What is hoarding disorder?
Hoarding disorder is characterised by a significant accumulation of possessions, accompanied by extreme difficulty in discarding these possessions. This can result in significant impairment to the person’s daily life such as not being able to bathe or cook at home, or not being able to sleep in a bed. The possessions accumulated can be any type of object; often people accumulate large quantities of papers / paperwork / books, clothes, recycling e.g. empty containers, items that remind them of other people or other times of their life, or items that they intend to repair or sell. It is very distressing to discard the items.
Hoarding disorder is estimated to affect 2-5% of the population. People are sometimes reluctant to ask for help as they fear that their possessions will be forcibly removed or that they will face legal proceedings or eviction. People are often ashamed, and isolated from family and friends. People with hoarding problems often have other psychological and physical difficulties, such as social anxiety, depression or diabetes.
Hoarding disorder was diagnosed as part of Obsessive Compulsive Disorder (OCD) or Obsessive Compulsive Personality Disorder (OCPD) until 2013 when it was reclassified as a separate problem.
Can treatment help?
Individual and group Cognitive Behaviour Therapy (CBT) has been found to be effective for people with hoarding problems.
Hoarding problems are usually longstanding and have had a severe impact on people’s lives. Standard CBT for hoarding does not always lead to significant improvements. Often people have experienced traumatic events in their past which have contributed to their beliefs about possessions, or had difficult interactions with authorities / professionals tasked to ‘clear’ their homes.
Aims of treatment
An assessment at OHSPIC will include use of standardised questionnaires that assess the severity of the hoarding problem, how the problem impacts on daily life, what thoughts and beliefs are associated with the problem, and an assessment of other difficulties such as anxiety disorders, trauma and depression.
Cognitive Behaviour Therapy (CBT) at OHSPIC includes:
• Working together to build a trusting relationship with shared goals
• Building a comprehensive shared understanding of the problem including the impact of trauma and other associated difficulties
• Identifying and working on beliefs about possessions including usefulness, intrinsic beauty, and how items relate to memories and personal identity
• Testing out the usefulness of beliefs about possessions
• Approaching change to the sorting and discarding possessions
• Looking at patterns of acquiring items and how to reduce acquiring
• How to sort, discard and organise items
• Devising a plan to help maintain progress and work towards longer term goals.
Hoarding difficulties can take a long time to overcome and OHSPIC would not expect to be involved beyond an initial 6-12 months. OHPSIC will liaise with local teams to ensure that the work on sorting and discarding possessions can successfully continue, including offering joint work and supervision. Home visits will be included and encouraged as part of joint work with local teams.