WHAT I LEARNED ABOUT HOARDING DISORDER THIS WEEK:

I learned that people with a hoarding disorder often do not, cannot, see the same things in their homes as someone who is visiting them. Their brains distort how the mess in their homes is perceived. If you show them a picture of the inside of their homes, they often do not recognize it as theirs, but if you take them to visit another hoarders home they are appalled.  Hoarding, as we are finding with many other brain disorders, is an integrated dysfunction: it is genetic, brain-based, and nurture based at the same time. In a culture of acquisition like this one, it can become very common and is reinforced.

Hoarders’ brains make it difficult to impossible for them to evaluate comparative worth of one thing from another.  A theme in treatment for hoarders is to try to teach them to make “quick and imperfect” decisions.

Hoarding is not OCD, although it is related. OCD is ego-dystonic, which means it brings no pleasure. Hoarding is ego-syntonic, in that it does bring pleasure. Hoarders have difficulty with jobs and with relationships for some of these related reasons: they are often unable to act as if a relationship (with friends, significant others, children) is more or less valuable than things. They are unable to recognize how their behavior devalues relationships or makes relationships equal to things. They have difficulty with prioritizing decision-making and the idea of perfectionism is a theme in how they approach day-to-day decisions. Hoarders and their hoarding very often come to the attention of authorities through Child Protective Services.

Hoarders often believe that their immense stash is valuable beyond measure and, even if they die suddenly, leaving family in charge of the clean up, they will be forever lauded because of the value of what they have left behind. The truth is that the cost of cleaning up after a hoarder has died costs families between 30,000 and 50,000 dollars.

Confrontation doesn’t work as an approach, mostly due to the manner in which the brain accommodates or produces the need to collect and store things and the inability to measure worth and discard what is unworthy. Neither does purging or forced clean up directed by a concerned friend or family, although there is often a need to do just that. Forced clean ups and purges often reinforce the need to collect and increase the frequency and amount of collection.

Hoarding at various levels occurs in up to 1 out of every twenty to one out of every fifty individuals and is more prevalent in men than in women.

Approaches, Ideas and Guidelines:

·      Cut off all paper flow

·      Steady throwing away daily

·      Throw away pieces if you can’t throw away entire objects

·      Foul the trash (to avoid retrieving)

·      Involve Family Members

·      Seek assistance to help develop guidelines for keeping vs tossing

Themes for Hoarding Behavior Change :

·      Do you want to build a legacy of trash?

·      Everything goes to the dumpster eventually

·      Build relationships with people… not things

·      Things are here to serve us, not the other way around

·      “How does this item add to my life?”

-- taken in part from  “Identifying and treating Hoarding Behaviors”

Laura M. Lokers LCSW

University of Michigan Dept. of Psychiatry

Suggested Reading: ”Stuff” R. Frost and G. Steketee. (good for both clinicians and as self help)