Hoarding Now Recognized as True Mental Disorder – Here’s How You Can Help a Loved One
Maybe your loved one is struggling with compulsive hoarding and doesn't even know it. It's time to take a look at what compulsive hoarding is so that you can recognize signs of it in those you love.
Hoarding has become big news, especially since A&E's TV show "Hoarders" made its debut in 2009. The psychological condition has long been associated with obsessive-compulsive behavior, but its categorization has been vague ... until now.
In the new edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5) due out in May 2013, "hoarding disorder" will be listed as a separate diagnosis, characterized by a "persistent difficulty discarding or parting with possessions, regardless of their actual value."
Being able to spot the telltale signs of a compulsive hoarder is the first step to figuring out how you may be able to get the person help.
- A compulsive hoarder finds it difficult or is unable to part with furniture, toys, clothing or other items.
- Piles of clutter all around the house of a compulsive hoarder make it difficult to move around or to use furniture and appliances.
- A compulsive hoarder often loses or misplaces important items, such as money, medical supplies or forms, permission slips, etc.
- Compulsive hoarders say they feel overwhelmed by the amount of stuff they have.
- Hoarders use the excuse that they're buying items to stock up or because they can't pass up a good deal.
- Compulsive hoarders avoid having family or friends over due to embarrassment or shame over their living conditions.
Just who are hoarders?
Strangely enough, there isn't a single profile that fits. The truth is that hoarders come in every shape and form, age, educational background, religious affiliation, social status and political leaning. They are young and old and in-between.
In short, they can be just like you and me.
A person can be a compulsive hoarder and still be affectionate and caring, smart and industrious, good at his or her job, have great relationships outside of the home. They can look terrific and seem to have everything going for them.
It's just that at home, things are altogether different. And, unless you take the time to seek the hoarder out and really look at the accumulation of unneeded, unused, dirty, moldy, broken, out-of-style and unworkable items that consume every inch of space, you're not likely to ever know there is a growing and potentially dangerous problem.
When it is your loved one who has a problem with compulsive hoarding, it could very well be that you've been distanced from the person for some time and had no idea that such a problem was developing.
Indeed, compulsive hoarding often takes years to progress to the level of needing to have a living space condemned due to unsanitary and dangerous living conditions. Maybe your parent just loved to collect trinkets and jewelry and was fond of crafts. Maybe your elderly mother couldn't bear to part with all the clothing that you and your siblings wore from the time you were born until you moved out of the house.
Maybe your dad has tools and equipment that are perpetually in a state of repair, or gather dust next to the sofa or on the countertops that have disappeared under the weight of piles of stuff.
Maybe your elderly parents or spinster aunt or eccentric uncle love to buy gifts. They just never get around to giving them. Instead, they languish in heaps and under boxes that have collapsed under the weight of still more items.
Getting professional help for a compulsive hoarder
If your loved one is a compulsive hoarder, it's going to take more than a simple clean-up attempt on your part to make a difference. The compulsive hoarder won't be able to overcome the urge to collect without the assistance of trained professionals. They may profess that they will get things together, but they simply aren't able to do so without someone who is completely objective and has years of experience in this area.
Treatment for compulsive hoarding is different than that for obsessive compulsive disorder (OCD). What works well for OCD doesn't necessarily translate into an effective way to treat compulsive hoarding. But a special form of cognitive behavioral therapy (CBT) has been developed that does work well in helping the compulsive hoarder overcome this behavior.
The method of therapy combines certain elements of motivational interviewing, several features of cognitive therapy and behavioral practice for OCD, and skills training.
Group treatment that may also be helpful for people with hoarding problems. Sometimes, just being in a group setting with others who share the same types of issues can be therapeutic, especially when combined with one-one-one therapy.
Interventionists may be a good choice to get help for your loved one with a compulsive hoarding problem. But since the number of trained interventionists in this area is limited, group therapy and/or one-on-one therapy may be more practical and affordable.
For help finding treatment for compulsive hoarding, check out the Find a Treatment Provider pages on the International Obsessive Compulsive Disorder Foundation (IOCDF).
Start the conversation: How to talk with a hoarder
Beginning the all-important conversation with a hoarder has to take precedence over trying to get him or her professional help. You cannot force a compulsive hoarder into treatment. Like any other addiction or process disorder, if the person doesn't recognize there is a problem and commit to learning how to overcome it, no amount of nagging or threats will make a difference.
Many concerned children, spouses and other relatives of a compulsive hoarder simply don't know where to begin to have the kind of conversation they know is necessary. Here are some suggestions. They fall into some recommendations for what not to say, as well as what should be said.
First, here's what to avoid:
- Don't use judgmental language. No one responds well to being spoken to in language that drips with judgment. A condescending tone will just turn off the compulsive hoarder to the point that they won't hear any of what you have to say. Before you utter words along the lines of, "What a mess! What are you thinking?" keep your cool. How would you feel if someone talked to you like that?
