The American Psychiatric Association (APA) estimates that two to five percent of the population suffers from hoarding disorder. The sense of distress, shame and social isolation which accompanies this condition often causes a person to turn to drugs or alcohol as a means of escape.
Individuals facing both conditions, termed a co-occurring disorder, witness better treatment outcomes within an individualized, dual diagnosis treatment program. This multidisciplinary approach combines behavioral therapies, counseling and medications (when needed), to facilitate emotional, mental and physical healing.
Is Hoarding An Addiction?
Though hoarding bears certain similarities to addiction, it isn’t classified as such. Despite this, hoarding, like addiction, can cause a massively declining quality of life, creating a need for comprehensive treatment.
The similarities between hoarding and addiction are as follows:
- compulsive behaviors
- preoccupation with finding and obtaining possessions (vs a substance)
- denial about the behaviors and their impact
- making excuses for the behavior
- continuing behaviors despite adverse mental and physical health effects
Even though both disorders are marked by debilitating, compulsive behaviors, there are some key differences which make hoarding disorder stand apart from addiction. Addiction is marked by long-term changes to the brain’s structure and molecular form, alterations which haven’t yet been shown to occur from hoarding.
How Hoarding Is Linked To Drug Addiction
Hoarding disorder can lead to or worsen any form of drug abuse, however, alcohol use disorders are witnessed more frequently than other substance use disorders in this way.
Mental health disorders are frequently linked to addiction. Many individuals with these diagnoses frequently self-medicate the symptoms of their mental illness with drugs or alcohol. The same holds true for hoarding disorder.
Drugs and alcohol alter a person’s cognitive functions, impairing their ability to make sound judgements and to effectively reason. For a person with a hoarding disorder, this can intensify already existent problems, making the hoarding behaviors more severe.
Substance abuse often intensifies the shame and isolation which already exists from hoarding. This can make it even harder for a person to reach out for help.
Like addiction and other forms of mental illness, healing and recovery are best achieved through a solid support network of loved ones and professionals.
What Is Hoarding Disorder?
Hoarding is a mental health disorder characterized by an excessive accumulation of possessions that have little to no value. Further, a person will have an inability to discard these items, despite the obvious toll they have on their life.
These behaviors are so extreme that a person suffers from high rates of distress and functional impairment. Hoarding can cause emotional, physical, mental, social, financial and/or legal instability. It’s estimated that as high as 14 million Americans suffer from the debilitating effects of compulsive hoarding, according to Scientific American.
Because of these states, a person becomes unable to use areas of their home or other personal spaces, such as offices, vehicles or a garage. The most frequently hoarded items are:
- bills or statements
- letters or other paper goods
Any item may be hoarded. Additional items include cardboard boxes, food, household supplies, paper and plastic bags and photographs. Some individuals even hoard animals, keeping dozens or even a hundred animals in unsanitary and unsafe conditions.
Hoarding is different from collecting. Collectors are generally organized and feel a sense of pride and well-being from their collection, whereas a hoarder experiences shame and detriment to their life.
When a person with a hoarding disorder is confronted with the possibility of throwing away their belongings (or giving away their animals) they typically experience a strong emotional reaction and intense anxiety.
The onset of hoarding usually occurs between ages 11 and 15 and in most cases progressively worsens as a person ages. Research has shown that difficult life experiences, like the death of a loved one, disability or illness, trigger or worsen hoarding behaviors. The average age of an individual pursuing treatment for a hoarding disorder is about 50.
Hoarding is more common in men and older adults. It has also been shown to run in families, similar to many other mental health disorders. The APA writes that “three times as many adults 55 to 94 years are affected by hoarding disorder compared to adults 34 to 44 years old.”
Many people with hoarding disorder have other problems which make it difficult for them to function. These issues may be symptoms of another mental illness. The cumulative effects of these problems increase the severity of the hoarding disorder.
These problems may include:
- difficulty planning
Further, a person may have obsessive thoughts or actions which fuel their hoarding behaviors. Some individuals may routinely check the garbage to make sure they didn’t accidentally throw something away. A person may be intensely preoccupied with the thought of running out of an item or requiring it in the future, leading them to buy more or save what they already have.
For many, hoarding isn’t just the compulsion to hold onto things, it’s also fed by the overwhelming desire to acquire new things.
Hoarding And Compulsive Shopping
A significant number of hoarders may have an acquisition-related impulse control disorder (ICD), meaning an ICD that drives a person to acquire more stuff. Examples include acquiring free things, compulsive shopping and kleptomania. These individuals may not be able to resist bargains or free giveaways, leading them to stockpile items they have no use for. Other people may compulsively steal to fuel their hoarding behaviors.
Individuals with compulsive hoarding are said to experience a sense of acute distress that does not dissipate until they obtain the object they’re fixated on. One study, reported on by Huffington Post, found that almost two-thirds of persons struggling with hoarding disorder had a compulsive buying problem.
Is Hoarding An Obsessive Compulsive Disorder?
Hoarding had long been considered a sub type of obsessive compulsive disorder (OCD), however, the updated official diagnosis now makes hoarding its own disorder. According to TIME, only 18 percent of people with a hoarding disorder meet the full criteria of OCD.
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Research has found that people with hoarding disorders have distinct patterns of brain activity which differ from healthy individuals and those with OCD. Specifically, these brain patterns originate when a person is faced with making a decision. Individuals with hoarding disorders have an extremely hard time making a decision to throw or give away their possessions.
