Hoarding Disorder: Causes, Symptoms, Treatment DSM-5 300.3 (F42)

You watch it on television, where a person can barely walk in his house because of stacks of papers and boxes piled on top of one another. The person sometimes can’t use the kitchen or living room, because there are so many things covering every square inch of the floor and all available surfaces. There was even a show about a man who had collected dozens of chickens and let them move into his house. The birds sat on top and under things—everywhere there was a space to roam—causing his family and friends not to visit him. While it’s shocking to see how much “stuff” people can cram into their homes, it’s a fact that Hoarding Disorder is taking over their lives. According to the International Obsessive-Compulsive Disorder Foundation, the estimates say one in 50 people battle serious hoarding. (https://iocdf.org/wp-content/uploads/2014/10/Hoarding-Fact-Sheet.pdf)

What is Hoarding?

Hoarding Disorder is when people consistently have a hard time throwing away or letting go of possessions and feel a need to save them. They agonize over the thought of parting with things, and the items they excessively save don’t have to be of any value.

When people hoard, they sometimes live in homes that are so filled with items that they aren’t able walk through the clutter except for making slim paths to other parts of the house. Whatever is available—stoves, stairs, counters—will suffice as a place to put more “stuff.” It gets to the pint when there is no more available space inside the home that the items may spill out into the yard, garage and even inside of cars.

Hoarding is developed gradually and is more of a private behavior. In fact, many times by the time the hoarding is found out by other people, a great amount of clutter has been accumulated. As the hoarder grows older, he may have little or no available space for the items. By the time the individual reaches middle age, symptoms are often serious and may be more difficult to treat.

Signs of Hoarding Disorder

Sometimes it’s hard to tell if a person is a hoarder or a “pack rat” (somebody who likes to keep things). There are factors to determine if a person has Hoarding Disorder, and his behavior doesn’t necessarily have to do with how much he has or whether he needs the things he has collected. It has to do with how the behavior is negatively impacting the person’s everyday life. Some of the signs of a hoarder are:

• Hanging on to old newspapers, magazines and meaningless mail.
• Not able to throw out items.
• Home is cluttered.
• Collecting items that are of no use or unnecessary, including trash.
• Taking items from one pile and moving them to another pile without throwing anything away.
• Having a hard time with everyday activities.
• Procrastinating.
• Having difficulties making decisions.
• Having trouble organizing things.
• Perfectionism.
• Inordinate attachment to things.
• Uncomfortable about letting other people handle or borrow their things.
• Little or no social interaction.

What Causes Hoarding Disorder?

What makes a person fill their house with things from floor to ceiling? How does an individual become attached to items like newspapers and magazines that are years old, and why does he have such distress about getting rid of any of it? It’s not fully understood what causes hoarding. The hoarder has some of the following things in common.

• The most severe hoarding is found to be common in adults at around the age of 50. However, a penchant toward hoarding begins about the ages of 11 to 15, where the adolescent begins saving old school papers, broken toys and other items.
• Not considered completely a genetic disorder, hoarders have a genetic inclination toward it.
• Many hoarders have a serious difficulty in making decisions.
• Many hoarders have experienced trauma and use hoarding as a way to cope with the event.
• The idea of throwing out or giving away items causes the person to feel uncomfortable and have serious panic.
• The build-up of food or garbage is excessive and unsanitary.
• Hoarders are not sociable and are often isolated. The hoarding is a way for them to find a sense of happiness and comfort.
• They have problems with other people who try to help by removing or lessening the clutter from the house.
• Hoarding is always associated with different levels of anxiety. People feel relief from anxiety when they hoard. However, the hoarding also produces anxiety. As they collect more and more items, they feel like they’re protecting themselves from the world and all of its dangers. But, this also is a factor in the individual becoming more isolated from the community, family and friends.
• Sometimes hoarding is developed with mental illnesses, including dementia and schizophrenia.

Hoarders usually save items, because they think they’re uncommon or will be needed at a later date, as well as not wanting to waste anything. The items may have important significance, such as reminding the person of more enjoyable times or are remembrances of people or pets. In addition, the hoarder feels safer when he is enveloped by the things that are saved.

It’s not only inanimate objects that hoarders save. Some people hoard animals, adding dozens and hundreds of pets to their inventory. The animals may live inside or outside. Since there are so many pets, they aren’t usually taken care of very well. This causes unsafe and unhealthy living conditions in the house.

Treatment for Hoarding Disorder

The disorder spans from mild to severe. For some people, hoarding doesn’t cause much difficulty in their lives, while in others it severely affects how they function on an everyday basis. People with the disorder may not see a problem, which makes treatment difficult. However, with treatment, they can learn how their behaviors and beliefs can be changed in order to live a safer life with more fulfillment.

Cognitive Behavioral Therapy for Hoarding Disorder helps the person uncover the beliefs about the emotional attachment to the items he collects. Motivational interviewing is a type of therapy that makes the motivation for treatment stronger, and it is often needed because individuals with Hoarding Disorder are either doubtful or hesitant about why they need treatment.

Behavioral exposure and response prevention therapy targets the avoidance of anxiety-producing experiences related to hoarding. It’s commonly used and is effective for the treatment to progress. Family therapy is a benefit in order to discuss these relationships that are often strained from living with a person’s hoarding behaviors. In addition, skills training is essential to help the person improve organization and as a way to assist in decision-making.

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