Hoarding

Compulsive hoarding means excessively acquiring items that appear of little or no value and not being able to throw them away, resulting in unmanageable amounts of clutter.

It is considered to be a significant problem when:

the amount of clutter interferes with everyday living – for example, someone is unable to use the kitchen or bathroom and cannot access rooms
the clutter is causing significant distress or negatively affecting a person's ability to function – for example, their social life, employment and maintaining a safe environment

People with hoarding difficulties may suffer from obsessive compulsive disorder (OCD), which may or may not be directly connected to their clutter problem. Hoarding is also often associated with other forms of anxiety and depression.

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 or the lives of others.

However, it's really important to encourage a person who is hoarding to seek help, as their difficulties with discarding not only cause loneliness and mental health problems, but pose a health and safety risk too. If not tackled, it is a problem that will most likely never go away.

This page explains:

Why someone may begin hoarding

The reasons why someone begins hoarding 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 strongly held beliefs related to acquiring and discarding, such as:

"I may need this some day", which can be applied to a very wide range of items
"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 person hoarding often 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.

However, there is always a reason behind keeping these items. For example:

sentimental reasons
because the objects appear beautiful or useful
the items "may come in handy someday"
they may have stockpiled food or clothes "just in case"

Compulsive hoarding is associated with:

a family history of hoarding
the experience of deprivation
growing up in a cluttered home
another mental health condition, such as anxiety, depression or social phobia (a fear of social occasions)
struggling to cope with a stressful life event, such as the death of a loved one (bereavement)
lack of relationships with family or friends

Typical profile of someone who hoards

Someone who hoards may typically:

keep or collect items that are of no monetary value, such as junk mail and carrier bags, or items they intend to reuse or repair
find it hard to throw anything away and just move items from one pile to another
find it hard to categorise or organise items
have difficulties making decisions
struggle to manage everyday tasks such as cooking, cleaning and paying bills
become extremely attached to items, refusing to let anyone touch or borrow them
do 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.

It is estimated that around 2-5% of the UK adult population experiences symptoms of compulsive hoarding.

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 tripping and falling. 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 person hoarding is usually reluctant or unable to have visitors, or even allow tradesmen in to carry out essential repairs. People who hoard can be isolated and lonely and often experience anxiety and depression.

They may ignore the pleas of family and friends to get help, as they do not see it as a problem or cannot 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 hoarding

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 GP. This will not be easy, as someone who compulsively hoards may not think they need help and may not want to seek treatment.

Ask your GP 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.

If you have difficulties accessing therapy, the charity OCD-UK may be able to help.

Reassure your loved one or friend that nobody 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, local authorities may take legal action to ensure that the property is cleared if the problem is not addressed.

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

How compulsive hoarding is treated

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

The main treatment is cognitive behavioural therapy (CBT). 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 is important that the person takes responsibility for clearing the clutter from their home. The therapist will support and encourage this.

A type of antidepressant – selective serotonin reuptake inhibitors (SSRIs) – 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.

The National Institute for Health and Care Excellence (NICE) recommends that a period of cognitive behavioural therapy is considered for adults who have significant problems with hoarding.

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 have purchased to monitor incoming clutter.

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