People who walk into a home inhabited by hoarders often have one overwhelming urge – clean out the house and remove the excess possessions. In the past, this was the main “treatment” for hoarding. Crews would come into the home, remove everything in it and give the hoarder a fresh start. Unfortunately, the conditions that brought the hoarding about were still present. This meant that the hoarder often began collecting once more, and months or years later, the home was once again stuffed to the gills.
Thankfully, researchers have spent years looking closely at hoarding and determining what sorts of therapies work and what sorts do not. Experts now agree that hiring a crew to clean out the house in one day is not the way to cure a hoarding disorder. But alternate therapies can vary quite a bit, depending on the therapist and the needs of the hoarder.
Many people have large collections that they tend to with loving care. Closets full of shoes or china cupboards full of antiques don’t necessarily point to hoarding. People who hoard have a collecting urge that’s been allowed to run wild. According to an article published in Psychiatry Online, people who hoard tend to fall into one of two categories: those who collect out of fear and those who collect out of nostalgia.
Hoarders who operate on fear remain convinced that everything they touch may be needed again one day. They cannot discard a broken appliance, for example, as they are certain the parts in the old appliance will help repair later versions. They cannot discard boxes, in case they need to ship something. They cannot throw out duplicate books, in case the first one goes missing. Hoarders who operate on nostalgia cannot throw out items because they remind them of someone they have lost. Clothing of the deceased is too precious to give away. Albums that person might have liked are treasures. Dishes the person used remain important parts of the collection.
People who hoard tend to make mountains and piles of possessions, and these piles may have no organizational background whatsoever. Important items are mixed with unimportant items. Old items mesh with new. The person might move items from pile to pile, but rarely does the person throw anything away. Even when the person can no longer walk about freely, the person might still feel compelled to hoard.
People who hoard may not be able to see the compulsion for what it is, and they may never ask for help on their own. While confronting a hoarder may not be easy, it’s often the first step toward healing. Asking open-ended questions that force the hoarder to think about the behavior might be the best way to bring the hoarding into sharp focus. Good questions include:
Questions to Ask
- How do these possessions fit in with your goals in your life?
- Does the condition of your home help you maintain your friendships?
- What would you like to do about the clutter in this house?
- What do you think your home will look like in five years? Ten years?
The Role of Medication
According to an article published in the Journal of Clinical Psychiatry, people who hoard sometimes have obsessive-compulsive disorder. Other people who hoard do not. Of the 190 people studied, 20 were defined as having a pure form of hoarding disorder that was not related to obsessive compulsive disorder. This study, and others like it, becomes quite important in the context of medication management for hoarding.
In study after study, some people who take medications for hoarding improve while others did not. According to an article published by the Mayo Clinic, some people who hoard see improvements when they take medications such as Paxil. But the Mayo Clinic is quick to point out that these medications don’t work for everyone who hoards. Almost all research on the topic mentions this same fact. It’s possible that people who have hoarding in response to obsessive-compulsive disorder respond to the medications, and those who have a pure form of hoarding don’t respond as well. In a separate article published in the Journal of Clinical Psychiatry, about half of people saw improvement in their obsessive-compulsive symptoms when they took medications, but people who were very compulsive about hoarding tended to do less well on medication therapies. It’s possible that one group of hoarders needs a separate sort of medication that hasn’t yet been developed.
In most cases, however, people with a hoarding disorder are given medications to help ease their symptoms. At this point, it’s too difficult for experts to separate those who would benefit from those who would not, so it’s best to give the medication to all parties to be on the safe side.
Cognitive Behavior Therapies
This form of talk therapy is often considered the cornerstone of treatment for any sort of addictive disorder. The hoarder needs to get to the bottom of why he or she is hoarding, and come up with strategies he or she can use to keep the hoarding addiction from taking over. The hoarder and the therapist meet in one-on-one sessions and discuss negative thoughts and irrational beliefs. According to an article published by the Lippincott Nursing Center, patients who use statements such as, “I can’t live without these things” might be encouraged to break that sentence down. Would life truly end without this item? Why not? If patients hoard because they have a deep-seated fear of criticism, that fear is slowly exposed and examined. Perhaps when these old hurts are healed, the hoarding behaviors will also cease.
While cognitive behavior therapies have been useful for some people who hoard, not everyone heals with this method, either. In fact, according to a study published in the Expert Review of Neuropathics, cognitive behavioral therapies used alone have “fared badly” when it comes to hoarding behaviors. This makes sense, as the hoarder could simply emerge from the therapy sessions and return to a house full of clutter. Nothing truly dramatic has happened to force a behavior change.
Forcing a Change
Therapists now believe that one of the best ways to help someone with a hoarding problem is to put that person through a form of coaching. Through this process, the person clears out the clutter in the home, and learns how to sort items and make good decisions about what to keep and discard. In other words, the person is forced to make a series of tiny decisions about possessions, and do the hard work to clear up the piles of items that have accumulated.
There are several rules the hoarder must follow in this method:
Rules to Follow
- The person must pick up the first item that comes to hand at the top of the pile. No sorting of clutter is allowed.
- The person must make a decision about that item.
- If the person chooses to discard the item, it must be discarded immediately.
- If the person chooses to keep the item, the person must immediately decide where it will be stored.
Often, this is a slow process. The therapist visits the hoarder’s home regularly and stands by as the sorting occurs. The therapist might remind the person that discarding items is the goal, and the therapist might coach the patient about what to keep and what to discard.
Some therapists don’t have the ability to travel to the hoarder’s home, and this therapy can be slightly modified to help those therapists reach their patients. In these scenarios, the hoarder is given a bin to fill before each session, and the sorting occurs in the therapist’s office. Once again, the hoarder isn’t allowed to sort the bin before the appointment. He or she simply picks the biggest pile and dumps it in the bin.
In addition to this sorting, the hoarder learns what to do with new items that enter the home. Perhaps the hoarder is given a mail inbox, and is told to read, sort and discard the mail each day. Perhaps the hoarder is given a small area for garbage, and told to take the trash out each day. To fill up the time the person used to spend on hoarding, the therapist might recommend an exercise routine or volunteer work. This allows the hoarder to enter society once more and feel a sense of accomplishment that isn’t tied to possessions.
This sort of therapy might sound basic or even a bit obvious, but it is truly revolutionary in the world of hoarding. By forcing the person to learn new habits, in his or her own house, the therapist is giving the hoarder a set of real-world tools and allowing the hoarder to practice using those tools. According to a study published in the journal Behavioral and Cognitive Psychotherapy, people who participated in this sort of therapy for 20 weeks showed improvement in hoarding, although people who participated for a year did even better. Progress might be slow, but it’s clear that this therapy does allow people to make progress.