What is Hoarding?

A view inside the Collyer Bros. brownstone, featuring
a very old organ and a long-defunct gas light era chandelier.

Because of its visibility and popularity in our modern culture, we hear the word HOARDER thrown around a lot these days. But hoarding or, more correctly stated, Hoarding Disorder actually has a clinical definition in much the same way as Post Traumatic Stress Disorder, Dissociative Identity Disorder and all the other disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM).

In the previous version of the Manual, the DSM-IV, Hoarding Disorder was actually listed as a subset of Obsessive Compulsive Disorder (OCD). It was only in the most recent version, the DSM-5, that Hoarding Disorder was separated into its own disorder. This newest version was published in May of 2013. Despite the newness of the study of Hoarding Disorder, it is certainly not a new problem as the sad case of the Collyer Brothers in the 1940s illustrates.

According to the DSM-5, to reach the level of a Hoarding Disorder diagnosis, a person must do more than simply have a lot of junk lying around. The manual set out five main criteria that must be met in order for the behavior to be severe enough to be considered a disorder. They are:

1. Persistent difficulty discarding or parting with personal possessions, even those of apparently useless or limited value, due to strong urges to save items, distress, and/or indecision associated with discarding 

2. The symptoms result in the accumulation of a large number of possessions that fill up and clutter the active living areas of the home, workplace, or other personal surroundings (e.g., office, vehicle, yard) and prevent normal use of the space. If all living areas are uncluttered, it is only because of others’ efforts (e.g., family members, authorities) to keep these areas free of possessions. 

3. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others). 

4. The hoarding symptoms are not due to a general medical condition such as a brain injury. 

5. The hoarding symptoms are not restricted to the symptoms of another mental disorder (e.g., hoarding due to obsessions in Obsessive-Compulsive Disorder, lack of motivation in Major Depressive Disorder, delusions in Schizophrenia or another Psychotic Disorder, cognitive deficits in Dementia, restricted interests in Autistic Disorder, food storing in Prader-Willi Syndrome).

The main feature of Hoarding Disorder, collecting large amounts of stuff, is widely known. More important to the diagnosis is criterion three. The symptoms must cause "clinically significant distress or impairment in social, occupational or other important areas of functioning." It is not enough to simply have a messy house. The level of mess must cause distress or impairment to the normal functioning of your life.  Jerome C. Wakefield's "harmful dysfunction" theory stated that in order to be considered abnormal a behavior or mental state must violate social norms in such a way as to be detrimental to the health and well being of the individual.  Despite their criticisms of Wakefield's work, Scott Lilienfeld and Lori Marino both agreed with this aspect of his theory.

There may be some difficulty in diagnosis of this disorder due to criteria four and five in the list above. There are several other mental disorders that may manifest themselves with similar symptoms of a messy home or the desire to collect lots of items. Those similar disorders must first be ruled out before a definite diagnosis of Hoarding Disorder can be made.

The main take away from this post is that hoarding is a complex disorder. Sufferers can hoard all sorts of items ranging from garbage to animals to objects of great value. What is important is the effect these things have on their owner's quality of life. If the potential hoarder, due to his or her hoard, has lost friends and family, lives in an unsafe environment, is unable to make use of the home's normal facilities like a kitchen or bathroom, has lost a job or is in danger of being evicted then there is a good possibility Hoarding Disorder is the problem.

Introduction

A typical scene in a modern hoarder's home.

Chances are, you either know someone or you are someone with too much stuff.

Maybe your garage has shelves stuffed to overflowing with tools, camping gear, tubs of extra clothes, you name it.  Or maybe your mom or your sister has a collection of tchotchkes that long ago overflowed her curio cabinet and has spread like a bad weed around her house.  Maybe your uncle still has the shoes he wore to his prom in 1968, and has added another three or four dozen pairs to his collection since then.  But at what point does this overabundance of stuff become abnormal?  Are the people in these examples hoarders?

The popularity of television shows like Hoarding: Buried Alive and Hoarders means that, even if you don't personally know anyone with these tendencies, there is a good chance you have seen people suffering with this problem in great detail.

The purpose of this blog is to provide education and resources for hoarders, people who fear they might be hoarders, the family and friends of hoarders and those who are just curious about this debilitating disorder.

Please know that whatever your connection may be to hoarding, there are resources out there available to help in whatever way you may need.  This is a blog that truly understands that all that stuff you have can be so much more than just junk.