Hoarding Disorder: More Than Just Too Much Junk

22-01 Hoarding Disorder: More Than Just Too Much Junk

[00:00:00] Reed Pence: This is Radio Health Journal. I'm Reed Pence. This week: Hoarding disorder and why it's not as simple as just throwing all that stuff out.

[00:00:08] Elaine Birchall: You can put someone into a psychotic break by going in and doing a clean up behind their back, and I have seen that happen.

[00:00:17] Reed Pence: The overwhelmed hoarder, when Radio Health Journal returns...

[00:00:25] Reed Pence: The gifts have been unwrapped and taken home. For some of us, we may have a little trouble finding space in the dresser drawer for that new sweater, or a place on the counter for that new smart speaker. But around 5% of Americans take gifts to a whole nother level. Their Christmas presents may be stacked in a huge pile, along with far more unopened boxes that reach to the ceiling, cluttering up entire rooms. But those who don't get inside the door, even some relatives, may never know.

[00:00:54] Dr. Carolyn Rodriguez: People with hoarding disorder are really embarrassed about the items in their home. And they don't have people over.

[00:01:01] Reed Pence: Dr. Carolyn Rodriguez is Associate Professor of Psychiatry and Behavioral Sciences and Associate Dean for Academic Affairs at the Stanford University School of Medicine.

[00:01:10] Dr. Carolyn Rodriguez: Individuals with hoarding disorder, what's notable about them is a level of disorganization. So things that belong in the garage are in the kitchen and the kitchen or in the bathroom. And the sheer volume of things make it so that you really can't move around in the living spaces. I was speaking to a firefighter the other day, who had lost one of his colleagues, because it's a big problem when people with hoarding disorder put items in their stove or store things that are very flammable, like collecting a lot of paper. And when there's a fire, the first responders go in and they don't have an idea of how that space is. And when something is on fire and they're big piles that are over your head, they have the possibility to cave in.

[00:01:55] Reed Pence: That kind of accumulation often comes in part from an inability to stop shopping, and maybe they have a half dozen of the same item on the shelf, all still unopened. Maybe they shop online for things they don't really need. However, the one trait that seems to be universal among those with hoarding disorder is the inability to get rid of things the way most people can.

[00:02:16] Dr. Carolyn Rodriguez: All of us have attachments to objects and items. But for some people, that attachment to items is so strong. They have a lot of difficulty letting go of items. This is not to be confused with things that are collecting. Collecting is a pleasureful activity. People are proud to show off their possessions. There's one study of British adults that shows that 30% really enjoy this collecting. And so we don't want to confuse hoarding disorder with collecting.

[00:02:46] Reed Pence: But where does collecting stop and hoarding begin? Three criteria exists for identifying hoarding disorder, according to Elaine Birchall, a social worker specializing in hoarding disorder and co-author of the book Conquer the Clutter: Strategies to Identify, Manage, and Overcome Hoarding. First, she says there obviously needs to be excessive accumulation of things. Second, the accumulation has to interfere with life.

[00:03:10] Elaine Birchall: Some or all of the living spaces can't be used for their intended purpose. You're still living in the environment, but you're making some pretty unusual life-changing, life-altering, life-limiting adaptations. The third criteria is somebody's upset. They're distressed. Or, if they knew the truth about the condition of the property, they would have cause to be concerned and distressed.

[00:03:41] Reed Pence: Among those likely to be upset about a person's hoarding? Relatives, of course. But more critical perhaps, our neighbors. Rodriguez says they're probably in more danger from hoarding behavior than the hoarder, him or herself.

[00:03:54] Dr. Carolyn Rodriguez: Everybody's entitled to keep things in their home. But when it violates building code, you know, just the sheer volume of stuff in an apartment, it can warp the floorboards. We talked about safety hazard. We haven't talked about pest infestation, but that's something that is a public health concern and can affect neighbors. So there is some guidance and code enforcement that needs to happen as well.

[00:04:16] Reed Pence: Authorities may also intervene when children are endangered.

[00:04:19] Elaine Birchall: Living in a hoarding environment does change children's lives, and not for the better. Their developmental stages can't be met appropriately and on time. So it does set them back. And the other thing about children growing up in a hoarded to environment is that the legacy of the stuff seeming to mean more than they are. That isn't a legacy that they can get beyond easily. And they often carry that through their whole life.

[00:04:51] Reed Pence: The scars may be felt in a variety of ways. Among them, these kids are more likely to suffer from hoarding disorder themselves, for a couple of reasons.

[00:05:00] Elaine Birchall: We know, depending on whose research you listened to and you read, anywhere from 50 to 84% of individuals who hoard have a first degree family, relative who hoards; mother, father, sister, brother. We also know that there are three chromosomes with markers in common. We actually know what those chromosomes are: four, five, and seven. We know that the power of modeling behavior, just exponentially magnifies the impact of genetic predisposition to hoarding.

