When is it Hoarding?

Now that the general public has been exposed to the issues of chronic disorganization and hoarding via reality TV, I hear this question fairly often. Some scales have been developed to measure clinical degrees of hoarding, and in the actual world of individuals I find the range can vary quite a bit. There are many factors that come into play; the actual type of objects in the home, exactly how much they impinge on normal functioning ,the role of family members and most important; the attitude of the person involved.

The handbook that therapists use to diagnose mental health conditions, the DSM-5, will include significant changes in the definition and diagnosis of hoarding in 2013. It has gradually come to be recognized as separate from OCD (Obsessive Compulsive Disorder) and while there may be an overlap, it is a statistically small one. It is currently estimated that about 2.5 – 5% of the population suffers from some aspect of hoarding, and of that group only 18% also have OCD.

Many people think that if they “keep too much” this makes them a hoarder. NOT SO. There are very particular emotional issues and a sense of anxiety that goes way beyond concern over having too many shoes. Hoarding happens when the clutter and amount of objects prevents areas of the home from being used as intended. This looks like being unable to take a shower because it’s full of boxes, having no access to a table for eating a meal, moving piles of things from a bed in order to lie down at night. What can be even more stressful is not letting family members or friends into the home, much less a stranger who might need to fix the unused stove. True hoarding prevents the individual from fully living in their home.

In addition, a crucial feature of a hoarding diagnosis is the degree of insight the person has about their situation. This is tied to awareness of just how much the behavior is getting in the way of normal functioning. People can become accustomed to simply not using their stove after it is covered with objects. If the person is bothered by this and says they want to be able to cook, I know they have some insight into the problem. If they insist that it’s no big deal and also leave food on the floor because the door to the fridge can no longer open all the way, I know we’re dealing with lower insight.

Things get much thornier if the hoarder is “busted” by family members or a social agency demanding change. In these cases the hoarder may be resistant to any interference. Forcing change can be traumatic to all involved, as well as ultimately damaging the likelihood of compliance by the hoarder. In addition to assessing the degree of insight a person has, the new indicators of hoarding as a condition include the following:

  • Persistent difficulty discarding or parting with possession, regardless of their actual value.
  • This difficulty is due to a perceived need to save the items.
  • High distress is associated with discarding them.
  • The behavior causes significant impairment in social, domestic, (my addition) occupational or other functioning. (maintaining a safe environment for the self or others)
  • The hoarding is not caused by other medical conditions.(brain injury or disease)
  • May include excessive acquisition; buying, collecting or stealing items that are not needed or for which there is no available space.

I would add that I also see elaborate reasons and justifications for keeping things, and sometimes outright refusal to consider any other options.

The questions below are designed to explore a client’s thinking about their belongings. They can reveal issues about beliefs and attitudes that need to be addressed. Ideally a qualified psychologist will be exploring these potential blocks and places of resistance, but they also need to be asked while physically handling the possession of the hoarder.


Questions about Objects:

How many do I have and is that enough? Will there EVER be enough??

Will I actually use, read or deal with it…in the next few months?

If not, can I find it or buy it again somewhere else?

Have I used it in recent memory?

How does it compare with things I already have?

Is it only important because I am looking at it now?

Is it current, good value, in shape, reliable, accurate?

Would I buy it if I didn’t already have it?

DO I HAVE SPACE FOR IT?

Do I need it or do I want it…

         or do I just want to need it…

               or do I think I’m supposed to want it??


Statements to Question:

My possessions make me feel handy, creative, intelligent, and losing them will diminish me.

I might make a mistake or wrong decision and lose something I’ll need later.

If something necessary or important is lost I will not be able to find it again.

Every object has beauty or value and deserves to be kept. I am responsible for doing this.

Every object could have a use and I am responsible for making that possible.

Objects that remind me of something must be kept in order to remember it. Losing it means I lose that memory.

Waste is bad and it is my personal responsibility to prevent it, no matter the cost to me.

Saving things that might be useful helps me feel in control over my environment, and my life.

For many hoarders the problem extends to anything on paper. In this age of the internet it is sometimes possible to assure them that they can also find things online. Unfortunately I have found that the having of the information on paper makes it somehow more valuable.


Beliefs to Question about Paper:

Information is important and keeping newspapers, magazines and papers will help me keep up.

If I fall behind on important information something bad will happen.

Interesting things will not be available to me if I don’t keep all the paper related to them.

I won’t be able to find this information any other way.

It’s my responsibility to get other people information that I think they might like or need.

Even if I am not sure the information is valuable I must not risk losing it.

What is the solution? Hoarders will do best with therapy as well as ongoing help with the actual STUFF. The goal is to make lasting changes in how they think, and how they handle the objects they surround themselves with. I have seen this work in clients with some insight into their own thinking and most importantly; a willingness to keep forging ahead.

 

Again and again the question needs to be asked: Which will I choose?

The old thinking, stories, reasons and fears about objects

or

Quality of life, long term health, relationships with family and friends….and my own well-being.


For information on therapy contact the office of:

Travis L. Osborne, PhD.
Anxiety & Stress/Reduction Center of Seattle
1218 3rd Avenue, Suite 500
Seattle, WA 98101
Phone: (206).374.0109
Email: tosborne@ebtseattle.com

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