Signs & Symptoms
People with hoarding disorder usually find it difficult or stressful to throw away items that others view as worthless or of little value. Over time, they may run out of room to store these things within their home and may start storing their belongs in their vehicles, garden, garage or storage unit, possessions are usually displayed in a disorganised manner.
People with hoarding disorder tend to acquire various items from free papers, newspapers, magazines, receipts and statements, books, cd’s. DVD’s, collectables, clothes. Plastic containers, cardboard boxes, plastic bags, domestic products, cosmetic products, household products, food waste, food and drinks, homeware products, toys, computers and accessories, electronic storage devices, video recorders and DVD players, TV’s, electrical cable and extensions, mobile phones and telephones, pets and animals, human waste, and animal waste.
Other symptoms that people with hoarding disorder may experience include:
- emotional distress, such as being overwhelmed or embarrassed by their possessions or living situation
- suspicion or fear of other people touching their items
- obsessive fears and actions, such as checking rubbish bins for discarded items or a fear of needing an item in the future
- feeling responsible for objects, and sometimes thinking of inanimate objects as having feelings
People with hoarding disorder also tend to experience associated issues with:
- organising and sorting
Some studies and research show the symptoms of hoarding disorder can begin during a person’s early teenage years, with the average age of onset being 13 years old.
Health & Wellbeing
Hoarding disorder can result in a range of negative emotional, social, physical, financial, and even legal complications.
For example, clutter may overrun someone’s home, blocking access to important living, cooking, washing and working and exit spaces.
Other common complications or consequences associated with hoarding disorder include:
- difficulty functioning in daily activities
- poor hygiene
- poor management of their health & wellbeing
- poor management of medication
- poor diet or nutrition
- mobility and sensory difficulties
- respiratory difficulties
- living in unsafe environments, with factors such as slips trips and falls hazards, fire hazards, or large piles of items that may collapse
- strained or severed marital, family, or friend relationships
- social isolation and loneliness
- lost work or employment
- financial difficulties and debt
- reluctance to let others into their home
- legal problems, such as those involving child custody and animal welfare
- lost property value or eviction
Research on hoarding disorder is still relatively new and still requires more funding, resources and time to piece together the connection with other illnesses, as well as these complications and consequences, research has shown people with hoarding disorder may also experience co-occurring mental health conditions such as:
- attention deficit hyperactivity disorder (ADHD)
- anxiety disorders
- obsessive compulsive disorder (OCD)
- autism spectrum disorder
- personality disorder
- alcohol and drug misuse
Less commonly, hoarding disorder is also associated with:
- pica disorder, in which a person consumes non-food items
- Prader-Willi syndrome, a genetic condition
Causes and risk factors
Usually, people with hoarding disorder are driven to obtain and keep items that:
- they believe may become useful or valuable in the future
- are free or are more affordable than usual
- have perceived sentimental value
- seem irreplaceable, unique, or perfect (often only to them)
- are a reminder of an important memory of a person, place, time, or event that the person fears they will forget
- Surrounding themselves with these items may also comfort the person.
Although researchers are not certain what causes people to develop hoarding disorder, several risk factors seem capable of triggering or worsening the symptoms. These include:
- a family history and childhood experiences
- challenging feelings, worrying and perfectionism
- brain injuries
- very stressful events, trauma, such as severe illness or the loss of a loved one or job
- other mental health concerns
- differences in brain function and neuropsychological performance unique from people with other conditions
Diagnosing hoarding disorder can be difficult, as many people with the condition are not willing to admit that they have it or are unwilling to seek treatment, often for fear of losing their belongings.
To diagnose someone with hoarding disorder, a psychiatrist will usually ask the person some questions about themselves, their belongings, and their homes. Common questions could include:
- How hard or stressful is it to get rid of (sell, give away, recycle) things that other people seem to discard easily?
- How hard is it to use rooms and surfaces at home because of clutter?
