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DEAR DOCTOR: Our older sister has become a hoarder. The halls in her house are filling up with junk, and you can’t even get into her kitchen anymore. My brother and I worry she’s not safe. Why does a hoarding disorder happen? How do we help her?
DEAR READER: Hoarding disorder is a recognised diagnosis in the DSM-5 — the Diagnostic And Statistical Manual Of Mental Disorders, which is the authoritative guide to the diagnosis of mental disorders. People who are hoarders struggle to discard or part with possessions that others see as useless. They acquire and store vast amounts of stuff, which compromises the function and safety of their homes. When asked why, they will express the belief that the objects have either monetary or sentimental value, or that they may be useful in the future. While other people see accumulations of old newspapers, magazines, plastic bags, tools, broken furniture or household items as worthless junk, these things exert a powerful mental and emotional pull on the person who amassed them. You and your brother are correct that a hoarding disorder can pose a real risk to health and safety. There’s the danger of trips or falls. The inability to use a bathroom, bedroom or kitchen as intended interferes with both physical well-being and hygiene. Piles of stuff often block ventilation or heating ducts and obstruct windows and doors, which create safety and fire hazards. Cramped and chaotic conditions encourage dust, mould or mildew, as well as insect and rodent infestations. All of this can lead to structural damage to the home, and even pose a danger to neighbours.
There are psychological harms as well. People who hoard often live with a profound sense of shame. And as you are experiencing, hoarding affects the family as well. It can cause relationships to become strained or impaired, and for many people who hoard, the disorder leads to social isolation.
It’s important to understand that hoarding has nothing to do with being messy, lazy or indecisive. Instead, it’s a mental health disorder. People who hoard struggle to decide when to throw something away. When faced with discarding or giving away their possessions, they experience great distress and anxiety. Researchers have linked hoarding to obsessive-compulsive disorder, or OCD, and to depression and anxiety disorders. Scans of hoarders asked to divide mail into “keep” and “discard” piles have shown spikes of activity in the emotional centres of the brain.
When it comes to helping someone with a hoarding disorder, persuasion, logic or arguments don’t work. Neither does force. Instead, experts recommend beginning by clearly stating your concerns for the person’s health and safety. Most hoarders know that something is wrong, and that their living situations are both peculiar and dangerous. Then, provide avenues of assistance. Some people find help with cognitive behavioural therapy, in which the individual is guided to identify and understand their thinking patterns, and then focus on gradual change.
Individual therapy with a specialist in hoarding disorders can be helpful, as can group therapy, which allows the person to see they are not alone.
Dr Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health.