Hoarding

by Jan E. Estrellado, Ph.D.

Most of us know someone who has difficulty throwing things away or cannot seem to stop him or herself from buying things at bargain prices, even when he or she doesn’t need them.  Extreme versions of these behaviors (i.e. “clinical hoarding”) affect up to 5% of the U.S. population (Samuels et al., 2008). What might cause an individual to let these situations get out of hand?  And what can that person or a loved one do to help that person change?

What is Hoarding Behavior?

According to the International OCD Foundation (https://iocdf.org/), hoarding consists of three related issues: (1) collecting too many items; (2) difficulty getting rid of items; (3) problems with organization.  Hoarding behavior can result in significantly limited living or work space, strained relationships with others, and in extreme cases, unsanitary or hazardous living conditions.

A person with hoarding behavior may experience severe distress when attempting to get rid of items.  That person may feel he or she need these things or that he or she will eventually use them.  Even if the person’s belongings are of little material value or use, the person feels unable or unwilling to get rid of the items. 

Hoarding behavior negatively impacts relationships.  If one person in a household hoards, others living in the home may resent and/or blame that person for the status of their living conditions.  While it may seem like an “easy solution,” (i.e., “Just throw those things away!”) this is a much more complex process for the person who has difficulty letting go of material things. 

Why Do People Hoard?

A person’s beliefs about his or her posessions, as well as the meaning he or she attributes to them, are core parts of why a person hoards (Steketee et al., 2003).  A person may be extremely sentimental about his or her items and feel as if losing the item is “like losing a friend.”  The individual may feel exceptionally protective over his or her belongings and become very defensive or territorial when another person suggests he or she get rid of them.  

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Wheaton et al. (2010) discuss the difficulty some individuals have with tolerating distressing emotions related to hoarding.  The actions a person takes or does not take in order to minimize upsetting feelings is called avoidance.  For example, a person who feels upset when trying to give or throw something away might avoid those feelings by saving the item.  By keeping the item, the person can also avoid feelings of loss that might result from not having the item.  An individual who hoards might also feel a “high” when acquiring new items, so he or she continues to obtain new items, even if the item is not needed.

Getting Help for Hoarding

Seeking mental health treatment for hoarding behavior might be particularly difficult.  By the time the individual shows up at his or her therapist’s door, it is possible he or she has been hoarding for years.  Treatment might not have been the person’s first choice, but was perhaps at the strong encouragement of a concerned family member or friend.

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Cognitive-behavioral therapy (CBT) is the treatment of choice to address hoarding behavior.  In a recent review of the scientific literature on hoarding treatment, Tolin and colleagues (2015) found that those who received CBT for hoarding had significant reductions in symptoms, especially with regards to a core feature of hoarding behavior, difficulty discarding.  A hoarding-specific version of CBT combines a number of different elements, including resolving the person’s ambivalence towards his or her hoarding behavior, and using exposure therapy to help the person directly confront his or her discomfort regarding discarding items (Tolin, Frost, Steketee, & Murdoff, 2015).

Another significant finding from the same study (Tolin et al., 2015) is that greater improvements with discarding symptoms were associated with greater number of therapy sessions conducted in the person’s home.  In-home sessions are more effective than office sessions because the therapist can be there with the client to help build new discarding and acquiring skills.

CSAM is here to help

If you or someone you love might benefit from acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), or biofeedback for hoarding, anxiety, depression, stress, or PTSD, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

References:

International OCD Foundation.  https://hoarding.iocdf.org/

Samuels, J. F., Bienvenu, O. J., Grados, M. A., Cullen, B., Riddle, M. A., & Liang, K. Y. (2008). Prevalence and correlates of hoarding behavior in a community-based sample. Behaviour and Research Therapy, 46, 836 – 844.

Steketee, G., Frost, R. O., & Kyrios, M. (2003). Cognitive aspects of compulsive hoarding. Cognitive Therapy and Research, 27, 463–479.

Tolin, D. F., Frost, R. O., Steketee, G., & Muroff, J. (2015). Cognitive behavioral therapy for hoarding disorder: A meta‐analysis. Depression And Anxiety, 32(3), 158-166. doi:10.1002/da.22327

Hoarding and Cognitive Behavioral Therapy

By: Sarah Bond 

Within the past couple years, the issue of hoarding has become polarized by the means of reality television shows and late night pundits.  Although this media attention has contributed to an increased public awareness, interest, and concern, the long-term implications that hoarding can have are often overlooked.  While hoarding has been associated with the diagnosis of obsessive-compulsive disorder (OCD) and obsessive compulsive personality disorder for many years, it was not until the recent publication of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) that it became its own diagnosis. 

Hoarding is characterized by collecting possessions that create clutter and serve minimal functional purpose (Tolin, Frost, & Steketee, 2007).  Anything living or non-living can be hoarded.  “Clothes, newspapers, and books” are reportedly the most common items hoarded (International OCD Foundation, 2010, p. 1).  However, fifty-percent of hoarders choose to amass complimentary items, such as bubble wrap and fast food containers, and some even acquire large numbers of living animals. 

Hoarding may result in the impairment of functioning and create significant distress.  The disorder can pose additional health risks associated with sanitation and an increased risk of fire (Tolin et al., 2007).  Aside from the physical hazards, it can also have immense social and psychological ramifications.  For instance, hoarding will affect the lives of those who share living spaces and may adversely impact interpersonal relationships.  Its clinical repercussions interfere with daily routines that many take for granted.  Simple tasks, such as cooking and showering, may be hindered by the unnecessary accumulation of items hoarded.  Thus, it is understandable as to why hoarders are commonly diagnosed with elevated rates of depression (Tolin et al., 2007, p. 1461). 

Hoarders usually do not realize that they have a problem (International OCD Foundation, 2010).  Many have trouble with organization and decision making.  Thus, they find it difficult to arrange their possessions in a manner that makes efficient use of their living space.  Additionally, hoarders often have an emotional attachment to their objects, which makes it challenging for them to discard or give away their possessions (International OCD Foundation, 2010).  It may provoke a sense of fear in anticipation of losing the objects that are important to them.  Thus, hoarders may arrange their items compulsively to help alleviate distress (International OCD Foundation, 2010).  Hoarders do not typically exhibit ritualistic tendencies and the accumulation of items tends to be passive in nature.  This differs from OCD, in which individuals deliberately seek to rid themselves of unwanted emotions by actively seeking out behaviors or rituals that provide comfort (International OCD Foundation, 2010).

 If you or someone you know experience symptoms similar to the aforementioned, it is important to consult a professional.  Although there is still a lot to be learned about the disorder, interventions such as cognitive behavioral therapy (CBT) can be effective.

 Please contact CSAM if you are interested in speaking with a professional in the San Diego area who specializes in CBT.

References

International OCD Foundation. (2010). Hoarding. Retrieved from http://www.ocfoundation.org/hoarding/

Tolin, D.F., Frost, R.O., & Steketee, G. (2007). An open trial of cognitive behavioral therapy for compulsive hoarding. Behavior Research Therapy, 45(7), 1461.

Tags: CBT, Cognitive Behavioral Therapy, OCD, hoarding