Hoarding: When Collecting Goes Bad

Karen Kent, Evergreen Healthcare

Hoarding behavior spans a continuum from normal collecting to pathological disorders. The behavior is normally well-established by early adulthood, but often doesn't come to the attention of community agencies until the person is older.

The difference between collecting and hoarding occurs when the items collected interfere with normal daily functioning, lead to an unsafe living environment, or are considered a public hazard.

A quick way to determine if you are a hoarder is to see if people around you make negative comments about your home. Other signs of hoarding would include:

• You are no longer able to use your kitchen or bathroom because of piled up items or you have to use a pathway to get around the house or apartment.
• You have rats or cockroaches because of large amounts of spoiled or outdated food.
• You are at risk of falling because you have to step over items to get places or your staircase is cluttered with items.

The common traits of most hoarders include limited insight into the problem and the inability to resist collecting. It is very, very hard to stop the behavior without assistance from others. Most hoarders are very anxious about discarding even a single item. Most hoarders don't ask for help in cleaning up because they may have an emotional attachment to the items. They feel safer or comforted surrounded by the items. Hoarders rarely clean up their environments unless forced to do so by others. 

Here is a quote by an 85-year old man who was forced to clean up in order to avoid eviction: "The emptiness is a little hard to get used to. For one thing, the traffic noise is very loud now. And I feel hollow. My junk was sort of a freedom. I put so much work into saving—years and years- and it's suddenly gone.  It's like somebody had died, a fire or an earthquake had happened. It's like the change from hot to cold."

The most important way to help hoarders is to make sure they are safe. Fire is a big hazard with hoarding. Remove items from stoves and heating elements. Avoid the use of candles. If the person is a smoker, provide a very large ashtray and move items two feet from the chair the smoker sits in. Throw away spoiled food. If there is evidence of rats, the Public Health Department can get involved. The Department of Planning and Development will get involved with clutter outside the house or if the building is unsafe. The local fire station can get involved when there are shared walls of apartments or condominiums. A referral to Adult Protective Services should be made with vulnerable older adults who self-neglect.

Hoarders must tackle three things: getting rid of the items, living well without the items, and avoiding re-collecting. The primary way to stop hoarding is for the individual to change their thoughts toward the items. For example, from "I may need this item someday" to "If I need this item someday, I can purchase it then."  To change the behavior, we each need a coach who reminds us to relax and breathe deeply and helps us make decisions about each item. The coach needs to be kind and patient, because the clean-up process is very slow. Begin with the most bothersome room and start with only 6 inches. Keep small goals but work consistently. Have three boxes or bags labeled: keep, recycle, donate. To keep the space clean, invite people over regularly, have a coach check on you monthly, give a bag of items to a charity pick-up monthly.  It is extremely important not to expect a hoarder to do a complete clean-up in a month.  Even working 30 minutes a day cleaning up, it will take months to have a fully clean environment with a place for every item.

Karen Kent is a Clinical Supervisor for the Geriatric Regional Assessment Team, Evergreen Healthcare and is a member of the Mayor's Council on African American Elders.