When and how does having too much stuff become Hoarding?

By Professor Paul Salkovskis, University of Oxford and Oxford Health NHS Foundation Trust & Patron of No Panic.

We are all capable of hoarding. At a time of relative prosperity, having more and more things is pretty much an issue for everyone. The things we have can seem to us to be useful or beautiful. They can remind us of and connect us to people, places and memories. They can demonstrate how important we are, can signal something about how we want others to see us or how we want to see ourselves. Possessions are valuable, and their owner typically feels responsible for their value. So, not a problem. 

Except it can be, when people have way too much stuff, in the words of Steketee, Frost and Tolin, they can end up living a deprived, lonely and desperate lifestyle where they are “Buried in Treasures”. 

Hoarding is not a joke. In fact, it’s a nightmare for the person with hoarding issues, for their family, for their neighbours and for services such as housing and fire and rescue services, to name just a few. The “image” of people with hoarding issues has tended to be dominated by TV programmes, most tend to sensationalise and distance the viewer from understanding the real issues.  One of my colleagues described these programmes as “clutter porn”.

So, let’s think about those affected by hoarding issues and how best to understand and help all concerned.

What is Hoarding?

So what is “Hoarding”? The definition is pretty simple: Hoarding is said to be present when accumulated possessions have got to the point where a person’s home is no longer usable in the normal way. For example: The kitchen can’t be used to prepare and eat food because all surfaces are covered with things (which at worst can include old and rotting food). The bath is full of shoes so can’t be used as a bath. Central heating doesn’t work because the engineer can’t get in (or is not allowed to) to repair the system. At its worst, rooms are full almost to the ceiling, meaning that they can’t be got into except through a narrow gap at the top. No chance of sleeping in that room, because the bed is under several feet of accumulated possessions. The loft and garage are stuffed completely with….stuff. Windows and some doors are blocked by piles of things of all kinds. No one can come in, not only because it is so full and therefore physically impossible, but also because the person living there is embarrassed or ashamed of the state of things. That embarrassment also brings another problem of course….how to ask for help when the solution seems obvious to the rest of the world……just throw stuff away. This common response comes from the same place as the other old chestnut in mental health problems: “Why don’t you just pull yourself together”. If only! It’s not as if all those concerned have not tried.

So, is it common? Very much so. Depends on how you define it, but somewhere between 2% and 6% of the population have this issue. Neighbours know about it, families know about it, and often Fire and Rescue Services know about it too. Mostly, mental health services tend not to know about it, which is a pretty big problem because hoarding is firmly rooted in psychological issues, and those affected need specialist and compassionate help. More of that later, but, spoiler alert, that’s not very available.

Who gets this problem?

Who are “Hoarders”? Well, for a start “they” are not Hoarders….; “they” are people with hoarding issues! Most mental health professionals are under the impression that those affected are typically in their later years. But…..”the average age of onset” (when the problem most commonly starts) is typically 17. Yes, 17. Often mum and dad keep it in check, as might a partner while they are around. But…people who have hoarding issues are less likely to be with a partner, to have a job and so on.

So hoarding can mean that you have way too much stuff so that you can’t appropriately live in your house? How does that happen? Well, it’s kind of simple…input and output! Too much stuff coming into your house relative to how much is going out. So how does that happen? Well, this is where we have to go all psychological. What do you expect, I am a Psychologist, after all!

How and why does hoarding become a problem?

Typically (but not always), Hoarding creeps up on the person it affects. We, as clinical researchers, think that, at the heart of hoarding issues is the sense of the person affected that they are the “custodian of value”: that is, they have a strong feeling that that they have to protect and look after their possessions. This typically means that people rapidly become attached to their possessions and, crucially, really struggle to dispose of them unless the item, whatever it is and whatever state it is in, is not somehow protected. Usually this means keeping it themselves so that they know where it is and can, in principle, access it.  

Why, then, do people with hoarding issues attach so much value to so much stuff? In terms of trying to help those who hoard, this is a crucial question and is likely to be particularly important when it comes to trying to overcome hoarding problems. Unsurprisingly, the reasons which underpin hoarding turn out to be complicated. Some of these are exaggerations of factors which affect most of us who live in our “consumer society”. The main “normal” reasons for acquiring and keeping stuff are (1) feelings of satisfaction, pleasure and comfort in getting new (to you) things and keeping them by you. At its most extreme, this can lead to “compulsive shopping” which can obviously become a major problem in itself. (2) Getting things which are to be used (tools, sports equipment, kitchen utensils, etc); this is sometimes called “instrumental hoarding”.

It is worth pointing out that there is an important difference between “collecting” and “hoarding”. Collectors typically gather objects with a theme, organise them and keep them without any intention of using them for their original purpose. For example, a stamp collector will not use a stamp they have got for their collection to send a letter! A key thing to note is that the person is able to dispose of things relatively easily; eg swapping an item from their collection in order to get another, harder to obtain item.

Beliefs and values in Hoarding problems.

The “normal” factors described above can, if taken to extremes, contribute to hoarding as a problem, but typically the problem is made much worse by a somewhat different set of beliefs, thinking styles and the behaviours related to these ways of thinking. In terms of “less normal” hoarding, different things come into play, or extreme versions of the normal motivations. We can simplify problematic patterns into a smaller number areas, although it is important to realise that any person seriously affected by hoarding issues may have (and usually will have) more than one of these.

