To understand hoarding disorder, we should consider the items hoarded, their value to the person hoarding, and the impact of hoarding at all levels, from individual to community.
Previous article in this series: Understanding Hoarding Disorder.
Jump to section:
Introduction
In this second article of our series on hoarding (read part 1 here), we come into relationship with the huge ramifications of hoarding, especially when we consider the low (objective) value of most hoarded items.
What types of items do hoarders hoard?
Do you wonder what hoarding individuals save? The short answer is “anything”, but there are common themes to what gets stashed away. The items are often of low financial value, in poor condition or need of repair, or relatively easy to re-acquire if needed. Mostly, they would not be regarded as meaningful by others. Typically, the disorganised piles of clutter are blended with important and useful possessions, and the clutter comes to occupy spaces of the home that render important areas (such as the fridge, kitchen bench, or washing machine) inaccessible or unusable (Collett, 2019; Chater et al, 2013). Commonly hoarded items include: clothes, kitchenware, haberdashery, ornaments, toys, CDs, DVDs, audio and video tapes, hardware, automotive parts, books, newspapers, brochures, documentation, magazines, containers (boxes, bags), possessions from deceased estates, animals, furniture, and food (Collett. 2019; IOCDF, 2009).
The ways hoarders perceive value
Many decades ago, Lita Furby (1978) described a way of categorising the value put onto their possessions by those who hoard. She talked about sentimental, instrumental, and intrinsically motivated attachments that hoarders have to their things.
Sentimental hoarding
This type of hoarding comes about with objects that the person holds onto as representations of the connection to important people, events, and places; the items evoke the memories and associated emotions. Kellet described this phenomenon in terms of “object-affect fusion”: that is, the person’s emotional association with an object is no longer an experience owned within the individual themselves. Rather, it is perceived as being the object (Kellet, 2006). With sentimental hoarding, the individual’s possessions are enmeshed with their identity, being viewed as an extension of the self and thereby making the environment emotionally “safe” for the person who hoards (Frost and Steketee, 1998; Furby, 1978).
Instrumental hoarding
Some people who hoard hang onto things that serve a clear purpose, such as hiking shoes, toothbrushes, or electrical extension cords. While some stashing away of practical items is helpful, the person who hoards is frequently motivated by a sense of responsibility to meet unspecified future needs, with the resulting excessive accumulation of things “just in case they are needed by someone someday sometime” (Frost & Hartl, 1996; Furby, 1978). This type of valuing is exemplified by those who hoard newspapers and magazines for fear of forgetting important information. Gaining a new perspective on the realistic consequences of not having the item can help such clients overcome barriers to discarding such possessions (Chater et al, 2013). The chart below offers questions that could be asked in a conversation about things hoarded for instrumental reasons (see Figure 1).
Figure 1: Questions to help decide if a possession is needed
(Tolin, 2011)
Intrinsic hoarding
Have you ever been so awed by the beauty of something that you just had to buy it, even though you recognised that it had little practical value? People who hoard are likewise struck by the beauty, elegance, or uniqueness of items, but the person who hoards attends to aesthetic or unusual features of objects that most people who don’t hoard would not find noteworthy, and certainly not worth acquiring (Furby, 1978; Chater et al, 2013): for example, the purple ink on an ordinary document, or the texture of a set of placemats, even though they haven’t seen the surface of their dining room table for years and so could not use the placemats. Re-evaluation is needed of the criteria for assessing an object’s true uniqueness and value (i.e., purple ink, in this day and age of technology, may not be such a big deal!) (Chater et al, 2013).
Collections: Are they hoarding or not?
Collecting and hoarding share some surface characteristics – in both, there is a focus on and attachment to material items – but there are significant differences. Collecting is a relatively common hobby, with 30% of people acknowledging that they collect something, be that stamps, rocks, butterflies, or hats. Hoarding has an incidence of around 2.5% of the population: not even one-tenth as common an activity as collecting. Collectors are more likely to use (including “display”) their items, whereas hoarders say their stuff is important, but rarely use or (seemingly) appreciate it.
Collectors usually have a space in their home where they put their collection and can locate specific items from it. Hoarders, conversely, find their possessions filling up space all over the home, often compromising the intended use of rooms (e.g., the kitchen bench or table). Collectors go for specific types of items (e.g., guitars) in a defined set (say, “musical instruments”), whereas hoarders may pick up items of any sort (Collett, 2019).
