About Hoarding Disorder
Definition of Hoarding Disorder
Frost and Hartl (1996) provided the first systematic definition, identifying three characteristics:
- the acquisition of, and failure to discard a large number of possessions that appear to be useless or of limited value
- living spaces sufficiently cluttered so as to preclude activities for which those spaces were designed
- significant distress or impairment infunctioning caused by the hoarding
This definition distinguished hoarding from the collecting of objects generally considered interesting and valuable.
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Characteristics of Hoarding
Two behaviors characterize hoarding: acquiring too many possessions and difficulty discarding or getting rid of them when they are no longer useful or needed. When these behaviors lead to enough clutter and disorganization to disrupt or threaten a person’s health or safety, or they lead to significant distress, then hoarding becomes a “disorder." Simply collecting or owning lots of things does not qualify as hoarding. A major feature of hoarding is the large amount of disorganized clutter that creates chaos in the home. Such as:
- Rooms can no longer be used as they were intended
- Moving through the home is difficult
- Exits are blocked
Collectors typically keep their possessions well-organized, and each item differs from other items to form an interesting and often valuable collection. Further, an important purpose of collecting is to display the special items to others who appreciate them. People who hoard are seldom able to accomplish such goals.
Source: Randy Frost at the International Obsessive Compulsive Foundation
What makes getting rid of clutter difficult for individuals that suffer from hoarding disorder?
- Difficulty organizing possessions
- Unusually strong positive feelings (joy, delight) when getting new items
- Strong negative feelings (guilt, fear, anger) when considering getting rid of items
- Strong beliefs that items are “valuable” or “useful,” even when other people do not want them
- Feeling responsible for objects and sometimes thinking of objects as having feelings
- Denial of a problem even when the clutter or acquiring clearly interferes with a person’s life
Hoarding Disorder: A new diagnosis for DSM-5
Hoarding Disorder Hoarding disorder is a new diagnosis in DSM-5. DSM-IV lists hoarding as one of the possible symptoms of obsessive-compulsive personality disorder and notes that extreme hoarding may occur in obsessive compulsive disorder. However, available data do not indicate that hoarding is a variant of obsessive compulsive disorder or another mental disorder. Instead, there is evidence for the diagnostic validity and clinical utility of a separate diagnosis of hoarding disorder, which reflects persistent difficulty discarding or parting with possessions due to a perceived need to save the items and distress associated with discarding them. Hoarding disorder may have unique neurobiological correlates, is associated with significant impairment, and may respond to clinical intervention.
Source: American Psychiatric Association, 2013
How to Talk to Someone with Hoarding: Do's & Don'ts
By Cristina M. Sorrentino, PhD, LCSW | Boston University School of Social Work
- Imagine yourself in the hoarding client’s shoes
How would you want others to talk to you to help you manage your anger, frustration, resentment, and embarrassment?
- Match the person’s language
Listen for the individual’s manner of referring to his/her possessions (e.g., "my things", "my collections") and use the same language (i.e., "your things", "your collections").
- Use encouraging language
In communicating with people who hoard about the consequences of hoarding, use language that reduces defensiveness and increases motivation to solve the problem (e.g., "I see that you have a pathway from your front door to your living room. That’s great that you’ve kept things out of the way so that you don’t slip or fall. I can see that you can walk through here pretty well by turning sideways. The thing is that somebody else that might need to come into your home, like a firefighter or an emergency responder, would have a pretty difficult time getting through here. They have equipment they’re usually carrying and firefighters have protective clothes that are bulky. It’s important to have a pathway that is wide enough so that they could get through to help you or anyone else who needed it. In fact, the safety law states that [insert wording about egresses], so this is one important change that has to be made in your home."
- Highlight strengths
All people have strengths, positive aspects of themselves, their behavior, or even their homes. A visitor’s ability to notice these strengths helps forge a good relationship and paves the way for resolving the hoarding problem (e.g., "I see that you can easily access your bathroom sink and shower," "What a beautiful painting!", "I can see how much you care about your cat.")
- Focus the intervention initially on safety and organization of possessions and later work on discarding
Discussion of the fate of the person’s possessions will be necessary at some point, but it is preferable for this discussion to follow work on safety and organization.
- Use judgmental language
Like anyone else, individuals with hoarding will not be receptive to negative comments about the state of their home or their character (e.g., "What a mess!" "What kind of person lives like this?"). Imagine your own response if someone came into your home and spoke in this manner, especially if you already felt ashamed.
- Use words that devalue or negatively judge possessions
People who hoard are often aware that others do not view their possessions and homes as they do. They often react strongly to words that reference their possessions negatively, like "trash," "garbage," and "junk."
- Let your non-verbal expression say what you’re thinking
Individuals with compulsive hoarding are likely to notice non-verbal messages that convey judgment, like frowns or grimaces.
- Make suggestions about the person’s belongings
Even well-intentioned suggestions about discarding items are usually not well-received by those with hoarding.
- Try to persuade or argue with the person
Efforts to persuade individuals to make a change in their home or behavior often have the opposite effect—the person actually talks themselves into keeping the items.
- Touch the person’s belongings without explicit permission
Those who hoard often have strong feelings and beliefs about their possessions and often find it upsetting when another person touches their things. Anyone visiting the home of someone with hoarding should only touch the person’s belongings if they have the person’s explicit permission.
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