Firstly, Hoarding arising from fears of having experiencing scarcity or poverty, most commonly linked to an earlier experience of serious material loss from a previous well provided situation (being made a refugee, house having burned down when you were younger, having to flee a violent home). The persons with such experiences typically have unpleasant memories of their loss and acquires and keeps things as an insurance against future loss and deprivation. Post Second World War rationing had a major impact on some.  A “make do and mend” attitude can lead to the accumulation, for example, of large amounts of broken items which “could be mended” but most likely will not. People who were forced to become refugees and migrants are often affected in this way.

Secondly, and closely resembling Obsessive Compulsive Disorder (OCD), Hoarding can happen because of worries about responsibility for the possibility of causing harm. Typically, the person has worries about the negative impact of throwing things away on other people. For example, the person believes that an item is contaminated, and feels that they cannot throw it away in case it contaminates someone else. A person opens a food tin and worries that the sharp edge might cut someone, so keeps it with all of the other used tin cans.

Thirdly, something called “sentimental” or “attachment” hoarding, where the person focusses on connections or memories linked to an object, and feels compelled to keep it in order to protect the memories or the things associated with it. It seems likely that this type of hoarding problem is linked to anxious or insecure attachment to childhood caregivers; the person feels able to trust possessions more than they feel able to trust people.

Fourthly, there is a version of hoarding sometimes referred to as “compulsive shopping”, particularly when it occurs without other aspects of hoarding. In this instance, the person gets a “lift” or “buzz” from getting new (to them) things. People describe feelings of elation, joy or contentment which nothing else gives them. Typically these positive feelings don’t persist beyond getting the new possession home and adding it to the large amount of “stuff” they already have.

Bad things happen to good people, and can cause serious long term problems

In common with other mental health problems, there are a wide range of traumatic experiences which can trigger or worsen hoarding issues, particularly it seems bereavement or other close interpersonal loss. Sometimes this may be due to the fact that the person who died (or left them) had kept hoarding tendencies at bay. For others, their possessions allow them to “keep in touch” with the person they have lost. We know that mood problems (persistent depression and anxiety) can make hoarding worse, and certainly make its consequence harder to bear for the person affected. There are suggestions that some people with hoarding might also have problems with attention (like “Attention Deficit Disorder”). It has also been suggested that difficulties in controlling unwanted emotions (“emotional regulation”) might also be involved. There is also evidence that feeling unsupported by those around them may also be important.

Which takes us to what might help. There is evidence that treatment, in form of specialist CBT (Cognitive Behavioural Therapy), is likely to be effective for some people. People experiencing hoarding issues are often embarrassed or even ashamed of their problem, something which can be made worse by those around them who don’t understand. This makes it difficult to seek help; even if help is sought, specialist and sympathetic treatment is very hard to get.

For many people, the first step is to seek support. We know that those experiencing hoarding issues feel cut off from support even if they have friends. They have often experienced very negative reactions to their problem which makes it difficult to reach out, let alone open up. Person centred peer support groups run by organisations such as the Fire and Rescue service, Help for Hoarders and Hoarding UK may help, as they are likely to include people with similar problems. These support groups can create a safe space for persons to feel supported without being judged and many experience these groups as the only place where they can gradually open up and talk about their feelings and experiences of hoarding together and the terrible isolation and suffering that they have felt trying to cope with this alone.

Evidence based treatment?

What would specialist evidence based treatment involve? It depends, but typically it would be offered by an NHS mental health professional such as a Clinical Psychologist or Cognitive-Behavioural Therapist. This should be someone who will offer a particular type of CBT which involves the following steps.

As you describe your problem, your therapist gets to know you before they get to know your problem. You should find them a person you would like to Trust. They will ask you about your experiences both of hoarding and life in general in order to try to make sense of how you are affected at the moment, and a bit about how it got like that. You and your therapist should begin to reach what’s called a “shared understanding”, which you have worked on together and which seems to make sense of your current situation. It is, after all, not the stuff that is your problem, but the way you react to it (eg in terms of the beliefs described above). They should work closely with you to help you make sense of the way the problem affects you and how your beliefs about your possessions have taken over despite your very best efforts. Having begun to make sense of the problem, you and your therapist will use this new shared understanding to start to consider new ways of reacting and behaving in which your possessions can be put into perspective (and often disposed of). My colleague James Gregory describes this process as “making space”, meaning not only in your home but also in your life and thinking. Often this will involve broadening your thinking to reclaim your life and your hopes, dreams and ambitions. Your therapist and you should, as part of this process, be experimenting with reducing acquisition and substantially stepping up discarding without going through every single item one at a time before agonisingly parting with it. That is, of course, the toughest bit and absolutely the most necessary. Once inroads are made, then new ways of thinking need to be established (for example, when it comes to new stuff, “one in means one out”. As part of this process, your therapist will support you in reclaiming your life, particularly the bit of it that’s connected to other people, which may mean re-establishing lost links with your family or friends and/or making new friends. Connection is crucial.

Acknowledgements: Many thanks to Karen Lock, Buckinghamshire Fire and Rescue Service and Fahreen Walji  from OXICPTR for helpful comments and amendments.

The Oxford Centre for Psychological Health (part of Oxford Health NHS Trust and the University of Oxford) are constantly seeking help with our research on Hoarding, Obsessive Compulsive Problems (OCD), Panic, Health Anxiety and other anxiety problems. We also appreciate participation from people who don’t have mental health problems!

You can see some examples of our work here:

https://oxicptr.web.ox.ac.uk/publications#/

If you would like to be informed of research participation opportunities, please email us at

psyresearch@oxfordhealth.nhs.uk

Please indicate what type of research you might be interested in helping us with. Ideally at least your first name and the best way to contact you.   

Further reading:

https://www.oxfordclinicalpsych.com/view/10.1093/med:psych/9780199329250.001.0001/med-9780199329250

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