The impact of hoarding
The public health and individual impact
Hoarding is associated with increased utilisation of public mental health services and more hoarders than non-hoarders suffer the psychological devastation of eviction. Productivity of those who hoard is about 30% lower than of those who do not have hoarding disorder (as people with the disorder report losing, on average, about seven workdays a month to illness (out of around 22 workdays in a typical month, so about 30%) (Darke & Duflou, 2017). In general 30% of hoarding deaths are from cold exposure, as people have so much clutter that crucial appliances, such as heaters and furnaces, either cannot be accessed or cannot be used due to clutter on top of or too near them (which would present a fire hazard). Moreover, many who hoard refuse to let repair people come into their homes (due to the stigma?), so such appliances may go unrepaired for months or even years (Darke & Duflou, 2017).
House fires
House fires are a scary potential danger from hoarding for several reasons, with cooking and heating equipment being the most common sources, although cigarette smoke is the direct culprit in about 10% of cases. In homes where hoarding is happening, it’s most often the case that papers or other objects have been left too close to the heater, stovetop, or other source of heat. Sadly, in about 25% of cases, the fire occurred because the normal appliances were either inaccessible or not repaired, and someone tried to cook or heat on old, unsafe appliances or worse, an open fire (Szlatenyi, Lucini, & Monk, 2009). One out of every four deaths from house fires are attributable to hoarding (Harris, 2010; Szlatenyi et al, 2009).
Pests, infestations, and unhygienic conditions
When major parts of a house cannot be accessed because of clutter, there is a shocking potential for not just grime and dust but also pestilence and small animal nests that might build up when major areas of a home are inaccessible, a potential magnified exponentially when animals are hoarded; they may deposit urine and faeces in hidden places, behind other piles of things, where the hoarding owner cannot even see the droppings, let alone reach and clean them. When the air in a home is befouled by such assaults, health problems such as infection, allergies, asthma, and other respiratory complaints are not far behind. Animal food and waste elevate squalor concerns due to the risk of parasite infestation and zoonotic transfer of disease (to say nothing of the deteriorating condition of the animals) (Collett, 2019).
Moreover, when essential facilities, such as the bath/shower, toilet, or washing machine cannot be accessed, or alternatively need repairing, there is a secondary problem – faulty hygiene – being exacerbated by the original issue of hoarding. In many cases, people who hoard are ashamed of how their place looks and refuse to allow any repair people in to fix things. The percentage of hoarding homes where there are unusable (unrepaired) appliances is up to 50% (Mathews, 2021; Szlatenyi et al, 2009).
Falls, mobility issues, and access problems
The prevalence of hoarding disorder increases steeply for those in their senior years (up to 7% of the population compared to only 1% for youth) (Mathews, 2021). Many more older people than younger ones need walkers, canes, or other assistive devices to get around. Add in that hoarding homes often have only a narrow trail or passageway available to move between areas, and some rooms may not be able to be accessed at all. Clearly, there is elevated risk of tripping or falling for an older person with mobility issues in a hoarding home.
Being unable to use, say, their kitchen or dining room table and possibly even their bed may cause a decline in health in itself (for both hygiene and postural reasons), but more importantly, it can be difficult in such environments to find medical equipment, such as finger-stick implements for those with diabetes or the mask or CPAP machine for those with sleep apnoea, exacerbating further a likely precarious health profile (Ayers, Iqbal, & Strickland, 2014). Refrigerators or pantries which cannot be easily accessed lead to rotting or expired foods, resulting in malnutrition, food contamination, and possible poisoning (Ayers et al, 2014).
Financial fallout
People who hoard but are attempting to live a functional life face financial difficulties not experienced in such high degree by non-hoarding others. For start, they may fail to pay bills or attend to other important matters of personal administration (e.g., renewing car registrations or driver’s licences, missing medical appointments) simply because they have misplaced the paperwork related to such matters. They may end up purchasing duplicate items of those they already own but cannot find (e.g., lost keys, mobile phones, credit and other cards).
More tragically, those who hoard are more often subject to forced evictions, and if health authorities or environmental health officers become involved, the cost to the hoarding tenant may be considerable if the home is subject to a forced clearing-out. Moreover, the hoarding former resident may struggle to find another place to stay, especially one that can accommodate the vast store of accumulated possessions that were not disposed of (Cooke, 2021). In this era of widespread housing crisis in much of the English-speaking world, a hoarding individual would not compete favourably with the many vying for a given rental property who may have a positive reference from previous landlords.
