Getting help for someone who hoards

Many of you may be familiar with an American reality TV show called Hoarders. This show first debuted in 2009 pulling back the curtain of a disturbing yet fascinating glimpse of the real-life struggles of individuals who suffer from compulsive hoarding disorder. Anyone who themselves or loved ones who deal with this condition, know all too well, what an extremely difficult disorder this is to get help for.

What is hoarding?

Some people may perceive hoarding as someone who collects things and has difficulty parting with them. This is partly true but those who have collections, take pride in their possessions and experience joy when displaying or talking about them. Usually collections are a type of hobby for them and they generally keep their items organized and manage their time and money on what they spend.

People who are hoarders do not want anyone to see what they have ‘collected.’ They are embarrassed and ashamed about the amount of ‘stuff’ they have packed their homes with. The homes of hoarders are often very difficult to maneuver in as they are loaded with anything and everything imaginable. Hoarding also can easily put people in debt as they buy more and more items.

Behaviors of hoarding can begin as early as the teenage years, but the average age of a person seeking treatment for hoarding is about 50 with the disorder most common in people over 55. They tend to live alone and may have other family members with the problem. It is estimated that 2 to 6 percent of people have hoarding disorder but as many as one-quarter of adults may have some hoarding symptoms.

What are the signs of hoarding?

According to the International OCD Foundation, here are signs of compulsive hoarding:

· Difficulty getting rid of items

· A large amount of clutter in their office, home, car, or in other spaces (i.e. storage units) that makes it difficult to use furniture or appliances or move around easily

· Losing important items like money or bills in the clutter

· Feeling overwhelmed by the volume of possessions that have taken over the house or workspace

· Being unable to stop taking free items, such as advertising flyers or sugar packets from restaurants

· Buying things because they are a ‘bargain’ or to ‘stock up’

· Not inviting family or friends into the home due to shame or embarrassment

· Refusing to let people into the home to make repairs

One of the most challenging interventions is trying to help someone with compulsive hoarding. They usually vehemently respond with strong negative feelings (guilt, fear, anger) if you talk to them about getting rid of items. Denial of having a hoarding problem or if the person sometimes thinks of inanimate objects as having feelings, can also make the process of breaking their cycle of hoarding seem impossible.

How is compulsive hoarding disorder diagnosed?

Compulsive hoarding disorder is considered a mental condition and is included in the latest Diagnostic and Statistical Manual of Mental Disorders (DSM-5). To diagnosis someone with this disorder, there are six criteria that must be met:

1. Persistent difficulty discarding possessions, regardless of their actual value.

2. Perceived need to save items, and distress caused by discarding them.

3. Accumulation of possessions that congests living areas and compromises their intended use. If living areas are uncluttered, it is only because of the intervention of family members, friends, or cleaners.

4. Significant distress or impairment in social, occupational, or other important areas of functioning as a result of hoarding.

5. The hoarding is not attributable to another medical condition, such as brain injury or cerebrovascular disease.

6. The hoarding is not better explained by the symptoms of another mental disorder (such as delusions in schizophrenia, cognitive deficit in dementia, or restricted interests in autism spectrum disorder).

How is hoarding treated?

Treatment is available but it must be tailored to the individual and what is troublesome for them. Cognitive behavioral therapy is usually considered the best treatment option. This helps people identify their dysfunctional beliefs regarding their ability to discard objects, and teaches them how to develop more rational beliefs.

A term called motivational enhancement is often used in which the individual is asked to determine their goals and values so they learn how their hoarding behavior conflicts with them. For instance, therapists may have them practice walking into a store without making a purchase. Other practical techniques might involve suggesting that the hoarder take photos of possessions, which can be kept instead of the actual object.

Finding and joining a support group or teaming up with a mentor or coach to help sort and reduce clutter are also effective methods for treating hoarding.

Unfortunately, relapses can happen and that is why even if a person appears or seems to have conquered their hoarding ways, also have a plant to address any signs of future hoarding coming back.

As far as any medication treatments, the efficacy of drug therapy is less certain. If the person also suffers from anxiety or depression, sometimes medications used to treat those conditions may help reduce hoarding symptoms. Selective serotonin-reuptake inhibitor antidepressants are sometimes used. Newer treatments include the dementia drug donepezil (Aricept) and galantamine (Razadyne). Other promising treatments include noninvasive transcranial magnetic stimulation, which is also sometimes used to treat Obsessive Compulsive Disorder (OCD).