At christmas most of us will get a hoard of gifts, wanted and unwanted, gift-wrapped. The wrapping is thrown away, and some of the gifts are too. We absorb this into our lives and, by January, everything is back to normal. Imagine, however, that you simply cannot get rid of any of it. Not only the unwanted presents, but the wrapping paper and the packing and the Christmas cards and the crackers and the pre-Christmas advertising and the sales leaflets. Nothing. And that that has been happening to you for 20 years, and not just at Christmas, but all year round. So now, your house is full to the ceiling. This is hoarding and it destroys lives.
When George* first attended for therapy, we were struck by the number of bags he had brought with him. George talked about bringing things with him “just in case” he might need them, and acquiring things wherever he went. George talked about the shame he felt because of his problem with hoarding and told us that he rarely invited anyone into his home.
Yet hoarding is far from rare. Recent studies of hoarding suggest that between 2% and 5% of the population is affected. It can therefore be estimated that over 114,000 people in the Republic of Ireland experience a problem with hoarding. Acquiring and saving possessions is a widespread human behaviour and is largely considered an acceptable aspect of human life. So when does acquiring and difficulty parting with possessions become a problem?
The attachments to possessions formed by people who have a problem with hoarding are not very different from the attachments all of us form to our possessions. We all keep things we believe we will need. For people who hoard, however, the attachments they form to their things interfere with their ability to live, and they attach value to a much wider range of possessions. People who hoard have such difficulty throwing away possessions, regardless of their value, that their living spaces become cluttered, eventually to the extent that their ability to use their living or work space is disrupted. They can’t have a bath because, even if they can get to it over the boxes, the bath is full of shoes. They can’t eat at the kitchen table because it is piled high with books and clothes.
For some people, the problem comes when the value they see in their things is unaffected by the trouble the clutter causes them. As well as holding onto possessions, people who hoard often acquire new items despite a lack of necessity or space.
There is usually a theme to someone’s hoarding, such as the comfort or safety provided by objects, or a fear of waste or fear of regret that something needed in the future will be thrown out. Sometimes possessions help people to feel connected to someone they have lost. For George, he felt it would be irresponsible to throw things out. He was also concerned that he did not discard anything which might potentially have some use in the future. This meant that he would hold onto worn out cooking equipment, old catalogues, newspapers, and clothes that he had not worn.
Hoarding often begins in mid-adolescence and can become increasingly severe over time. It is still unclear why compulsive hoarding develops. Some studies have linked traumatic life events, bereavements and loss to the development and intensification of problematic hoarding.
Hoarding is a debilitating condition, which can have a significant impact on the sufferer, their family and the community. Sufferers often experience depression as a result of the impact of this difficulty on their daily lives. Those affected often report loneliness and social isolation due to being too embarrassed to have visitors. Hoarding brings with it a terrible stigma and is often carried on in secret. While there has been an increased awareness of hoarding in recent times with various TV programmes about hoarding, this has been a largely sensationalist approach. In reality, hoarding is a complex and often, long-term condition with which people struggle, and which requires effecitve treatment.
Psychological interventions, such as a specially modified version Cognitive Behaviour Therapy, have shown promise in the treatment of hoarding. When George attended therapy for his hoarding difficulites, sessions took place both in the therapist’s office and, perhaps more importantly, in his home. By the end of therapy, George had a better understanding of his difficulty and began to tolerate the discomfort he experienced while reducing his acquiring and saving behaviours. George could eventually use the rooms in his home for the purposes they were intended; he could eventually cook in his kitchen.
There is a relative lack of treatment options in Ireland for hoarding at present, perhaps in part because it is newly-recognised. Current research aims to develop a better understanding of the problem and to develop better treatment.
Leading expert Professor Paul Salkovskis from the University of Bath, working with Dr Olivia Gordon from St John of God Hospital, Dublin, says: “Any attempt to help people with hoarding problems must begin with understanding and care rather than diagnosis and pressure. People with hoarding problems are stuck or trapped in terms of how they live; we should first try to see the person who has been overwhelmed by their possessions rather than the possessions themselves, and to help that person find a way out of a situation when they are overwhelmed and engulfed by what they own.”
Dr Olivia Gordon is a Senior Clinical Psychologist, with St John of God Out – Patient Psychological Services, Dublin (277 1440). For information see www.sjoghosp.ie. For more information about research currently being undertaken visit the University of Bath or @Hoarding_Bath.
*George is an amalgamation of a number of individuals we have worked with, highlighting common issues in hoarding