Hoarding disorder
Overview
A hoarding disorder is where someone acquires an excessive number of items and stores them in a chaotic manner, usually resulting in unmanageable amounts of clutter. The items can be of little or no monetary value.
Symptoms
Someone who has a hoarding disorder may typically: keep or collect items that may have little or no monetary value, such as junk mail and carrier bags, or items they intend to reuse or repairfind it hard to categorise or organise itemshave difficulty making decisionsstruggle to manage everyday tasks, such as cooking, cleaning and paying billsbecome extremely attached to items, refusing to let anyone touch or borrow themhave poor relationships with family or friends Hoarding can start as early as the teenage years and gets more noticeable with age. For many, hoarding becomes more problematic in older age, but the problem is usually well established by this time.
Causes
The reasons why someone begins hoarding are not fully understood. It can be a symptom of another condition. For example, someone with mobility problems may be physically unable to clear the huge amounts of clutter they have acquired, and people with learning disabilities or people developing dementia may be unable to categorise and dispose of items. Mental health problems associated with hoarding include: severedepressionpsychotic disorders, such asschizophreniaobsessive compulsive disorder (OCD) In some cases, hoarding is a condition in itself and often associated with self-neglect. These people are more likely to: live alonebe unmarriedhave had a deprived childhood, with either a lack of material objects or a poor relationship with other members of their familyhave a family history of hoardinghave grown up in a cluttered home and never learned to prioritise and sort items Many people who hoard have strongly held beliefs related to acquiring and discarding things, such as: "I may need this someday" or "If I buy this, it will make me happy". Others may be struggling to cope with a stressful life event, such as the death of a loved one. Attempts to discard things often bring up very strong emotions that can feel overwhelming, so the person hoarding often tends to put off or avoid making decisions about what can be thrown out. Often, many of the things kept are of little or no monetary value and may be what most people would consider rubbish. The person may keep the items for reasons that are not obvious to other people, such as for sentimental reasons, or feeling the objects appear beautiful or useful. Most people with a hoarding disorder have a very strong emotional attachment to the objects. A hoarding disorder can be a problem for several reasons. It can take over the person's life, making it very difficult for them to get around their house. It can cause their work performance, personal hygiene and relationships to suffer. The person hoarding is usually reluctant or unable to have visitors or even allow tradesmen in to carry out essential repairs, which can cause isolation and loneliness. The clutter can pose a health risk to the person and anyone who lives in or visits their house. For example, it can: make cleaning very difficult, leading to unhygienic conditions and encouraging rodent or insect infestationsbe a fire risk and block exits in the event of a firecause trips and fallsfall over or collapse on people, if kept in large piles The hoarding could also be a sign of an underlying condition, such asOCD, other types ofanxiety,depressionanddementia.
Treatment
CBT is a type of talking therapy that aims to help you manage your problems by changing how you think (cognitive) and act (behaviour). It encourages you to talk about how you think about yourself, the world and other people, and how what you do affects your thoughts and feelings. Regular sessions of CBT over a long period of time are usually necessary and will almost always need to include some home-based sessions, working directly on the clutter. This requires motivation, commitment and patience, as it can take many months to achieve the treatment goal. The goal is to improve the person's decision-making and organisational skills, help them overcome urges to save and, ultimately, clear the clutter, room by room. The therapist won't throw anything away but will help guide and encourage the person to do so. The therapist can also help the person develop decision-making strategies, while identifying and challenging underlying beliefs that contribute to the hoarding problem. The person gradually becomes better at throwing things away, learning that nothing terrible happens when they do and becomes better at organising items they insist on keeping. At the end of treatment, the person may not have cleared all their clutter, but they will have gained a better understanding of their problem. They will have a plan to help them continue to build on their successes and avoid slipping back into their old ways.