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By Joanne Mainsbridge
Hoarding is a topic that frequently comes up in our case conferences, supervision sessions and internal discussions. The question “what can I do to manage someone who is a hoarder” frames hoarding as a behaviour that requires managing and correcting. We acknowledge many of the negative associations of hoarding are fire hazards, falls, injuries, living in unsanitary conditions which can pose a health and safety risk, making areas of one’s living environment inaccessible and therefore restricting engagement in daily activities.
What is hoarding disorder?
Before jumping in to tackle what an outsider may perceive as a problem it is first important to understand what constitutes hoarding and compassionately consider if it warrants our intervention.
According to the Merriam Webster Dictionary a hoarding disorder is defined as “a psychological disorder characterized by the persistent accumulation of a variety of items that are often considered useless or worthless by others and by the inability to discard such items without great distress”.
Reason behind hoarding
The reasons for hoarding are complex, it is noted that prior to 2013, hoarding was classified as an obsessive-compulsive disorder. Nowadays it is recognised that the reasons for hoarding are not fully understood. A person may be diagnosed with a “hoarding disorder” which is a mental health problem and can be psychosocial disability, but hoarding can be a symptom of another condition including mobility problems, mental health problems, intellectual impairment and cognitive impairments. Hoarding disorder often starts early in life and can be associated with certain personality traits including perfectionism, difficulty with decision making and procrastination.
Some people hoard because they are afraid of throwing things away, they feel a need to save everything, or they have difficulty letting go of things. Others hoard because they are trying to cope with difficult emotions, such as anxiety or depression. Hoarding is not a choice and the people who engage in it are not lazy or messy. Often the people doing the hoarding do not see any issue with it or conversely may experience intense shame related to their condition, both of which make seeking and receiving help difficult.
Forced decluttering can be highly distressing, does not alter the behaviour, may lead to hostility which deters further help and is generally opposed by those that hoard. Common treatments for hoarding include cognitive behavioural therapy (CBT), medication, family therapy and support groups.
Occupational Therapy perspective about hoarding
From an occupational therapy perspective “hoarding can be seen as an activity which encompasses a series of tasks which relate to the collection of and saving of meaningful and valuable items” (Clark, 2019). At the core of occupational therapy practice is supporting people to engage in daily occupations which provide value, purpose and meaning and is therefore ideally placed to contribute with supportive interventions. In the first instance we need to understand the person we are working with and their hoarding behaviour including its severity, potential causes and the distress is creates before creating a tailored plan and reflects the participants goals.
Instead of rushing into forced decluttering and organising this may involve considering the hoarding as an activity that provides structure, purpose and meaning to one’s day. Whilst working to optimise their health and wellbeing and offering interventions that support choice and control balanced with mitigating any potential harm the hoarding may be causing. It may involve building capacity to manage one’s distress and build skills to engage with their possessions or home or find alternative activities that can provide structure, purpose and meaning to their day.
In addition to building capacity to support a participant the NDIS may fund professional organiser providers. This is generally considered when the participant has goals related to learning new skills to keep their home and life organised and that promote independent living, enhance safety and functionality of the participants home or to manage stress and make it easier to work, study or socialise.
References
Clarke, C.(2019).Can occupational therapy address the occupational implications of hoarding?Occupational Therapy International,2019,1–13.https://doi.org/10.1155/2019/5347403
“Hoarding disorder.” Merriam-Webster.com Dictionary, Merriam-Webster, https://www.merriam-webster.com/dictionary/hoarding%20disorder. Accessed 9 May. 2024.
About the author
Joanne Mainsbridge is the Psychosocial Clinical Lead at KEO. Jo started her career as an OT in mental health over 20 years ago. Jo has worked in various roles across Australia, NZ and the UK, including inpatient and community mental health roles, occupational rehabilitation and occupational health.
She has various special interest areas including trauma, substance use and ethics in healthcare, and has always been passionate about psychosocial disability, working in a client-centred manner and promoting recovery.
In her role as Psychosocial Clinical Lead at KEO, Jo’s priority is ensuring the team feels psychologically safe and empowered to support their participants to achieve their goals, whilst supporting them in their professional development and growth.