This abnormal brain activity occurs in regions of the brain which are responsible for determining an object’s emotional significance. This could explain why a person with hoarding disorder has such strong emotional attachments to objects which wouldn’t typically draw such a response.
Signs Of A Hoarding Disorder
Unlike addiction, a person with a hoarding disorder may not exhibit many visible symptoms outside of the home. However, the signs of hoarding become quite clear once a individual’s personal space is observed.
Signs of hoarding include when a person:
- has an extreme need to save things, even though they have little to no worth
- is unable to give or throw away items
- struggles to categorize or organize possessions
- becomes suspicious or upset if other people handle or touch their possessions
- experiences emotional distress over hoarding behaviors and excess possessions
- has overwhelming anxiety at the thought of throwing things away
Other signs include:
- areas of the home are unusable
- the only way to navigate through a space is by small paths
- the hoarding interferes with daily activities
- large accumulations of food and trash
- excess numbers of animals, often suffering neglect
- unsanitary and hazardous living conditions
- family or marriage problems which stem from the hoarding
- growing social isolation
The effects of hoarding can become so great, that a person’s health, relationships and quality of life begin to suffer.
The Risks And Dangers Of Hoarding
Hoarding can severely impair a person’s ability to function, both within and outside of their home. As the hoarding gets worse, the dangers and risks associated with living in this environment increase.
- animal or insect infestations
- animal neglect
- economic and financial burden
- illness and disease
- isolation and loneliness
- losing custody of a child
- trip and fall hazards
Many people with this disorder struggle to take care of basic, daily needs, such as eating, cooking, bathing and sleeping, due to the obstacles in their home. Hoarding has also been linked to poor medication compliance and increased rates of obesity. Some people also develop respiratory problems from the dust mites and squalor which result from the hoarding.
The severe clutter and obstructions caused by hoarding can make it difficult for a person to safely exit their home during emergency. This could be life-threatening during a fire.
The Washington Post reports on research which found “that hoarding-related fires ranked among the most deadly of all blazes, with 48 such fires responsible for 10 fatalities over a 10-year period.”
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This same article found that in New York, 22 percent of individuals facing eviction struggled with hoarding. Housing instability is a common threat for these individuals. Eviction causes many individuals to lose their home, some of whom become homeless.
For individuals abusing drugs or alcohol, these effects may be felt more intensely. A substance use disorder can make it harder for a person to maintain their daily needs and habits of self-care. Addiction increases the odds a person will struggle with marital problems, financial turmoil and illness and disease, potentially worsening conditions already triggered by hoarding.
The Link Between Hoarding Disorder And Mental Illness
Like many mental illnesses, including addiction, hoarding is often accompanied by another mental illness. Quite often, the hoarding is a symptom of another mental illness, though it can exist on its own.
The following are most frequently associated with hoarding:
- alcohol use disorders
- attention-deficit/hyperactivity disorder (ADHD) (especially the inattentive form)
- major depressive disorder
- obsessive-compulsive disorder (OCD)
- obsessive-compulsive personality disorder (OCPD)
- social phobia
According to the Anxiety and Depression Association of America, in more limited instances, hoarding may also be linked to dementia, eating disorders, pica, Prader-Willi syndrome (a genetic disorder) or psychosis. Schizophrenia and brain injuries are also linked to hoarding.
How To Help A Person With A Hoarding Disorder
Helping a person with a hoarding disorder often requires a team approach. To fully address all the adverse impacts caused by hoarding, a collaboration of professionals and individuals close to the person in need may be assembled.
Example of individuals who make up this team include:
- the landlord
- home-health nurse
- a code enforcement officer
- family members or other loved ones
- social workers
This combination ensures that physical, mental, emotional, social and safety-oriented needs are addressed in a timely manner.
Some individuals may benefit more fully from a private intervention. The best outcomes are achieved when the assistance is individualized to each person’s unique temperament and needs. Seeking professional assistance can help loved ones to make the most informed decision in these circumstances.
Mutual support groups exist for both the person with the hoarding disorder and their loved ones. These groups provide opportunities for support, shared stories, coping skills and recovery resources. Examples of peer support programs for people with hoarding disorder or collecting behaviors include the Buried in Treasures program and Clutterers Anonymous.
Many individuals enlist the aid of a “clutter buddy” (sometimes referred to as a “declutter buddy”). This person keeps them accountable and encouraged throughout the decluttering and recovery process. Therapy and counseling are also integral parts of recovery from hoarding.
The Institute for Compulsive Hoarding and Cluttering at the Mental Health Association of San Francisco is a local, national and international organization which may provide resources and support for individuals in need and their loved ones.
Finding Treatment For Hoarding And Addiction
Individuals contending with a co-occurring mental health disorder, or dual diagnosis, have the highest chance of recovery within individualized treatment programs. This holds especially true for a person seeking to overcome both a hoarding and substance use disorder.
Treatment should be sensitive to a person’s emotional and mental needs. At the same time, a person needs to be challenged so that they can learn to adapt to the demands of a drug-free life.
Individual and group therapy and counseling sessions help a person to heal individually and on an interpersonal level. Cognitive behavioral therapy (CBT) has been shown to help a person overcome the damaging thoughts and behaviors associated with hoarding disorder. This psychotherapy is also an evidenced-based therapy for the treatment of a substance use disorder.
An inpatient drug rehabilitation program gives a person more time to develop coping and stress reduction skills, so that they’re better adept at living a balanced life.