- How hard is it to organise things or decide where they should go?
- To what extent do items or clutter impact overall daily functioning?
- Does clutter impact work, school, social, or family obligations or relationships?
- How common are fears about other people touching, using, or destroying belongings?
The doctor or the community mental health team may also ask to see pictures of the person’s major living areas or ask to visit it themselves to better assess the extent or impact of their symptoms.
For a diagnosis of hoarding disorder, someone will need to display:
- long term problems with getting rid of possessions, regardless of their value
- significant distress tied to losing items
- items that block, fill, or clutter primary living spaces and prevent proper use
For an accurate diagnosis, a psychiatrist will also need to make sure that hoarding disorder is not a symptom of another condition.
NB: If you are a carer, close friend or family member, here are some question you may want to ask the person you are trying to support.
- When was the last time you needed it?
- When was the last time you used it?
- How likely is it that you will use it in the future?
- What is your track record of using items like this?
- What is the impact of keeping the things in relation to your problem?
Here are some useful assessment tools you could use when supporting a person with hoarding behaviour:
Click the link: Saving Inventory – Revised
Click the link: Clutter Image Rating Scale
Click the link: Hoarding Rating Scale
With the right tailor-made treatment, most people with hoarding disorder can reduce their major symptoms and the risk of complications.
Healthcare professionals in the UK tend to treat hoarding disorder using a type of therapy called cognitive behavioural therapy (CBT).
During CBT sessions for hoarding disorder, a mental health professional will show people ways of coping and strategies on how to part with unnecessary items less stressfully, research has shown that providing a home support service to challenge their hoarding behaviour in their own environment as apart of the CBT session can potentially see a better outcome and success rate, also CBT conventional session lasting 6/12 week would usually need to be extended up to 24 weeks to see any true impact.
CBT can also help a person improve motivation, health, relaxation, organisation, and decision-making skills, future management and relapse prevention.
Recently there has been research in providing alternative therapies to help manage people with hoarding behaviour thoughts, emotions and behaviour, some of these alternative therapies used to help people with hoarding behaviour show signs of reasonable success rates, but there is still a lot of work to be done due to the number of cases coming forward for treatment, the current knowledge at community level, funding and resources.
In some cases, medication may also play a role in treatment. This is particularly the case when hoarding disorder is related to other conditions that respond well to medication, such as severe anxiety or depression.
When to see a doctor
People with symptoms of hoarding disorder should try to talk to a doctor, particularly if these symptoms:
- are severe, chronic, or accompanied by other symptoms
- interfere with everyday activities, such as cleaning, cooking, washing, working, or engaging with the community
- cause significant interpersonal problems
- cause severe anxiety, depression or embarrassment
- have made living environments unsafe or unhealthful
How to support someone with hoarding disorder
Family members or friends may want to meet with a doctor or mental health professional to learn how to approach the topic of diagnosis and treatment with someone they suspect has hoarding disorder or hoarding-related behaviours.
Loved ones may also want to accompany someone to their first GP or mental health meeting to make them feel more comfortable.
Having someone else attend early mental health appointments may also help give the doctor a better perspective of the person’s habits, home, and interpersonal relationships and family support.
It is also worth noting that local voluntary organisations, community and peer support groups may have programs and services dedicated to helping people with hoarding disorder.
In extreme cases, the community mental health team and the council’s safeguarding team may need to become involved in someone’s care and health treatment pathway.
Early recognition, diagnosis, signposting, and treatment pathways usually increase the likelihood that someone with hoarding disorder can reduce the severity of their symptoms.
Untreated hoarding disorder is likely to become chronic, often getting more severe over time.
People with signs of hoarding disorder should try to speak to a doctor or mental health professional as soon as possible or get a trusted person to speak on your behalf.
People who think that someone they know or someone they know in the community may have hoarding disorder or hoarding-related behaviour should consider contacting their councils safeguarding team to raise their concerns.
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