During the holiday season, we have occasion to interact with friends, neighbors and family members that we may not see very often. These holiday visits may reveal problems that we were not previously aware of. A problem that often goes unnoticed or overlooked is hoarding. According to the medical staff at the Mayo Clinic, hoarding is the excessive collection of items, along with the inability to discard them. While it is not uncommon for older adults to hold on to items that we would usually discard, when this tendency becomes excessive, and interferes with their ability to function and threatens their health, it can no longer be ignored. The home of a hoarder is unmistakable – there are piles everywhere and often only a narrow path remains to get around the house. Hoarding animals is a commonly example and the person may have as many as a hundred pets that are kept in conditions that are unsanitary. Hoarding is often associated with an anxiety disorder called Obsessive Compulsive Disorder (OCD); however, some individuals who hoard do not have OCD. Therefore it may make sense to understand hoarding as a separate condition that has its own characteristics and treatment. Hoarding behavior appears to occur on a continuum ranging from mild to severe. Mild hoarding does not usually interfere with a person’s ability to function and is not usually identified as a problem by those who know the individual. Severe hoarding can lead to life threatening situations because of the unsanitary and hazardous conditions that typically exist in a hoarding environment.
It is not clear what causes hoarding, but it tends to run in families and the characteristics are usually first manifest in the early teen years. The behavior gets worse over time and that is why hoarders are usually only brought to the attention of authorities and the medical community when they reach their latter years. Other risk factors for hoarding include having a stressful life situation and it is more common in individuals who are socially isolated. Another identifying characteristic of hoarders is that they tend to be perfectionists and are very rigid about how things are done.
Just as the symptoms become worse with age, so the treatment becomes more difficult as a person gets older. Treatment is further complicated by the perception, by the hoarder, that there is nothing wrong with their basic need to collect things. They may concede that a specific situation is problematic, but they will not accept that there is anything wrong with the underlying tendency. How the person is approached can be pivotal in the success or failure of an intervention. A person who hoards will need reassurance about how their belongings will be handled and that the treatment staff have his/her interests in mind. Treatment is most likely to succeed if the ostensible focus of the treatment is something that the hoarder wants to change (i.e., something they subjectively experience as a problem). The inclusion of a trusted other can aid treatment. Attempts to treat hoarding have met with mixed success, but the most successful interventions combine psychotherapy (counseling that is aimed at understanding behavior and changing thoughts and behaviors) and medications (usually medications that effect serotonin levels in the brain).
Hoarding presents real and increasing danger to those who are afflicted and, because it tends to get worse over time, the earlier the person gets help the better. As family and friends of those who hoard, we may be in the best position to help the person understand that there is a problem and that treatment is needed. In cases of severe hoarding it may be necessary to get the authorities involved and for those over age 65 years county aging services may be the best place to start.