Associated medical conditions
To add to this grim picture, let us note the many medical and health conditions arising in hoarding individuals at much higher rates than equivalent prevalence for those who do not hoard. We speak of obesity, diabetes, cardiovascular disease, arthritis, chronic pain, sleep apnoea, and more. Note the comparisons to non-hoarding cohorts matched for aspects such as age, gender, weight, smoking history, and mental health conditions in Figure 2, below; these are from an online Brain Health Registry survey (Nutley, Camacho, & Eichenbaum et al, 2020).
Figure 2: Prevalence of associated medical conditions in individuals with hoarding disorder (HD) compared to non-hoarding cohorts (NH)
(Nutley, Camacho, & Eichenbaum et al, 2020).
Many associated conditions, and you don’t even have to have severe symptoms!
The snapshot in Figure 2 reveals those who had hoarding disorder were more likely than their non-hoarding cohorts to report a lifetime history of cardiovascular/metabolic conditions: diabetes and hypercholesterolemia. They were also more likely to report chronic pain and sleep apnoea. There was a much higher incidence of stroke, allergies, and concussion/traumatic brain injury of those diagnosed with hoarding disorder (Mathews, 2021).
Importantly, the likelihood of diagnosis did not differ in many of the conditions between hoarding disorder and subclinical hoarding disorder, so even having some of the symptoms moderately (or many of them to a mild degree) is enough for there to be a strong association between the symptoms and multiple adverse health conditions. Thus, assessment and management of medical complications in individuals with hoarding disorder is a fundamental component in improving quality of life, longevity, and overall physical health outcomes (Nutley et al, 2020).
Hoarding’s broader impact
Impact on household and other family members
Hoarding is hard on other members of the household or non-resident family members. There is likely to be resentment and tension over all the things that continue to come into the home, taking up precious space, without unnecessary items being discarded. Children and partners of people who hoard can feel intense embarrassment or shame about the state of their home, resulting in the inability to invite friends, relatives, or other acquaintances over for a visit. Household members may feel guilty about the things that are not being tended to while being aware of how onerous any repairs or replacements would be given the access problems to the appliances.
When a kitchen is not usable and/or a dining room table is chronically piled high with possessions, celebration of any rituals, such as Christmas dinner or special occasions, becomes impossible, or at least highly compromised, generating more bad feelings. Children may have no place to do homework, and even sleep quality may be reduced due to the poor environment. Because other household members are subject to the same health and hygiene risks that a hoarding person has, hoarding greatly strains relationships, either between the hoarding person and other residents, or with non-resident family members who find the situation intolerable but encounter resistance from the hoarding person when trying to ameliorate it.
Impact on the neighbours
Human beings may respect the fence that divides one property from the next door one, but animals are not so boundary-aware. Hoarded cats, for example, cause problems with nearby neighbours, as they jump the fences surrounding the hoarder’s property. Once a rodent infestation or other pestilence has begun in a hoarding home, it’s hard to stop it spreading, as the breeding rats or fleas come to claim increasingly large swathes of area. Foul odours from animals and infestations flow next door when the wind is just right. Any enquiries or “friendly” complaints from neighbours are likely to be met with hostility and a shutting-down of contact from the (stigmatised) hoarding person, thereby worsening ongoing relationships in the neighbourhood. Eventually, neglected properties of hoarders may result in decreased property values, not only for the home of the person hoarding, but also for all the houses on the street.
Impact on the community at large
Naturally, all of the factors above will also impact on the community at large, creating resentments and tensions and decreasing the goodwill that builds social capital. The higher level of hoarder illness not only decreases the level of engagement such persons can have with their community; it also places a much higher burden on public health care and often, on social services. When young people grow up in the chaos of a hoarding home, they are less likely to be able to concentrate their full attention on their studies, resulting in lowered educational attainment and thereby less fulfilled potential to offer back to their community in their working years. Retired elders caught up in hoarding (either as the person hoarding or a household member) are less likely to be well enough to offer volunteer services in any capacity (Chater et al, 2013; Cooke, 2021; Mathews, 2021; Collett, 2019).