[00:05:31] Reed Pence: Birchall says the second path to hoarding behavior comes from a variety of comorbidities, other disorders that increase the risk.

[00:05:39] Elaine Birchall: Could be ADD/ADHD, depression and anxiety… It could be bipolar, schizophrenia, autism, Asperger's, social anxiety, there are a host of addictions. And so the other physical health conditions are MS and Parkinson's. Because at a certain point in the deterioration of those diseases, it's not unusual to develop a cognitive impairment, which then puts you at a higher risk for starting to clutter, starting to make decisions that lead to hoarding disorder.

[00:06:18] Reed Pence: However, Birchall says a lot of people without those disorders may be vulnerable if the wrong circumstances occur.

[00:06:24] Elaine Birchall: I believe that most people are vulnerable to this. And that is, you're just one of those individuals who is either chronically or repeatedly overwhelmed. Or chronically or repeatedly disorganized. We don't have to be tremendously disorganized, tremendously overwhelmed. It's just an ongoing thing that you fight. And then you become vulnerable. Some noxious event occurs, a setback. And that happens to everybody. Either a big one, and it totally overwhelms the person, brings them to their knees. Or sometimes it's not a big event. It's a series of smaller ones.

[00:07:09] Reed Pence: Hoarding disorder carries a great deal of stigma, made worse by the TV shows that highlight its devastating impact. The disorder is still difficult for many people to understand. Birchall says virtually all of those she's worked with admit they're overwhelmed by all their stuff. But Rodriguez says they don't use the word hoarder. Instead many call themselves finders or keepers. They can't throw anything away because to them, it all has immense value.

[00:07:37] Dr. Carolyn Rodriguez: If I came to your home and I gave you so many ancient artifacts and treasures. So many that we just stuffed your whole living room with these like priceless artifacts. And then a week later, I say, you know, it's really hard to like, get in and use the space. Let's just throw some of these things away. You may feel, I don't want to speak for you, but you may feel mortified. Like my goodness, like these are ancient artifacts. We can't possibly throw these in the trash. And so that is a little bit the experience of somebody who, in their mind, it's something extremely valuable, it's a treasure.

[00:08:14] Reed Pence: However, for many people with hoarding disorder, the emotional attachment goes even farther than that. Well-meaning relatives may not understand it. They may see their family members home and think that if you simply clean up the clutter and throw it all out, everything will be okay. But that might be the worst thing they can do.

[00:08:32] Elaine Birchall: You want to have a mental health professional available for that person. Because the remediated environment is extremely destabilizing. You can't... this is not drama or exaggeration: you can put someone into a psychotic break by going in and doing a cleanup behind their back. And I have seen that happen, with clients who have come to me after that's happened. They actually had to be hospitalized. They had to be kept, they had to be on a suicide watch for 72 hours because of the trauma.

[00:09:10] Dr. Carolyn Rodriguez: You had a case of an individual who was away on a trip, and I think the neighbors didn't know. And when they looked in, they thought that he had passed away. So they cleaned out his home. And when he came back from his travels, he was so distraught that he actually committed suicide.

[00:09:28] Reed Pence: Birchall says cleaning up a hoarding environment behind a person's back also shatters their trust in those who ordered it. And no amount of making nice will ever patch it up.

[00:09:38] Elaine Birchall: And you are probably creating a situation where that person will be a lot more cautious about becoming visible, about leaving themselves open to being discovered. And I can guarantee you, I put my life dollar down on this one: that hoarded environment is going to be recreated, not out of stubbornness. But you've missed the point when you've done that, it will be created worse and it will be created faster than it was the first time.

[00:10:10] Reed Pence: Rodriguez says experts are just beginning to understand hoarding disorder. However, they do know that throwing things away isn't the way to treat it, just as throwing away bottles doesn't treat alcoholism. She says hoarding disorder needs the same level of psychological attention. Medications can help, though none are indicated for hoarding disorders yet. Treatments may also include cognitive behavioral theory.

[00:10:33] Dr. Carolyn Rodriguez: That involves helping individuals examine the way they think and behave, and to change the thought process or behaviors that may be problematic. So the elements that are specific to hoarding disorder include skills like restricting acquiring, like going to a flea market and practicing not getting things. Practicing sorting, practicing discarding, challenging the thoughts and beliefs about an attachment to an item. So one thought may be, you know, I can't part with us because what if I need it someday? But yet, the individual will have like 50 duplicates of that item. The other is a peer-led support group called Buried in Treasures that has some evidence-based studies. And these are support groups, they follow the cognitive behavioral format and practice these kinds of activities.

[00:11:23] Reed Pence: Birchall says respect for the person with hoarding disorder is extremely important as well. With support, they may ultimately be able to make a decision about their things that they couldn't before. But it's the relationship with things that has to be worked on, not just the clutter. You can find out more about Elaine Birchall's workbook approach through her book, Conquer the Clutter on her website, hoarding.ca. You can also find more links and information about all our guests on our website, radiohealthjournal.org. I'm Reed Pence.