This week I attended the annual conference hosted by Hoarding UK, as I do every year. Hoarding is largely misunderstood, but awareness is slowly increasing and there are now several charities in the UK providing advocacy and support. There’s also a growing number of Professional Organisers (like myself!) who work with people with hoarding issues. Far from the media stereotypes that depict hoarding as a lifestyle choice, hoarding is a complex psychological condition requiring empathy and specialist support. In my experience, people on the hoarding spectrum are overwhelmingly intelligent, sensitive folk who have suffered challenging life experiences and are doing their best to cope despite a reduced quality of life.
What is hoarding?
As with most things, there are varying levels of hoarding behaviour but in this post I’m going to focus on Hoarding Disorder. This is a diagnosable mental health condition at the severe end of the spectrum. People with hoarding disorder have an excess of clutter and difficulty discarding at a level that significantly impacts everyday living. They may be unable to use their kitchen and bathroom, unable to access living areas and have no running water or heating. There may be trip hazards, fire risks and infestations. The level of clutter is usually so severe it causes a risk to health and safety and negatively affects the quality of life of the person and family. It can also have a detrimental effect on relationships with family and friends and lead to social isolation. It tends to be a hidden condition due to the levels of shame and embarrassment that the individual experiences.
Who is affected?
Some research has indicated that hoarding disorder is more common in men, but women are more likely to ask for support. The limited research available shows no distinction between age, gender, ethnic group, education level or income, so contrary to the stereotype, it is not something that just affects older people with low income levels. There is often a family history of Obsessive Compulsive Disorder or hoarding within the family, usually affecting parents, siblings or children. It is thought that only 5% of people who hoard come to the attention of professionals, and hoarding difficulties often come to the forefront when patients seek support and treatment for other mental health or physical conditions.
When does it start?
Hoarding often begins in adolescence and without support, increases over time often becoming a significant problem for people when they are in their thirties. The average age of people seeking treatment is around the age of fifty, although many people never seek support and may never reach the stage where they see their behaviour as problematic. Traumatic life events and hardship are frequent in people with Hoarding Disorder and can lead to social vulnerability, isolation and housing insecurity.
What are the features?
People with hoarding disorder acquire items excessively and are unable to discard. They are often chronically disorganised, find it difficult to make decisions or decision making is hampered by perfectionism. They have a very strong attachment to the things they own, which often no obvious monetary value or worth in the eyes of others. Hoarding is often accompanied by a lack of insight and although there is limited distress experienced from living conditions, there is significant anxiety when asked to discard. Hoarding Disorder tends to exist alongside other mental health conditions, especially depression, linked to a high frequency of adverse life events characterised by trauma, grief and loss. Other common comorbidities include O.C.D. and Attention Deficit Hyperactivity Disorder.
What helps?
Once Hoarding Disorder is identified, a long term co-ordinated approach is needed. There has been a distinct lack of support in the past, but local authorities are increasingly recognising the need for protocols and partnership working between social services, health, fire service, housing and professional organisers. A trauma-informed non-judgemental approach, which seeks to improve peoples health, safety and wellness and empowers the individual to make positive changes, is the one most likely to achieve success. But it takes time, alongside lots of patience and understanding. There are no quick fixes, and the enforced ‘clear outs’ of old (which only served to cause more trauma) are thankfully a thing of the past. Motivational interviewing techniques can be very useful, as this helps the person see at the discrepancy between the current situation and how they would like to live and increases confidence in their ability to make a change.