The impact of hoarding is far-reaching. It has the ability to touch aspects of human services, mental health, health care, housing, public health, protective services and public safety.
About 5 percent of children and adults nationwide are believed to meet the criteria for hoarding disorder.
As testament to the wide impact of the mental health disorder, more than 700 people attended “Too. Much. Stuff,” a free, day-long workshop Tuesday at City Bible Church to learn how to identify, assess and treat hoarding.
The workshop, which was co-sponsored by the Multnomah County Hoarding Task Force and Portland State University's School of Social Work, was offered primarily to human service workers, mental health professionals, home care workers, first responders and professionals from the fields of health care, public health, housing, inspectional services, animal welfare and legal services, but also attracted concerned family members, and people who themselves experience hoarding.
“A person holds on to the objects that they have, they view them to be of a lot of value and they actually have a lot of meaning to them. Sometimes their relationships with their things are more valuable than human relationships and so for family, friends, those that want to intervene the first thing to do is recognize that this is a mental health problem,” Portland State University assistant professor Christiana Bratiotis said. “We tend to focus really on the stuff, on the house… This is not a house problem, it’s a brain problem.”
Bratiotis, who teaches in the university’s School of Social Work and is also the author “The Hoarding Handbook: A Guide for Human Services Professional,” co-led the workshop with Jesse Edsell-Vetter, the Hoarding Intervention Coordinator for Metropolitan Boston Housing Partnership.
Bratiotis said hoarding is a mental health disorder defined as the excessive acquisition and failure to discard objects, actions that make living spaces so cluttered as to be unusable. Hoarding also results in significant distress or impairment, Bratiotis said.
Answering the question of why people hoard is complicated, Bratiotis said, because it involves the complex interplay of a number of factors including biology, neurobiology, genetics, thoughts, emotions and life experiences.
Collecting is not hoarding
She was careful to point out that hoarding is not synonymous with clutter and collecting. A home can be cluttered or disorganized because its occupants lack time to clean it, Bratiotis said. But they don’t have difficulty parting with the stuff inside.
Meanwhile, collectors are able to gather objects to display without having those possessions obstruct living areas.
“A lot of people are collectors. But collectors actually care about being able to display their items appropriately and take good care of their items,” Bratiotis said. “And often you can have an amassed amount of possessions without it having an interference in carrying out daily life activities.”
In cases of hoarding, piles or stacks of objects can prevent the use of countertops, bathtubs and even entire rooms.
“When someone can no longer sleep in their bed or shower in their shower...that’s when we start to be curious about whether this is something more than a collection,” Bratiotis said.
If left unaddressed, hoarding can lead to eviction, public health and safety threats and, in some cases, death. Still, Bratiotis said, well-meaning social workers, case managers and relatives should be careful when attempting to intervene in cases of hoarding.
Treat the brain, not the house
For instance, going in and cleaning out someone’s home without first addressing the underlying mental condition is not helpful and will likely only lead to the home filling up with stuff again, she said.
“Going in and shoveling things out is never a recommendation from those of us who do research and treatment in this field,” Bratiotis said. “Instead what we say is to work with the person to get them appropriate help from a mental health provider or a case manager, someone who can systematically work with them to slowly reduce the clutter in their home.”
Studies show that 60 percent to 70 percent of people who received cognitive behavioral therapy for a hoarding disorder on an outpatient basis became well-enough to live healthfully and safely in their homes, Bratiotis said.
She also suggested that family members who want to begin a conversation with a loved one about the disorder, first listen closely to how that person describes their items.
“Work hard to mirror that language. So if they call it things, you call it things. If they call it stuff, you call it stuff,” Bratiotis said. “This is a problem that is often very stigmatizing, demoralizing and shaming for the person with hoarding so not blaming, not calling names and certainly not calling objects trash or rubbish is important.”
Bratiotis is part of Multnomah County Hoarding Task Force, which was created nearly two years ago as it became increasingly clear that there was both a need and desire to assist people who experience hoarding.
The task force builds and maintains a community network of trained professionals who provide information, access to resources and consultation about hoarding. Furthering the group’s work is a priority for the county, Department of Human Services Director Liesl Wendt said.
“It’s the goal to ensure that people with hoarding tendencies interact with well-trained, respectful and compassionate professionals who are driven by ensuring dignity for all,” Wendt said. “The challenge now is how do we take that work at a task force level to action.”
Tips on Hoarding
Hoarding is not synonymous with filthy homes and dirty people. The term hoarding refers to the volume of clutter or quantity of objects in a given space. It does not refer to cleanliness. Instead, the term squalor describes filth or the ruin of a space due to neglect. It is possible, and in fact quite common, to have an environment that is filled with clutter but is relatively clean.
Hoarding disorder is a mental illness recognized by the American Psychiatric Association. People who hoard express shame, sadness, guilt, remorse, and embarrassment at how their illness negatively impacts their lives and those they love.
There is no scientific evidence to suggest that deprivation or trauma alone cause hoarding. Hoarding is a complex problem with many factors contributing to the onset and course of the illness, including genetic predisposition, neurobiological factors, difficulties with cognitive processing, problematic thinking, and strong emotions.
Research suggests that hoarding occurs at similar levels in many industrialized countries throughout the world. Clinical treatment and research is taking place in countries such as the United Kingdom, Germany, Italy and Australia. It is still unclear how common hoarding is in developing nations.
A large scale, one-time clean-out of a hoarded home will mostly likely result in feelings of helplessness, violation, and resentment that may lead to further hoarding behavior or serious mental health problems. Instead, the best way to help a person with hoarding disorder is through slow, systematic exposure to sorting and discarding possessions and resisting the acquisition of new items.
