Hoarding

It's considered to be a significant problem when:

• the amount of clutter in the person's home is increasing
• they bring in more things each day and discard very little
• the amount of clutter interferes with everyday living – for example, they're unable to use the kitchen or bathroom and cannot access rooms

People with hoarding difficulties often suffer from

, which may or may not be directly connected to their clutter problem. Hoarding is also often associated with and .

Compulsive hoarding is challenging to treat because many people who hoard don’t see it as a problem, or have little awareness of their disorder and how it's impacting their life.

However, it’s really important to encourage a hoarder to seek help, as their obsession can not only cause loneliness and mental health problems, but poses a health and safety risk, too. If not tackled, it's a problem that will most likely never go away.

Why someone may become a hoarder

The reasons why someone becomes a hoarder are still not fully understood. However, the problem tends to persist because:

• the person finds it difficult to discard things
• they may have problems with order, organisation and decision-making
• they acquire more things than they throw away

The person will also have unhelpful beliefs, such as:

• "I may need this someday"
• "If I throw this away, I won't be able to cope with the feelings of loss"
• "If I buy this, it will make me happy"

Attempts to discard things often bring up very strong emotions that can feel overwhelming, so the hoarder tends to put off or avoid making decisions about what can be thrown out.

Often, many of the things kept are of little or no monetary value, and may be what most people would consider rubbish. The person may acquire several of the same items because they're unable to find what they need, or they may have stockpiled food or clothes "just in case".

A person is more likely to become a compulsive hoarder if:

• there's a family history of hoarding
• they've experienced deprivation
• they grew up in a cluttered home
• they have another mental health condition, such as
  anxiety
  ,
  depression
  or social phobia (a fear of social occasions)
• they're struggling to cope with a stressful life event, such as the death of a loved one
• they have a history of alcohol dependence
• they're lonely (hoarding brings comfort)

The typical profile of a compulsive hoarder

A compulsive hoarder typically:

• may keep or collect items that are of no value, like junk mail and carrier bags, or items they intend to re-use or repair
• finds it hard to throw anything away, and just moves items from one pile to another
• finds it hard to categorise or organise items
• has difficulties making decisions and struggles to manage everyday tasks, such as cooking, cleaning and paying bills
• becomes obsessively attached to items, refusing to let anyone touch or borrow them
• does not socialise with other people

Some studies suggest that hoarding often starts in the teenage years (as early as 13 or 14), where broken toys or school papers may be collected. The hoarding then becomes worse with age.

Why compulsive hoarding is a problem

Compulsive hoarding is a problem for several reasons.

Because of the amount of clutter, the person may not be able to use the rooms in their house for their intended purpose, or even be able to sit in a chair without having to move things.

In extreme cases, the piles of clutter can become a fire risk and can result in the hoarder tripping and falling. And because the home is virtually impossible to clean, living conditions tend to be very unhygienic and can lead to rodent or insect infestations, blocked drains and other problems that may also affect neighbouring properties.

The hoarder is usually reluctant or unable to have visitors, or even allow tradesmen in to carry out essential repairs.

They quickly become isolated and lonely and are often prone to

and . The hoarding probably brings them comfort, but deep down they're unhappy.

They may ignore the pleas of family and friends to get help, as they don't see it as a problem or can't bring themselves to tackle it.

The hoarding literally takes over the person's life, causing their work performance, personal hygiene and social life to suffer.

What you can do if you suspect someone is a hoarder

If a member of your family or someone you know is a compulsive hoarder, try to persuade them to come with you to see a doctor. This won't be easy, as someone who compulsively hoards may not think they need help, so may not want to seek treatment.

Ask your doctor to refer you to your local community mental health team, which may have a health professional who specialises in OCD and is familiar with hoarding.

Reassure your loved one or friend that no one is going to go into their home and throw everything out. You're just going to have a chat with the doctor about their hoarding, to see what can be done and what support is available to empower them to begin the process of decluttering.

It's generally not a good idea to call in the council or environmental health to clear the rubbish away, as it won't solve the problem and the clutter often quickly builds up again. However, if the problem is not addressed, local authorities may take legal action to ensure that the property is cleared.

Don't be tempted to get extra storage – this is only a quick fix, is costly, and doesn't address the problem. The problem is too much stuff, not too little space to keep it.

How compulsive hoarding is treated

It's not easy to treat compulsive hoarding, even when the person is prepared to seek help, but compulsive hoarding can be overcome.

The main treatment for compulsive hoarding is

. The therapist will help the person understand what makes it difficult to throw things away and the reasons why the clutter has built up. This will be combined with practical tasks and a plan to work on. It's important that the person takes responsibility for clearing the clutter from their home. The therapist will support and encourage this.

A type of antidepressant –

– has also been shown to help some, but not all, compulsive hoarders.

Cognitive behavioural therapy (CBT)

CBT is a type of therapy that aims to help you manage your problems by changing how you think and act. It encourages you to talk about how you think about yourself, the world and other people, and how what you do affects your thoughts and feelings. By talking about these things, CBT can help you to change how you think (‘cognitive’) and what you do (‘behaviour’), which can help you feel better about life.

Regular sessions of CBT over a long period of time are usually necessary and should include some home-based sessions, working directly on the clutter. This requires motivation, commitment and patience, as it can take many months to achieve the treatment goal.

The goal is to improve the person's decision-making and organisational skills, help them overcome urges to save, and ultimately clear the clutter, room by room.

The therapist won't throw anything away, but will help guide and encourage the person to do so. The therapist can also help the person develop decision-making strategies, while identifying and challenging underlying beliefs that contribute to the hoarding problem.

The person gradually becomes better at throwing things away, learning that nothing terrible happens when they do so, and becomes better at organising items they insist on keeping.

They may also be encouraged to keep a daily log of what they've purchased, to monitor incoming clutter.

At the end of treatment, the person may not have cleared all their clutter but will have gained a better understanding of the problem. They'll have a plan to help them continue to build on their successes and avoid slipping back into their old ways.