past traumatic experience.

Although the onset of Hoarding Disorder may occur in adolescence or young adulthood, the symptoms may escalate in older people, particularly among those who are ages 55 years and older. In fact, the risk for hoarding disorder triples after age 55. Risks for hoarding disorder are also higher among those who are not married nor do they have a partner.