Hoarding: the complex slide into clutter blindness

13 04 2014

room that is hoarded

Hoarding is a personal and/or professional issue for many of us. Some have a gift for viewing it compassionately. For others, especially when confronted by family members who are hoarding, it can create revulsion, horror, anger and great sadness for their lack of quality of life. Children may grow up experiencing shame and trauma from living with a caretaker who cannot stop hoarding. I have been on the verge of vomiting after trying to tackle the hoarding of a family member, and I could not go in to the house without someone with me for support.

Locally, we sometimes hear about animal hoarding in the press where someone whose love for animals and other mental health issues causes them to adopt more animals than they can manage. In areas populated by apartment and condominium complexes, there is the added risk to neighbors’ safety due to the potential for fire, mold growth and rodent/insect infestations. Some people are able to keep the hoarding inside their homes and family members, neighbors and co-workers are unaware of the situation. Others have lost control and the hoarding spreads out onto the lawn and other property. One woman even bought the house next door so she could expand her storage as she had filled her own home to capacity with hoarding. The thought of giving away a small item that most of us would consider as trash can cause significant anxiety for some individuals. My heart aches for them. It is important to remember that hoarding is not about laziness, yet this is often the judgment made.

What is hoarding?

Hoarding is a complex disorder that includes: collecting too many items (valuable as well as trash); difficulty letting items go (selling, giving away, throwing away, recycling); and disorganization (growing piles mixed with valuable items and trash with difficulty de-cluttering). There is also commonly a lack of recognition of the seriousness of the problem. Hoarding may be referred to as “compulsive hoarding”.  Clutter blindness refers to the inability to “see” and recognize the accumulation of hoarding and its impact. Animal hoarding focuses more specifically on the acquisition of animals and often includes the inability to adequately care for the animals resulting in unsafe situations for the animals and humans caring for them. DSM-5 hoarding disorders summary.

Why do people develop hoarding behavior?

This is a hard question to answer. Hoarding may co-occur with other diagnoses including Obsessive Compulsive Disorder, depression, General Anxiety Disorder, eating disorders, as well as Posttraumatic Stress Disorder. Hoarding can be a reaction to psychological trauma. When there is hoarding involved, it adds an additional level of complexity to the assessment, diagnosis and treatment plan. Sometimes hoarding is seen in several family members such as the adult child raised by a hoarder grows up and displays similar hoarding behavior.

Other aspects of hoarding development are defined by Paul Salkovskis, PhDobsessive compulsive hoarders; deprivation hoarders (have been through a period of massive deprivation) and those that Salkovskis defines as the hardest to treat – sentimental hoarders (damaged by unpredictability and possibly even neglect during childhood, possessions have become more reliable than people).

How to assess and diagnose hoarding behavior

There are tools at the International OCD Foundation website and the tools below are an excerpt from their website:

 Saving Inventory-Revised (SIR)

The Saving Inventory-Revised is a 23-item questionnaire designed to measure three features of hoarding: excessive acquisition, difficulty discarding, and clutter.

Hoarding Rating Scale (HRS)

The Hoarding Rating Scale is a 5-item semi-structured interview that can also be used as a questionnaire. The five questions include questions about clutter, difficulty discarding, excessive acquisition, distress caused by hoarding and impairment resulting from it. Initial studies suggest that a score of 14 or higher indicates a probable hoarding problem.

Clutter Image Rating (CIR)

In our work on hoarding, we’ve found that people have very different ideas about what it means to have a cluttered home. For some, a small pile of things in the corner of an otherwise well-ordered room constitutes serious clutter. For others, only when the narrow pathways make it hard to get through a room does the clutter register. To make sure we get an accurate sense of a clutter problem, we created a series of pictures of rooms in various stages of clutter – from completely clutter-free to very severely cluttered. People can just pick out the picture in each sequence comes closest to the clutter in their own living room, kitchen, and bedroom. This requires some degree of judgment because no two homes look exactly alike, and clutter can be higher in some parts of the room than others. Still, this rating works pretty well as a measure of clutter. In general, clutter that reaches the level of picture # 4 or higher impinges enough on people’s lives that we would encourage them to get help for their hoarding problem. These pictures are published in our treatment manual (Compulsive Hoarding and Acquiring: Therapist Guide, Oxford University Press) and in our self-help book (Buried in Treasures: Help for Compulsive Acquiring, Saving, and Hoarding, Oxford University Press).

