Hoarding: A Complex Issue Needing Community Support

Hoarding Project co-founder Jennifer Sampson discusses some of the biological, psychological, and social factors behind the disorder.

As the Renton Housing Authority Resident Services Coordinator, I have worked with residents that struggle with hoarding disorder; however, I felt uninformed about this issue. In my search to educate myself, I was referred to The Hoarding Project by the Snohomish Task Force on Hoarding. I was delighted to find a wealth of information on the organization's website and had the pleasure to meet Jennifer Sampson, M.S., Ph.D. Candidate and co-founder of The Hoarding Project. Following is an edited conversation we had about hoarding disorder.

Jennifer, what is your expertise and training in hoarding disorder?

Currently, I am a Ph.D. candidate at the University of Minnesota and am completing my dissertation about the dynamics of families who have a member who hoards. I am a Licensed Marriage and Family Therapist. At my Tacoma practice, I work with families struggling with problems related to compulsive hoarding. I also see clients with issues relating to depression, anxiety, life transitions and couples' conflict. I am the co-founder of The Hoarding Project, a nonprofit specializing in helping people who hoard and helping their family members, as well as offering training about hoarding to other professionals.

How did you first get involved with people who hoard?

Several years ago, I started watching TV shows about people who hoard. I decided to focus my Ph.D. research on interviewing family members who have someone in their family that hoards. From there, I developed support groups for family members. The more that I learned, the more it became obvious that hoarding is a very misunderstood problem. It became apparent that more supports and services were needed to help the person with hoarding disorder, for family members of people who hoard, and support for the community at large. In 2010, Janet Yeats and I co-founded The Hoarding Project as a hub for resources for people that hoard, families, professionals and the wider community.

What is hoarding?

Hoarding is a complex mental health disorder that is made up of three related problems:

  • Collecting too many items
  • Difficulty getting rid of items
  • Problems with organization

What most people know about hoarding comes from TV shows. The TV stories are the extreme cases of hoarding. In reality, hoarding covers a wide spectrum of situations. For instance, a person may have significantly less clutter than someone who we may see on TV, but if he or she isn't able to use their living spaces for their intended purpose and has an extremely hard time parting with their possessions, they may classify as someone who hoards.

What sets hoarding apart from collecting or simply a messy home is the inability to use the spaces for what they're supposed to be used for. So, if a person's kitchen can no longer be used as a kitchen because of clutter—they cannot safely use the stove or the cupboards are filled with non-kitchen items—this may be an indicator of hoarding.

Hoarding Resources

International OCD Foundation Virtual Hoarding Center

Children of Hoarders

Digging Out: Helping Your Loved One Manage Clutter, Hoarding and Compulsive Acquiring

Buried in Treasures: Help for Compulsive Acquiring, Saving and Hoarding

What causes hoarding?

Many things contribute to hoarding, including biological, psychological, and social factors. For example, a psychological factor can be unresolved trauma. A biological factor can be a genetic predisposition and/or an information processing deficit. Social factors that can contribute to hoarding behavior are a lack of strong social supports or unresolved losses. Many combinations of factors can cause this complex disorder.

What are some of the myths about hoarding?

One of the most harmful and inaccurate myths about hoarding is that the person is simply lazy, unmotivated, or gross. This is an example of the stigma that goes with hoarding. The reason people hoard is a complex patchwork of a lot of different reasons that I discussed earlier. One of the important things to really realize is that, much like someone with a diagnosis of Attention Deficit-Hyperactivity Disorder (ADHD) who has a hard time paying attention due to the way his or her brain works, people may hoard because they have some cognitive deficits in the area of the brain that helps us to organize and make decisions. It isn't that the person is lazy but rather they aren't as able as the average person to carry out some of the tasks we need to in order to organize and make decisions. 

Another myth is that clean-outs or partial clean-outs will solve the problem of hoarding. If work has not been done to address a hoarder's underlying issues, we can be almost certain that the problem will arise again. The house will fill back up, and may do so in a shorter amount of time. Oftentimes, some level of traumatization happens during a forced clean out.

One more myth is that a single professional alone can handle a hoarding situation. Hoarding is such a multifaceted issue that we need to include many different types of professionals—mental health professionals, social workers, professional organizers, landlords, and building inspectors. It really takes a village to help someone with a hoarding disorder.

What does therapy offer?

Therapy can help the person discover the underlying issue—such as unresolved emotions, grief or loss—that initiated the need to hoard in the first place. Therapy also helps the client identify some of the "faulty beliefs" as to why they thinkthey need the hoarded items to begin with and can help them to change those beliefs. It can also help the client to increase their ability to discard possessions, make smarter decisions about purchasing or acquiring items, and develop ways to maintain these practices over the long run so that hoarding doesn't get to be a problem again down the road.

How can family members help a relative who struggles with hoarding?

Family members can struggle with the person who is hoarding, their lack of understanding of the situation, and how dangerous it may be. Out of concern for the person who hoards, many family members and friends insist on cleaning out the home; however, this can do more harm than help. It can cause trauma and ruin their relationships.

Photo credit: Shadwwulf at en.wikipedia

The first thing families need to do is to educate themselves about hoarding behavior. A very helpful book is "Digging Out," by Michael Tompkins, which offers great help for family members to learn more about hoarding and how to talk about it with their loved one.

Family members also need to be encouraged to have conversations with the person who is hoarding, as the problem won't resolve on its own. It is important to get involved in a caring and supportive way. Also, family members should seek out support for themselves, whether it is seeing a therapist or joining a support group. Hoarding can evoke deep emotions, feelings and unresolved issues, for the person struggling with hoarding and their family members and friends.

One of the things you offer is a "Safety Day." What is that?

"Safety Day" is a term we've coined to talk about conducting a "modified clean-out" of a hoarded home to ensure the safety for the people living in and about the home. The term came from a conversation about needing to call the process something other than a "clean-out," as that term can heighten the anxiety of our client.

From the outside, a Safety Day can look very similar to the clean-outs you might see on TV. It involves a lot of moving, sorting, and discarding large amounts of possessions from the hoarded home. What is different is that we take steps over the weeks leading up to the day to ensure that the client's stress level is as minimal as possible on the day.

Prior to the Safety Day, we help the client learn coping skills, discuss the details about the day, and make important decisions, such as how to sort and discard items and continue this process during the Safety Day. We also help the client practice stress management skills. On the day, we continue this process with a trained mental health provider on-hand to ensure that the process runs smoothly and the client minimizes their distress. We also provide continuing after-care to do our best to ensure the client takes steps to prevent relapse.

You are developing a task force in King and Pierce Counties. What do you hope this will accomplish?

The purpose is to have a wide variety of professionals come together to work on a community-wide response hoarding. As I said before, hoarding is a multifaceted issue that requires many different types of approaches in order to help someone who has a hoarding disorder. Anyone who would like to learn more or join our task force can contact me at WAtaskforce@thehoardingproject.org.

Any final thoughts?

Up to 15 million people in the U.S. struggle with hoarding problems. It is important that we work toward lessening the stigma around this disorder. It is important to approach conversations about hoarding disorder and those who may be affected by it with compassion and respect, and recognize that the more we can come to learn from and promote accurate education, the more we can contribute to creating positive change for those who need it.

For more information, visit The Hoarding Project online or e-mail info@thehoardingproject.org.

Susan G. Dailey, MSW is Resident Services Coordinator at Renton Housing Authority. In January 2013, she coordinated The Full Continuum of Hoarding: A Researched Based Workshop for Professionals and contributed an article on downsizing, Deciding What to Do with a Life's Worth of Possessions and Memories, to AgeWise King County.