- Avoid using words that devalue the person's belongings. Keep in mind that the stuff compulsive hoarders hold on to has meaning to them. You may not be able to see it or even be repulsed by what you see, smell, touch and hear, but watch out for using words that give away your thoughts. This means you forgo calling their stuff trash, garbage or junk.
- Monitor your nonverbal expressions so you don't convey what you're thinking. A compulsive hoarder will pick up like radar on your grimaces, frowns, smirks and other expressions that convey judgment and distaste.
- Don't make suggestions about throwing out items. Even though your comments may be well-meaning, compulsive hoarders aren't likely to receive them that way. All they know is that you're trying to get them to part with their treasures.
- Steer clear of arguing or trying to persuade the hoarder to get rid of belongings. Arguments and attempts to persuade hoarders are likely to backfire, encouraging them to hold on to the items even more fiercely.
- No touching the hoarder's items unless permission is granted. Remember that these are the possessions of the compulsive hoarder. They may be held with deep reverence, even though they look like trash to you. Never just reach out and pick up or touch what belongs to the hoarder – unless you have been granted permission to do so.
Now, here are some things to definitely say:
- Think how you'd want to be talked to if you were in the hoarder's shoes. It may be tough for you to do, but try to imagine yourself as the hoarder. How would you want others, especially loved ones, to talk with you? What things would you want them to say to help you manage your frustration, guilt, shame and anger over compulsive hoarding and what it's done to your life?
- Use the same language. This may not be intuitive, but you can quickly catch on. Pay attention to how your loved one with a compulsive hoarding problem refers to his or her possessions. These are "my things," "my collections," "my treasures," my antiques," and so on. You should refer to them as "your things," "your collections," "your treasures," and "your antiques."
- Use language that encourages. You might have a little more difficulty with this suggestion, but the idea is that you offer subtle encouragement to the compulsive hoarder without being blatant about it. Suppose there's only a tiny pathway between piles of items from the front door to the kitchen or bedroom or bathroom. You could say something like, "I can see that you've done a good job clearing a walkway so that you don't trip and fall over your things. I want you to be safe and I wonder, if something happened and a firefighter or emergency worker needed to get in to help you, would they be able to navigate your home? This is one area where, for your own safety and that of others, changes need to be made."
- Comment on strengths. It may take some doing to figure out the strengths that the compulsive hoarder has, but there are definitely some and you should call them out. No matter who the compulsive hoarder is, he or she has some positive aspects or strengths about themselves, their behavior or their home. When you can recognize and acknowledge those strengths, you're on the way to forming a closer relationship that is instrumental in helping your loved one resolve his or her hoarding problem.
- Focus on safety and organizing possessions first. In the process of helping a compulsive hoarder, professionals focus first on safety and getting the hoarder's possessions organized. After that, the focus can move toward making decisions about discarding items, donating certain things, or reorganizing space to accommodate what will remain in the home.
Other points to keep in mind
Of course, there are some overarching points to keep in mind when trying to help your loved one overcome compulsive hoarding.
Above all, treat your loved one with dignity and respect. This will go a long way toward bridging any chasm that exists between you. Key to this is to acknowledge that your loved one has the right to make decisions at the pace that he or she feels comfortable with.
It is also important that you are sympathetic with your loved one's attachment to his or her things.
Encourage your loved one by helping to come up with ideas for how to make the home safer.
Work together to figure out what will prove motivating to your loved one to organize or possibly discard things.
Talk about goals. What does your loved one hope to achieve? Does your mother or father want to be able to hold social or family gatherings? Talking about values and goals and how you can work together to achieve them is a sound building block to increased trust.
Maintain hope. Change may take time and it may occur in only small increments. Keep up your spirits, portray a positive attitude and maintain hope that your loved one will find comfort in making improvements in his or her life. Once change has begun, it can be a very powerful self-motivator.
Before diving in and trying to help your loved one who is a compulsive hoarder, it might be worthwhile to look at additional resources.
Check out some episodes of "Hoarders" on A&E TV to see how others have been helped by interventions and treatment.
In addition, here are books that may prove helpful.
- Stuff: Compulsive Hoarding and the Meaning of Things, by Randy O. Frost and Gail Steketee
- Compulsive Hoarding and Acquiring: Therapist Guide (Treatments That Work), by Randy O. Frost and Gail Steketee
- Compulsive Hoarding and Acquiring: Workbook (Treatments That Work), by Gail Steketee and Randy O. Frost
- Buried in Treasures: Help for Compulsive Acquiring, Saving and Hoarding, by David F. Tolin, Randy O. Frost, Gail Steketee
- Digging Out: Helping Your Loved One Manage Clutter, Hoarding and Compulsive Acquiring, by Michael A. Tompkins, Tamara L. Hartl
- Overcoming Compulsive Hoarding: Why You Save and How You Can Stop, by Jerome Bubrick, Fugen Neziroglu PhD, ABBP, ABPP, Jose Yaryura-Tobias MD
- The Hoarding Handbook: A Guide for Human Service Professionals, by Christiana Bratiotis, Cristina Sorrentino Schmalisch, Gail Steketee