How to treat hoarding

Hoarding is often very challenging to treat. In many areas, there are not any experts in hoarding behavior. Treatment approaches may include elements of Motivational Interviewing; Cognitive Behavioral Therapy (CBT); individual and group therapy; medication for depression, anxiety or OCD;  and trauma specific treatment for those who have a trauma history. When the person feels ready and choose to de-clutter their home, a plan for volunteers and services to assist them.

Author: Lesa Fichte, LMSW, Director of Continuing Education
Photo Credit: Compulsive Hoarding Wikipedia

Select Resources

Understanding a Hoarding Disorder

Compulsive Hoarding

Hoarding as a reaction to trauma. Psychology Today

International OCD Foundation, Annual Hoarding Meeting

Anxiety and Depression Association of America Hoarding Basics

Help for Hoarders (UK)

Hoarding Inventories and Scales, International OCD Foundation

Treatment for Hoarding Disorder: Therapist Guide (Treatments That Work) by Gail Steketee, Randy O. Frost

Buried in Treasures: Help for Compulsive Acquiring, Saving, and Hoarding (Treatments That Work) by David Tolin, Randy O. Frost and Gail Steketee

Stuff: Compulsive Hoarding and the Meaning of Things Hardcover by Randy O. Frost  (Author), Gail Steketee

Animal hoarding FAQs, ASPCA

Animal hoarding and laws, Animal Legal and Historical Center, Michigan State University College of Law

Animal Hoarding from Wikipedia

Diogenes Syndrome, Hoarding – or Merely an Avid Collector? (thanks to Dorlee at Social Work Career Development blog)

From Dante to DSM-5: A Short History of Hoarding

Hoarding disorder as defined in the DSM-5

 


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7 responses

1 05 2014
Shirley Mazourek, LCSWR

Nice overview, and I appreciate the emphasis on compassion. If anyone needs a place to refer a client or loved one in the WNY area, I am running an open compulsive hoarding treatment group, based on Steketee & Frost’s published works. (716) 898-1675 for more information.

1 06 2014
Hoarding a Hidden Disorder » Chit Chat

[…]   […]

3 05 2015
Casey

It is time for people to learn that hoarding is not a disease nor illness, it is a condition mainly caused by some traumatic experience in person’s life. More info here: https://medium.com/@casfleming/hoarding-disorder-horror-of-letting-go-53062a692db0

4 05 2015
UB Social Work Continuing Education

Thank you for sharing the additional information, Casey. Yes, there is often a connection between traumatic experiences and hoarding behavior.

10 05 2015
Andrew G

Thanks for the info..Any groups in Central Fla?? I had several houses (4 til Oct 2014)and two warehouses for over 25 years..Overwhelmed in Orlando.

11 05 2015
UB Social Work Continuing Education

Hi Andrew, thank you for your interest in our post and your comment. There are two pieces to the approaching a situation where someone is hoarding. One is the need to find a qualified therapist to assist with healing. The other is a service that can assist in cleaning out hoarded homes and buildings if the person cannot do it themselves. A quick internet search pulled up this site and at the bottom of the page is a list of some therapists in Florida as well as some clean-up services for hoarded buildings. http://childrenofhoarders.com/wordpress/?page_id=3968 You can also contact your local mental health association to see if they have any resources or referrals for you. Their website is http://www.mhacf.org/ Holding you in healing thoughts.

19 10 2015
Andrew Gaba

Thanks for reply with info..I just searched clutterblindness to find this site again..I am trying to find dinner with no counter space to cook and I.m out of butter..Hopefully will find this blog site again..

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