Before we go further into the details of hoarding, we should talk about a clear definition of the disorder – it will help us work from the same page throughout this blog. As well, it gives us something to go back to. I often get questions from professionals and family members about a situation and I’m asked, “is this hoarding?” I bring them back to the definition. Also, when we are clear about what hoarding is, we can also then be clear about what it isn’t, for example, clutter and collections (we’ll talk about those definitions in the next post).
The thing is, hoarding disorder is not well understood in the general population or by mental health professionals. The fact is that many mental health professionals don’t know enough about hoarding to be able to help their clients in appropriate ways. Another fact is that there is very little money to help address hoarding. We might as well be up front with this right now. The lack of financial resources makes hoarding disorder treatment very difficult. Professionals who work with people who hoard have to get really creative in finding help, resources, and funding. No city or county has a line item in their annual budget for hoarding, nor do states, and certainly not the federal government. Yet, hoarding is a huge problem throughout our country. It is an uphill battle. However, some specific populations may be able to access resources, for example, seniors may be able to use elderly waivers to help pay for professional organizers or clean-out help. It’s not impossible, but it’s a lot of work. I hope this will change as more people understand hoarding disorder.
In 2013, the fifth edition of the DSM (the resource mental health professionals use for diagnosing) listed Hoarding Disorder as a mental health disorder under the Anxiety Disorders section. Prior to 2013, hoarding was understood to be a symptom of obsessive-compulsive personality disorder. The more professionals worked with hoarding and OCD, the less they saw a connection between the two. However, I’m sure if you’ve worked with a person who hoards, you can easily understand why hoarding could be listed as an anxiety disorder. Just talking about the hoard can raise the level of anxiety for a person who hoards and make it difficult to strategize change. With the new disorder came a definition that has four parts to it: 1) acquiring too much, 2) not letting go of possessions, 3) an inability to use the rooms in the home for their intended purpose, and 4) emotional distress and physical impairment due to the amount of stuff in the home. Let’s take each of these apart to further understand the definition.
- Acquiring too much – we all acquire passively and actively, people who hoard acquire too much. Active acquiring is going out to bring things in to the home, such as shopping, dumpster diving, picking up furniture in an alley or on a boulevard, collecting free things like brochures, programs, free magazines. Passive acquiring is gathering things into the home without doing anything to get them. Think junk mail, gifts, inheritances – you haven’t done anything but these things come into the home nonetheless.
- Difficulty in letting go of possessions – there are a lot of reasons why it can be hard to let go: emotional connection to the item, fear that I won’t have what I need when I need it, the “you never know” reasoning, “I got a good deal on this,” and other reasons. The bottom line is that the first two parts of the definition work well together – too much is coming in, not enough is going out, and pretty soon there’s no liveable, safe space in the home.
- Rooms that can’t be used for their intended purpose because of the stuff – the question here is about how the home is accessed. When was the last time you cooked in the kitchen? Can you sleep in your bed? Can you take a shower in your bathroom? Is the car parked in the garage? When the answer to these questions is a negative, then the rooms in the house aren’t usable.
- Emotional distress and physical impairment – think of this part of the definition in how both the person who hoards and others are impacted. If we have a loved one who hoards and we are worried about their safety, we are experiencing emotional distress, the person who hoards is not. However, when we start talking about getting rid of stuff, or about the inaccessibility of the house, the person who hoards will likely become distressed. Physical impairment is about the lack of ability to get safely through the house, or even a room, because of all the things in the home.
So that’s the definition of hoarding disorder. One thing to keep in mind about the acquisition part of the definition – sometimes we can have a person hoarding who does not excessively acquire, they just never let anything go out of the house. It may take longer, but eventually the home will be overfull. We often see this in people who lived through the Great Depression and World War II, as well as new refugees who have had to leave their home and country of origin with little or nothing. What I think we see here is the belief that they have lived through a time in which they didn’t have what they needed when they needed it, and they will never put themselves through that again. So they hang on to everything – you never know when you might make use of it.
Janet Yeats is a marriage and family therapist and writer who specializes in issues of trauma, grief and loss. Janet consults, speaks and writes on hoarding disorder as well as other trauma and loss-related topics. Visit her youtube channel (Janet Yeats) to see videos and webinars on these topics.