Saturday, October 19, 2013

Hoarding Disorder, part 1

I promised an overview of the “new” DSM 5 disorder, which has just come out from under the umbrella of a mere OCD symptom. There is a connection between the two disorders - about 25-30% of people with OCD are also compulsive hoarders. But while hoarding can be a part of the anxious, defensive rituals associated with obsessive compulsive traits, it also affects other people, about 2-5% of the general population. Compulsive hoarding can be fully as harmful as any other mental disorder, destroying relationships, safety and health, ability to work, function and socialize, and more.  One informal definition I ran into was, “When your stuff no longer serves you - instead you live to serve your stuff.”

Some of us can relate to that definition, and some of us might joke that it is a favorite American pastime! But what does it take, under the new DSM 5, to qualify as needing treatment? There are six criteria, and all of them must be met to earn the diagnosis of Hoarding Disorder proper.

The first is trouble discarding things regardless of their value. They may actually be valuable, or the person may just ‘see’ them as valuable. Secondly, the patient feels a strong need to save these things and will experience considerable distress at the threat of getting rid of them. Thirdly, the result is a clutter of possessions that congest living areas to the point of interfering with using those areas (or even using the things being saved for whatever their intended purpose). Any areas still free in this scenario are due only to the intervention of someone else. Fourthly, and here is where we really get to it, this clogging has reached the point of causing serious distress or impairment, say in social or work life or in safety or health (for instance, a person no longer invites people in, even just to the front hall, and their house is a serious fire hazard). Fifthly, an important proviso is that this behavior must not be a side effect of another medical condition such as brain injury; and sixthly it must also not be better explained by another mental illness (the hopeless lack of energy in Depression, for instance, or a Schizophrenic delusion). The doctor may also specify if the condition is accompanied by a tendency to excessively acquire new items even though there is no need or no space; and there is a specifier for how much insight a person has into their problem, from “good or fair” to “absent.”

So what can be done about this condition? Many normal people have small caches or collections in their homes (or perhaps at work), from the drawer full of junk, to the desk full of paperwork that never gets cleared, to decades of junk in the attic. Well, the answer depends on how much insight the person has, first of all. Interventions in which relatives or authorities clear the space without permission not only cause the patient quite a lot of pain and distress, but he or she usually builds the collection right back to where it was before, sometimes within as little as 3 months. Conventional treatment, if the person is willing, generally consists of psychotherapy, particularly an extended series of Cognitive Behavioral Therapy sessions, and sometimes medicines such as anti-depressants. The figures for success of such treatments are not very impressive, however. If you want to know more about causes and treatment, a good place to look is

There are a handful of Yahoo groups for hoarders who are working on their behavior, such as “Messiness and Hoarding” and “Declutter Support.” It has also been noted that hoarding tends to be a family disease - 50% of hoarders have at least one first degree relative with the same condition. Sometimes the children of hoarders may not really have the full disorder but need basic training in how to sort through and discard things, which can be very daunting after years of not doing so (There is also a Yahoo group called “Children of Hoarders,” as well as “Friends & Family of Hoarders and Clutterers” and “Friends of Hoarders”).

For those who’d like to change, I discovered a UK site called Cluttergone which not only offers information , decluttering services and self-tests, but has a wonderful and hopeful blog of a woman who took a year-long journey and rediscovered her own home under all her things (In her case, the impetus for hoarding seems to have been a long disability followed by clinical depression. The role of trauma in hoarding is being researched, as well as possible genetic connections). Though it’s 40 entries long, I recommend reading it for the wonderful sense of hope it imparts and for the practical tips on how to get started clearing out the clogs.  It’s here: The Cluttergone general site also has a list of which books on the topics of decluttering, reorganizing and understanding this disorder are worth your time; you can find that here:

In my next blog, I’ll give some tips on how to get started on your own decluttering project, plus a fictional piece I’ve written on the topic.

Deborah is the author of Is There Room for Me, Too? 12 Steps & 12 Strategies for Coping with Mental Illness, available at Amazon and other major vendors. Visit her web page at, or see her catalog at