Conclusion: hoarding is a big problem, with far-reaching impact! In the final article of this series, we look into how you can assess for and treat hoarding disorder.
Read next: Hoarding Disorder: Assessment and Treatment.
Hoarding disorder training
This article was adapted from Mental Health Academy’s hoarding disorder training course, Helping Clients with Hoarding Disorder. In this 6-hour course, you’ll learn the epidemiology, aetiology, and neurobiology of hoarding disorder; how and why hoarding impacts individuals and communities; the co-morbidities of those who hoard; and how to assess and treat hoarding disorder.
Note: Mental Health Academy members can access 500+ CPD/OPD courses, including those listed above, for less than $1/day. If you are not currently a member, click here to learn more and join.
Key takeaways
- Hoarded items could be anything, but are often of low financial value, in poor condition or need of repair, and relatively easy to re-acquire if needed.
- Items can be of sentimental, instrumental, or intrinsic value to the person hoarding.
- The impact to the individual and their household can be from increased risk of fires, pest or other infestations, access and mobility issues, and financial fallout, with hoarding individuals suffering elevated risk of many medical conditions, from obesity to pain and sleep apnoea.
- Households experience shame, guilt, resentment, and decreased functionality in hoarding homes, whereas neighbours suffer from spreading infestation and decreased property value.
- Communities experience less engagement and contribution from hoarding households and increased burden on the public purse.
References
- Ayers, C.R., Iqbal, Y., & Strickland, K. (2014). Medical conditions in geriatric hoarding disorder patients. Aging Ment Health, 18(2), 148-151. https://doi.org/10.1080/13607863.2013.814105
- Chater, C., Shaw, J., & McKay, S.M. (2013). Hoarding in the home: A toolkit for the home healthcare provider. Home Healthcare Nurse, Vol 31(3), pp 144-154. Retrieved on 11 April 2024, from: http://journals.lww.com/homehealthcarenurseonline
- Cooke, J. (2021). Understanding hoarding: Reclaim your space and your life. London: Sheldon Press.
- Darke, S., & Duflou, J. (2017). Characteristics, circumstances, and pathology of sudden or unnatural deaths of cases with evidence of pathological hoarding. J Forensic Leg Med 45, 36-40. https://doi.org/10.1016/j.jflm.2016.11.004
- Frost, R.O., & Steketee, G. (1998). Hoarding: Clinical aspects and treatment strategies. In M.A. Jenike, L. Baer, & W.E. Minichiello (Eds.), Obsessive-compulsive disorders practical management (3rd ed.), St. Louis, MO: Mosby.
- Furby, L. (1978). Possessions: Towards a theory of their meaning and function throughout the life cycle. In P. B. Yates (Ed.) Life-Span development and behaviour (Vol. 1, pp, 297-336). New York, NY: Academic Press.
- Harris, J. (2010). Household hoarding and residential fires. (Paper). International Congress for Applied Psychology, Melbourne, Australia, July 11-16, 2010.
- International Obsessive Compulsive Disorder Foundation (IOCDF). (2009). What is compulsive hoarding? Author. Retrieved on 25 April 2024 from: http://www.ocfoundation.org
- Kellet, S. (2006). The treatment of compulsive hoarding with object-affect informed CBT: Initial experimental case evidence. Behavioural and cognitive psychotherapy, 34, 481-485.
- Mathews, C. (2021). Recognizing and treating hoarding disorder: How much is too much? New York: W. W. Norton & Co.
- Nutley S.K.; Camacho, M.R.; Eichenbaum, J.; Nosheny, R.L.; Weiner, M.; Delucchi, K.L.; Mackin, R.S.; Mathews, C.A. (2021). Hoarding disorder is associated with self-reported cardiovascular / metabolic dysfunction, chronic pain, and sleep apnoea. J Psychiatr Res. 2021 Feb;134:15-21. doi: 10.1016/j.jpsychires.2020.12.032. Epub 2020 Dec 15. PMID: 33360440; PMCID: PMC8108138.
- Szlatenyi, C.S., Lucini, G.L., & Monk, I.M. (2009). An analysis of fire incidents involving hoarding households. Digital Commons. https://wpi.edu/iqp-all/592
- Tolin, D. (2011). Understanding hoarding: A biopsychosocial perspective. Journal of clinical psychology, 67(5), 517-526.