Plain Talk about Hoarding Tendencies

It’s unschooled and possibly destructive to throw around the term “hoarder” casually or without a diagnosis.

Just like jokingly referring to yourself as an alcoholic if you aren’t really … 

Ask yourself what you get from this labeling if it’s not accurate. Is it just a way to draw negative attention to yourself and be a bit dramatic?

I’m all for playfulness and appreciate dismantling and humanizing labels that are often applied with prejudice and come loaded with stigma  … 

And it’s important to acknowledge that at least some of the stigma around actual hoarding is perpetuated by the casual use of the term to refer to a lot of clutter that doesn’t come bundled with some mental health issues or diagnosis.

Unfortunately, the shame and stigma that often come with hoarding disorders become major obstacles to seeking timely treatment.

This is why a thorough education about the consequences that hoarding can cause and how difficult treatment can be, particularly when it is not treated early, is essential to de-stigmatize this condition.

Hoarding is not a personality quirk.

It can cause great emotional and financial damage to a hoarder and their loved ones, and it can take many years—including a lot of hard work and patience—to get the behavior under control.

Treatment is primarily behavior-based. Talk therapy will have little impact compared to physically working with the clutter and the person to make different choices.

It’s also important to set realistic goals and expectations when a hoarder is first attempting to change their behavior.

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‍What the DSM-5 Says About Hoarding ‍

2% to 6% of the population have a hoarding disorder.

Hoarding is more common in older adults (55-94 years).

It appears to begin between 11-15 years of age and starts to cause significant impairment when people are in their 30s.

Hoarding is no longer considered a type of obsessive-compulsive disorder (OCD), but 20 percent of people with hoarding disorder also have OCD and are likely to collect strange objects like trash, feces, urine, nails, hair, and rotten food.

Those diagnosed with hoarding frequently also have diagnoses of:

Depression ( 57%)

Social phobia (29%)

Generalized anxiety disorder (28%)

and
Attention deficit disorder.

Hoarders often have tendencies towards perfectionism, indecisiveness, procrastination and difficulty planning.

‍DSM-5 Diagnostic Criteria for hoarding disorder include:

‍Disorder Class: Obsessive-Compulsive and Related Disorders

Persistent difficulty discarding or parting with possessions, regardless of their actual value.

This difficulty is due to a perceived need to save the items and to the distress associated with discarding them.

The difficulty of discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially compromise their intended use. If living areas are uncluttered, it is only because of the interventions of third parties (e.g., family members, cleaners, or the authorities).

The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for oneself or others).

The hoarding is not attributable to another medical condition (e.g., brain injury, cerebrovascular disease, Prader-Willi syndrome).

The hoarding is not better explained by the symptoms of another mental disorder (e.g., obsessions in obsessive-compulsive disorder, decreased energy in major depressive disorder, delusions in schizophrenia or another psychotic disorder, cognitive defects in major neurocognitive disorder, restricted interests in autism spectrum disorder).

‍Specify if:

With excessive acquisition: If difficulty discarding possessions is accompanied by excessive acquisition of items that are not needed or for which there is no available space. (Approximately 80 to 90 percent of individuals with hoarding disorder display this trait.)

‍Specify if:

With good or fair insight: The individual recognizes that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are problematic.

With poor insight: The individual is mostly convinced that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are not problematic despite evidence to the contrary.

With absent insight/delusional beliefs: The individual is completely convinced that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are not problematic despite evidence to the contrary.

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What’s the Difference Between Clutter, Collecting, and Hoarding?

In the early stages or less extreme cases, it isn’t always easy to differentiate hoarding disorder from being messy and disorganized or having too much stuff. 

Again using alcoholism as a parallel, there’s an invisible line for each person where problem drinking ends and addiction begins. 

Similarly, as the pathology manifests, a “clutter bug” or “pack rat” will cross their own line and on the other side, what previously worked to regain order and organization may no longer work without additional treatment.

Most people who are messy or prone to clutter will still feel comfortable having other people in their spaces. 

They may make self-deprecating comments and “jokes” consciously or reflexively to preempt any perceived or anticipated criticism or judgment.

And regardless of the degree of messiness, their spaces are still fundamentally functional and accessible. 

By contrast, a person who’s hoarding may store random items in functional spaces, often loading up bedrooms, kitchens, and bathrooms with shopping bags, old newspapers, magazines, groceries, toiletries, or even completely worthless items like trash and recycling, preventing these rooms from being used for their intended purposes.

People who collect often display their possessions with pride for their own and others’ enjoyment. Depending on the volume of items collected, they may rotate through their collections, actively curating the viewer’s experience. 

While possibly obsessive to the point of creating financial hardship, a fundamental element of their collecting is the pleasure they derive from the pursuit and acquisition of the subject of their collections. 

This again contrasts with the shame, guilt, or anxiety that is associated with and usually accompanies hoarding. 

Most collections have at least some monetary value, although not often as great as the collector believes. 

And while their homes may be crowded or even overfilled, they are seldom as disorganized or possibly as hazardous as a hoarder’s likely is.

People who hoard tend to acquire and accumulate things with an intensity and volume that distinguishes them from collectors and messy people. 

Their need to retain even worthless items is compulsive and not easily interrupted or impacted by neurotypical logic or “reasonable” arguments.

Their resistance to letting things go is often presented as rational and logical—but underlying the words is a pathological drive that talk therapy is seldom able to penetrate by itself. 

In addition to standard psychotherapy, behavioral modifications, intervention, and monitoring are almost always required to affect any level of sustainable change.