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Hoarding: The “Invisible” Disorder

By February 12, 2019April 6th, 2021Alberto Collazzoni, Ph.D., Blogs

What is Hoarding Disorder?

Have you ever watched an episode of any hoarding reality television series? They typically present people who live in extreme clutter, submerged by piles of paper, clothes, plants, food, and other objects accumulated over many years. These shows may give you and external glimpse into the possible severe outcomes of hoarding; however, there are typically underlying psychological fears at play. Hoarding Disorder (HD) is now a recognized mental disorder in the DSM-5. It is characterized by a persistent difficulty to discard and need to order possessions, without often considering their real value. In particular, the hoarders are afraid that they will later need a specific object in a catastrophic, but hypothetical, future situation; therefore, the simple thought of discarding is discomforting for hoarders. As a consequence, hoarders live in a congested and cluttered environment, which often impairs their social functioning as well. This is worsened by two other possible factors. Firstly, the presence of “excessive acquisition” behavior, which means living in a more congested living area. Second, a low level of insight; therefore, they don’t see their behaviors as problematic. In these cases, significant others and relatives may seek treatment or consultation about their family member because the hoarding has impacted their lives as well.

Is it possible to threat it? How?

Yes, it is possible to threat HD. Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP), in particular, are evidenced-based and highly effective treatment interventions. ERP consists of purposely exposing an individual to his/her fear, without escape from them, until the distressing feelings decrease. In this way, individuals learn to tolerate distress. It is important to keep in mind that a common underlying fear for hoarders in discarding objects is worrying that they could need that object in the future, but not have it available. And as previously mentioned, level of insight may be low. Therefore, ERP for the treatment of HD should ideally begin with motivational interviewing and identifying a clear personal goal for the patient. This treatment is challenging; therefore, motivation is key. Next, therapists help patients develop a hierarchy of objects to discard and use an anxiety scale to measure their subjective level of distress during exposures. The hierarchy should be structured from the least distressing object(s) to discard to the most distressing object(s) to discard. The hierarchy is crucial in preventing patients from becoming flooded and feeling overwhelmed by beginning with highly distressing exposures.

 What can you do to help friends and/or family members who hoard?

 If you want to help your friend or relative effectively tackle their hoarding, it is important to remain patient, empathic and assertive. Change may not come easily or quickly; therefore, patience can encourage you and your loved one to notice small changes overtime and reinforce those changes without unintentionally instilling feelings of guilt or shame. Furthermore, empathy helps to foster understanding for your loved one’s distress. And if insight into their underlying fear is lacking, then frustration from friends and relatives could lead to further shame, sadness, or cause them to hide or collect in secret. Lastly, assertive communication helps in clarifying and continuing to motivate them. Remind the person of his/her goals, redirect them when those goals are forgotten, and continue to offer support in their efforts to attain those goals.