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Hoarding....Out Of Hand

We asked Dr Dr Stephen Macfarlane, Associate Professor and Director of Aged Psychiatry at Caulfield Hospital about ‘Hoarding’

1.. What is hoarding/senile squalor?
Hoarding refers to the compulsive acquisition of items, associated with an anxiety that arises when it is suggested that the items be disposed of. often, the hoarded items have an emotional significance to the person that is not obvious from their objective worth. Compulsive hoarding is likely a variant of obsessive-compulsive disorder (OCD), and is planned to be recognised as such within the official psychiatric nomenclature in the near future. It usually begins as early as the teens or early twenties, but often only comes to attention in old age, as it takes many years for hoarded items to accrue to such an extent that a ‘critical mass’ is achieved.

should[.b] be distinguished from simple collecting. Many of us collect certain items as part of a hobby or area of special interest, but hoarding goes way beyond that.

When hoarded items occupy so much of a given area within a property that the area is no longer able to be used for its intended purpose, squalor can result.

Not all squalor arises as a result of hoarding, and it's important to make this point, as the terms squalor and hoarding are often used interchangeably. A passive failure to adequately maintain the environment can also occur. This usually happens to older persons, and has been associated with a variety of conditions, including schizophrenia, dementia, depression, head injury, alcohol abuse, mental retardation and injury to the frontal lobes of the brain.

2..Why do people hoard?
Hoarding may be an expression of an illness such as OCD. Others might hoard because they grew up in a time of great scarcity, and associate a plethora of possessions with security. Some feel reluctant to ver throw anything out for fear that ‘it will be needed someday.’ One theory related to hoarding is that sufferers transfer emotions to the acquired objects that might better be directed towards other people….love, comfort, reassurance, security. Relationships are thus formed with objects, whcih will never expose you to the vulnerability of rejection, rather than with others.

3.. Is it a problem related to (old) age, or are ‘hoarders’ always ‘hoarders’?
Obsessive hoarding usually commences in the younger years, but often only presents to clinical attention in later life. The passive degeneration into squalor is more a phenomenon of old age. It's important to enquire how longstanding the problem has been, because the approach taken to treating the two groups differs widely.

4.. When is it a problem?
When the environment begins to pose significant risks to an individual in one or more areas of their life, whether this be a medical risk (posed by squalid surroundings, a falls risk, or risks posed by vermin infestations), a fire risk, an environmental risk (following collapse of load-bearing structures within the home, or a risk to family and community relationships. Compulsive hoarders are often aware of, and distressed by, the problem, but fail to seek help because they perceive little can be done. Those who passively degenerate into squalor ten to have little awareness ofthe risks their living circumstances pose to them, and are thus more vulnerable to harm.

5.. How can people help? / what can be done to ensure ‘things don't go bad’?
Obsessive hoarders can be reassured that effective treatments are available, and should be encouraged to seek this help. Those whose living conditions degenerate into squalor in the absence of hoarding will generally not be aware that their living circumstances are seen as problematic by others. In these cases, family members are often well-positioned to monitor the living conditions of their loved one, and should be encouraged to seek referral to a geriatrician or aged care psychiatrist for specialist evaluation if they are concerned about an apparent deterioration in their relatives' ability to maintain the home environment adequately.

6.. What strategies can people adopt to ensure they do not 'hoard'
A tough question! Hoarding behaviours have often been present for decades, and there's no easy answer once the behaviour is entrenched.

7.. Is it ‘therapeutic’ to have a ‘Spring clean’ (ie: do people realise that it makes them feel better)?
In compulsive hoarding, a ‘quick clean up’ is usually counterproductive. Hoarders hoard for a reason, and invest great emotional attachment to their possessions. Quick clean ups will thus often generate overwhelming anxiety for hoarders, and a cluttered environment is highly likely to be re-established shortly thereafter, as a way of managing this anxiety. A slow, staged approach, taken at a pace that is less threatening for the individual, and supervised by a psychologist with an interest in the area, is much more likely to succeed in the long run.