Hoarding Disorder

You are surrounded by stuff.

Not a few things scattered around; not clutter, but piles.

These are your belongings, that you knowingly collected, and over time they have taken over your space.

You have paths between boxes in your living space that you wade through daily.

Your home is overrun with your belongings and the thought of having others visit makes you cringe.

And yet when you think about discarding these things, a major wave of anxiety passes through you. You can’t do it. Maybe loved ones have tried to help. Maybe they have told you they are worried about your home being a fire hazard, or causing you health issues.

These things concern you but something deep inside keeps you collecting more belongings; a security of sorts that later brings more distress.

While exact statistics aren’t available, it is estimated that 1.2 million Americans struggle with compulsive hoarding. In our culture we throw the term “hoarding” around a lot, but the implications of this mental health disorder can be devastating to those who struggle with it.

Hoarding is a complex behavioral disorder that can manifest as a result of other underlying anxiety disorders and conditions. Frequently, (75% of cases) hoarding disorder coexists with diagnoses of depression, social phobia, or generalized anxiety disorder. Approximately 20% of people with hoarding disorder also have symptoms of obsessive compulsive disorder. Generally, the distressing elements of these other conditions is what instigates treatment for people who struggle with hoarding, since the hoarding itself is frequently shrouded in deep shame and secrecy and is promoted by anxiety and avoidance.

Typically, hoarding disorder begins in middle childhood and progresses throughout the decades when untreated. Hoarding becomes an impairment to everyday life, or takes on a pathological component when it interferes with life function; typically this can emerge for young adults by their mid-20s and 30s. The disorder is three times more prevalent in adults between 55-94 than in earlier decades of life. Men and women are affected by hoarding disorder, however, women are more prone to excessive acquisition of belongings through purchases than men.

People who struggle with hoarding disorder have more treatment options available now than in the past. As the disorder becomes more widely acknowledged, treatments such as Cognitive Behavioral Therapy that specifically deal with hoarding have emerged. The treatment is generally around 26 sessions in length, depending on need. Tools such as the ADL-H and Hoarding Rating Scale are used to determine baseline functioning and are then used continuously during treatment to assess progress.

CBT for hoarding is a particularly useful strategy for treatment because it also helps identify the driving forces of this disorder, exploring the underlying causes for the behavior. It is important during assessment of this disorder that other conditions are ruled out, as some medical conditions such as brain injury and neurodevelopmental issues can contribute to hoarding behaviors. Just as in any traditional CBT treatment modality, the thoughts, feelings, values and behaviors are explored to identify the myriad of layers that contribute to our lives. With hoarding disorder, patients team up with their therapist to unravel the triggers for excessive collecting, and rules are often developed to help guide the process of treatment. Coping strategies such as use of timers and relaxation techniques are important factors of treatment, since the work is emotionally demanding and requires much self care along the way as one explores the reality of changing what is often a life-long pattern of behavior. Factors such as indecisiveness, environmental and traumatic life events all impact the possible development of hoarding disorder. In about 50% of cases, people who struggle with hoarding disorder report having a family member with the same condition.

Untreated hoarding disorder can have grave consequences. Sometimes the home can deteriorate to the point of unsanitary living conditions, infestation of rodents or mold. In addition to health factors, those who struggle with hoarding frequently isolate themselves away from others, increasing the likelihood of worsening depressive symptoms and anxiety related challenges. Often the disorder of the home can limit access to sanitary practices, heating units and meal preparation standards. Relationships with family and friends often deteriorate. Sometimes law enforcement can become involved and eviction proceedings can become a reality. Elderly people who struggle with hoarding disorder are at increased risk of falls in the home, which can have life-changing implications for independence and autonomy.

Of those seeking treatment for hoarding disorder, 70% make progress. Much depends on the level of insight one has about a need for change. Naturally if someone has good insight into their challenges and is able to acknowledge a problem, they stand a better chance of changing those behaviors than someone who does not see hoarding as an issue.  Family members and friends can become discouraged, but ongoing support and compassion is needed for those struggling with hoarding disorder.

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