Compulsive hoarding has attracted a great deal of media attention. These media portrayals, whether they are television, newspaper, or other illustrations of the problem, tend to be somewhat unidimensional. Yes, these individuals’ homes are frequently difficult to navigate, and, yes, these individuals appear to be excessively attached to items that many of us view as of very little or no value. However, these snapshots into the lives of these individuals sometimes lack the depth of difficulty these individuals have in their lives.
Let’s look at a few of the challenges that are often under-conveyed, but that are very real, very significant challenges to individuals, their family members, and to us, as psychologists who treat them.
- Interpersonal Difficulties. Hoarding behavior frequently leads to social isolation in individuals who reside alone. They tend to keep to themselves and do not have guests in their homes. This can lead to problems with depression, loneliness, and further difficulties. Adult children often have strained relationships with a parent who hoards, as the stress of the situation causes significant conflicts.
For those who do not live alone, this behavior is frequently a significant strain on a marriage and on relationships between the individual and his/her children. Feelings of anger, resentment, sadness, embarrassment, and frustration are commonly reported by such family members.
- Co-Occurring Psychopathology. These individuals frequently have co-occurring psychopathology which poses an added challenge to their treatment and to improving their living conditions. For example, 60% of these individuals meet criteria for major depressive disorder. Other conditions that commonly co-occur include social phobia (30%), generalized anxiety disorder (25%), and obsessive compulsive disorder (15%-17%). These problems also need to be identified and treated.
- Perfectionism and other Erroneous Beliefs. Compulsive hoarders frequently have thoughts, beliefs, and values that are maladaptive and contribute to the maintenance of the problem. For example, an individual may believe that they must clean and organize their kitchen perfectly. They then get overwhelmed by this expectation and do not approach the task at all because they believe they will not do it perfectly. By avoiding the task, they avoid experiencing those unpleasant, anxious, overwhelmed feelings, but the clutter continues (negative reinforcement). These engrained patterns of thinking need to be identified, challenged, and replaced with more adaptive thoughts, a major goal in therapy.
- Insight and Desire to Change. Many individuals are considered to have poor insight and are resistant to change; however, this is often misunderstood. These individuals typically know there is a problem and they experience a great deal of anxiety about failed efforts or desires to change, but their anxiety can be so significant that it is paralyzing.
Many of these individuals have made efforts to change their environment. They do not have guests in their come, as they know that their home would not be met with approval, yet their tendency toward over-valuing of their belongings, fear of losing their belongings, as well as many other associated worries leads them to emotionally shut down and reject assistance, leaving them prisoners in their own homes.
Contrary to some beliefs, individuals who hoard are not simply “lazy.” Their difficulties are complex. It is only with compassion, understanding, and dedication that we may help these individuals improve their homes and their lives.
Lead photo available at 123RF