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Honoring Hoarding Disorder


It wasn’t a fire, actually. The newspapers, stacked tightly, had been shoved against a floor furnace. They didn’t burn; they smoldered. Cause of death: smoke inhalation.

This shouldn’t have happened. Friends and family had loved the dear woman who suffered. Many knew of her hoarding but didn’t know what to say or how to help. This event was the beginning of my journey to learn about hoarding disorder so that I could assist those who struggle and those who want to help.

The above story focuses on the stuff that can collect and take over a house, making rooms uninhabitable and health and safety compromised. However, recognize that hoarding is far more complex than this. Although pack rats have been recognized for decades, understanding the process of hoarding has been studied and researched only since the early 1990s. This led to Hoarding Disorder being added as a new diagnosis in the DSM 5, the most current manual of mental health disorders.

Hoarding Disorder defines the struggle that a person has relative to possessions. The need to save and the inability to discard results in extreme clutter which inhibits use of space and impairs functioning. Although much of the stuff seems useless to others, to the person who owns the possessions, each piece has importance. Many of us save items to which we are sentimentally attached or which we see as valuable or available to be reused or repurposed. Those who hoard can take these values to the extreme.

Organization and decision-making are a struggle. One person may be concerned about how to categorize objects so will dither about the decisions. Others may have a need to have items in sight instead of stored so that they are aware of what they have. Many have no room to store because the spaces are filled with items that they cannot access. These obstacles interfere with the process of organization and elimination.

Those who hoard may or may not have insight. Even with insight, the ability to limit acquisition of items and to initiate and manage the decluttering can be overwhelming. Many people who hoard also struggle with comorbid health and/or mental health disorders. Depression and anxiety are the most common co-occurring mental health conditions. Those who have the comorbid health and mental health problems are more apt to lack motivation for change and resist assistance or intervention. It is critical to address these issues, as well as cognition and behavior, in order to declutter and organize.

Those who hoard and clutter have vulnerabilities that influence cognition and behavior. Brain functioning and life experiences intensify the problems with object-person fusion. Research has identified genetic markers and neurobiological structures that predispose someone to hoard. Some people who hoard have great difficulty with attention and problem solving. Others may have learned from family about saving and repurposing. Still others may have suffered trauma and/or multiple losses with “stuff” providing comfort and protection. Although there are patterns of cognition and behavior among those who hoard, each person’s story is unique.

The person who has decided to address his/her own excess clutter will work on a plan focused on decision-making and discarding. I encourage each person to avoid guilt-related verbs when choosing their tasks. Examples of those are when we will say, “I need to, want to, should, or have to” do something. I encourage people to say, “What can I do? What will I do?” It is important to stay within those parameters. It is also helpful to have a list of tips to say to yourself when facing the stuff.

It can be very helpful to have an assistant or “coach” partner with you as you process the stuff. This person must be supportive, non-judgmental and respectful. The person who has the possessions is in charge of the decluttering process. The coach assists with focus, cheers and hauling. The coach must remember the following:

  • This is an emotional journey for the person who hoards.
  • Allow expression of feelings without judgment or criticism.
  • Do not take over decisions or move items without permission.
  • Allow disagreement.
  • Avoid argument.
  • Celebrate successes.

Those who hoard and clutter and who are open to support and assistance respond well to a variety of interventions. Cognitive Behavioral Therapy with an emphasis on hoarding is helpful. Psychotherapy for co-existing mental health disorders is imperative. Community education, support groups, individual peer support and psychoeducational groups increase awareness and reduce stigma.

Decision-Making Questions

When you’re about to begin organizing a large amount of stuff, ask yourself or your loved one these questions in order to make the decision process easier.

  • What is the worst that could happen to me without this item?
  • What are other sources for this information or item?
  • What do others do with similar items?
  • Do I have time to actually use, review or read this?
  • Do I have a specific plan to use this item within a reasonable time frame?
  • Does this seem important just because I am looking at it now?
  • Do I have enough space for this?
  • Will not having this help me solve my hoarding problem?

Clutter Cleaners Club

Individuals who struggle with hoarding and cluttering are encouraged to attend the Clutter Cleaners Club. This group meets the third Wednesday of each month from 2:30 to 4 p.m. at the Central Plains Area Agency on Aging in the Ronald Reagan Building, located at 271 W. Third St. North, Suite 500, Wichita.

Nancy Trout is a licensed specialist clinical social worker at Prairie View’s Legacy Park office in east Wichita. She is a hoarding specialist and regularly speaks at various educational events and conferences in the south central Kansas area.