Dr. Eddie offers advice to a weary reader, who has so filled her house with items that she has little room to live. He offers advice on how to overcome this difficult condition. 

Dr. Eddie,

I would like help with my house, which I began to fill with things when I was in my early 30s. I now have very little room to live. My kitchen is almost entirely full, so I use a mini-fridge and a toaster oven that I have wedged between piles of paper in the hallway. I eat my meals on a chair. At night, I move piles of papers from the bed onto that same chair so I can sleep. I buy items from charity shops and pick up any free newspapers I find. I plan to read them in the future, but of course I don’t.

I am deeply ashamed by the state of my house. I am not in a relationship and my sisters don’t visit me any more. I avoid gatherings and dating, despite being friendly and very lonely as I could not invite anyone to my house. A picture of my house would show furniture, papers, boxes and clothes piles from floor to ceiling. I would really appreciate any advice.

Mary

Dear Mary,

Hoarding is so hard and raises many different and complex emotions, including anxiety, shame and guilt. Psychologists have begun to think differently about hoarding, now defining it as a persistent difficulty discarding or parting with possessions because of a perceived need to save them. A person with hoarding experiences distress at the thought of getting rid of the items. Excessive accumulation of items, regardless of their actual value, occurs.

Hoarding often creates such cramped living conditions that homes may be filled to capacity, with only narrow pathways winding through stacks of clutter. Countertops, sinks, stoves, desks, stairways and virtually all other surfaces are usually piled with stuff. And when there's no more room inside, the clutter may spread to the garage, vehicles, yard and other storage facilities.

Hoarding can range from mild to severe

Hoarding ranges from mild to severe. In some cases, hoarding may not have much impact on your life, while in other cases it seriously affects your functioning on a daily basis.

People with hoarding may not see it as a problem, making treatment challenging. But intensive treatment can help people with hoarding understand how their beliefs and behaviors can be changed so that they can live safer, more enjoyable lives.

Symptoms

Getting and saving an excessive number of items, gradual build-up of clutter in living spaces and difficulty discarding things are usually the first signs of hoarding, which often surfaces during the teenage to early adult years. Problems with hoarding gradually develop over time and tend to be a private behavior. Often, significant clutter has developed by the time it reaches the attention of others.

Signs may include:

  • Excessively acquiring items that are not needed or for which there's no space.
  • Persistent difficulty throwing out or parting with your things, regardless of actual value.
  • Feeling a need to save these items, and being upset by the thought of discarding them.
  • Building up of clutter to the point where rooms become unusable.
  • Having a tendency toward indecisiveness, perfectionism, avoidance, procrastination, and problems with planning and organisation.

Excessive acquiring and refusing to discard items results in:

  • Disorganised piles or stacks of items, such as newspapers, clothes, paperwork, books or sentimental items.
  • Possessions that crowd and clutter your walking spaces and living areas and make the space unusable for the intended purpose, such as not being able to cook in the kitchen or use the bathroom to bathe.
  • Build-up of food or trash to unusually excessive, unsanitary levels.
  • Significant distress or problems functioning or keeping yourself and others safe in your home.
  • Conflict with others who try to reduce or remove clutter from your home.
  • Difficulty organising items, sometimes losing important things in the clutter.

People with hoarding disorder typically save items because:

  • They believe these items are unique or will be needed at some point in the future.
  • The items have important emotional significance — serving as a reminder of happier times or representing beloved people or pets.
  • They feel safer when surrounded by the things they save.
  • They don't want to waste anything.

Hoarding disorder is different from collecting. People who have collections, such as stamps or model cars, deliberately search out specific items, categorise them and carefully display their collections. Although collections can be large, they aren't usually cluttered and they don't cause the distress and impairments that are part of hoarding disorder.

Treatment

Presently, the treatment pathway is going to your GP and referral to community mental health services. Previously hoarding was seen a subtype of Obsessive Compulsive Disorder (OCD) but now is seen as a discrete problem. What we are also looking at is that for some individuals with hoarding, there may have been significant trauma in their lives, such that the "creation" of hoarding as a problem is to avoid the hurt of the original trauma.

Myth

A big clean out isn't always the best remedy for hoarding

Big clean-outs are often seen as the cure for hoarding, but in fact they can lead to further distress as the root cause and trauma and loss is not addressed.  

What we need when it comes to hoarding are regional teams that encompass health professionals, housing and compassionate declutterers working as a team. Unfortunately, at present they don’t exist but I believe that they would both make economic sense and more significantly, help individuals with hoarding issues to improve their quality of life.  

If you are affected by any of the issues raised in this article, you can contact; The Samaritans (phone 116123), or Pieta House (1800247247).