When hoarding becomes a health problem and how to talk about it

Hoarding disorder doesn’t discriminate and can affect anyone – no matter their age, gender or financial situation. In fact, about two in every 100 people in the general population meet the criteria for the disorder.

Far more than just being untidy or collecting things, hoarding is a compulsive desire to hold on to things that may or may not have value – and the volume can get out of control, sometimes taking over people’s homes entirely.

Professor Jessica Grisham, of UNSW Science, has more than 17 years’ experience researching and treating obsessive-compulsive disorder (OCD) and OC spectrum disorders, such as hoarding.

Prof. Grisham has shared her expertise to help people avoid tension with family members who may be struggling with hoarding disorder. She urged them to remember that, although a house stuffed with things may be frustrating, hoarding is a mental health issue.


“It has been an uphill battle to shift people’s perceptions of hoarding, but we have made some progress through identifying it as a psychological disorder in the most recent DSM-5 (Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition),” she says.

“It’s a myth that people who hoard are just lazy or messy. Hoarding disorder is a treatable mental health condition and we need to make the public aware of that and remove the stigma. People with hoarding problems are much less likely to seek treatment if they feel ashamed.”

And it’s not just a messy house that comes with a hoarding disorder, it also poses considerable health and safety risks to the people living in the house and the wider community.

“A Melbourne study in 2009 showed hoarding fire incidents accounted for only 0.25 per cent of all residential fires but 24 per cent of preventable fire fatalities during the same period,” says Prof. Grisham.

“And NSW Fire and Rescue states that 12 per cent of all fire fatalities in NSW are people reportedly living in hoarding and squalor conditions. These tragedies show just how acute the issue is.”

What is hoarding?

Hoarding is the excessive accumulation of items and an inability to let them go, even those with little or no value. The accumulation is often so great that rooms can’t be used for their designed purpose, and the symptoms frequently affect other areas of life such as health, work and relationships.

Those with the disorder are typically stereotyped as unclean or lazy but it goes beyond that, the deeply ingrained attachment to possessions may have its roots in a traumatic event. For example, someone may keep the contents of a wardrobe after the death of a loved one because the items remind them of the past and make them feel secure. Often those with a hoarding disorder don’t know why they are so attached to certain items, but they know that they will feel a great loss if those things are removed.

This is why the disorder needs to be tackled slowly and with great empathy; evictions or forced clearances can be traumatising for the person.

How is hoarding different to having a messy house?

The majority of us probably have a few extra items around the house that we don’t need, but that doesn’t equate to a hoarding disorder.

“The official psychiatric diagnosis is defined in the DSM-5 as a persistent difficulty discarding or parting with possessions, regardless of actual value, that leads to a perceived need to save the items and significant distress associated with no longer having them,” says Prof. Grisham.

“So, a person who hoards is excessively attached to their belongings and this prevents them from discarding those items, leading to a huge amount of clutter in their homes – to the point where they are unable to live or function in the way other people do.”

There are also levels within the hoarding disorder diagnosis. It’s possible for people to reach a certain level of hoarding and not take it any further. As long as the house isn’t a fire hazard and their standard of living isn’t significantly affected; for example, if they are still inviting people in and can access all rooms, windows and doors, it’s okay. But it’s when those things start to slip away that it becomes a bigger issue.

“Many people relate to having a disorganised space or a bit of extra clutter, but they are otherwise able to function properly in their home and would be happy to have the mess tidied up and the rubbish thrown out,” says Prof. Grisham.

“The difference with someone who has a hoarding problem, however, is their extreme emotional attachment to things – they would feel very upset or threatened if anyone tidied up, cleaned or removed their objects.”

Preventing or discouraging hoarding

Helping someone with their hoarding problem is extremely challenging. Prof. Grisham offered some things to keep in mind.

1. Never discard possessions without their permission. Massive clean-ups cause huge distress to the person and they generally will start hoarding again if everything is forcibly removed.

2. Many people with hoarding problems are unmotivated or ambivalent about seeking treatment and some lack insight into their situation.

3. Emerging treatment programs encourage relatives to start a conversation with the person who is hoarding about minimising health and safety risks linked to their habits. Safety is an important goal of intervention as achieving a perfectly clean house might be impossible. For example, bring attention to fire hazards, blocked toilets or covered electrical outlets.

4. Minimise and discourage friends and family who may be accommodating or enabling the problem. People can often try to prevent distress by driving the person to a garage sale or dropping off unwanted things instead of taking them to an op shop.

5. People who hoard often have co-existing physical and/or mental health problems – for example, physical disability, chronic fatigue, arthritis, obesity, depression or anxiety. This is where evidence-based treatment programs can help to address these challenges in conjunction with the hoarding problem.

How to seek professional intervention

If you suspect someone has a hoarding disorder and want to get them help. It might be best to first start a conversation about how the clutter is affecting them and find out how they feel about getting help.

“Ask the person about how the clutter is affecting their life and reassure them that you are not going to ask them to do anything initially, but that you think their excessive collecting and saving might be causing them some challenges. Ask if they would be open to considering possible ideas,” says Prof. Grisham.

“It may help to debunk the myth that the person will be immediately forced into a big clean-out if they seek help, while bringing up the topic of how their clutter is impacting them to warm them up to the idea of getting help.”

If they agree to seek treatment, you could then suggest that they ask their GP to refer them to a specialist hoarding treatment provider.

Do you suspect someone you’re close to has a hoarding disorder? What are the most treasured possessions in your house?

Also read: What is agoraphobia and how is it treated?

Ellie Baxter
Ellie Baxter
Writer and editor with interests in travel, health, wellbeing and food. Has knowledge of marketing psychology, social media management and is a keen observer and commentator on issues facing older Australians.
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