Compulsive Hoarding (Part II) – Treatment and Seeking Help for Yourself or a Loved One
Compulsive hoarding affects the lives of millions of people. While it can severely disrupt the life of the hoarder, it also inevitably impacts his or her loved ones as well. It can make life especially difficult for a spouse, family members, or anyone else who shares their home with a compulsive hoarder.
Unlike the "packrat" who finds it very hard to let go of sentimental or potentially useful things, the compulsive hoarder has a deep-seated need to keep almost everything while constantly accumulating more and more of the same. Whether it’s clothing, household goods, any and everything on sale, or even pets, compulsive hoarders often find their lives spiraling out of control as their excessive stuff takes over their life.
In extreme cases, compulsive hoarders inadvertently put themselves and others in toxic and even dangerous situations. This is typically due to fire hazard, risk of injury, and potential health issues due to the vast accumulation of clutter, stored items, and / or animals in the home.
When to Seek Help
The first signs of a problem with hoarding typically occur during adolescence, although they may appear in childhood. Without treatment, the problem usually gradually gets worse over time and can become quite serious by or before middle age. As with all disorders, it’s always better to seek help sooner than later.
Like most behavioral issues, compulsive hoarding can range from mild to severe. The degree of severity is determined by the degree to which the behavior disrupts or impairs the person’s ability to function or live a normal life. The more the behavior interferes with any important area of life – e.g. relationships, work, school, family, and social life – the more imperative it is to seek help.
It’s also important to seek help if hoarding is causing distress of any kind. This can include feelings of anxiety, depression, shame, guilt, low self-esteem, and sadness. Many hoarders have co-occurring disorders which should also be treated, such as depression, anxiety, bipolar disorder, and / or substance abuse problems.
Treatment for Compulsive Hoarding
Hoarding is a compulsive disorder that isn’t simply managed with self-control. Since it compromises a person’s happiness, health and well-being, getting professional help is an important step towards recovery.
Treatment for compulsive hoarding typically involves psychotherapy and / or medication. The course of treatment will be determined to some degree by the underlying issues. For example, if your hoarding behavior is due to OCD, your treatment plan will be a bit different than for a hoarder who does not have OCD. Compulsive hoarding is often related to and co-occurs with other disorders as well, such as schizophrenia, social anxiety, depression, anorexia, and Alzheimer’s.
One of the most effective therapies for the treatment of compulsive hoarding is "Cognitive Behavioral Therapy" (CBT for short). CBT focuses on identifying and changing irrational, destructive thought patterns into ones that are healthy and empowering. It works on the premise that our thoughts (which include how one perceives things) influence our emotions and behavior. Individuals who engage in hoarding have problematic thought patterns that fuel their unhealthy behavior.
While other types of psychotherapy may also be beneficial, CBT has been extensively researched. It’s considered to be one of the best types of therapy for hoarding as well as many other disorders, including depression and anxiety.
Medication may be beneficial for some hoarders, particularly those with OCD. However, it’s not likely to be as effective as psychotherapy, and may not be beneficial at all for some individuals. Antidepressant medications known as SSRIs (selective serotonin reuptake inhibitors) are the most commonly prescribed medications for compulsive hoarding.
Unfortunately, compulsive hoarding is generally difficult to treat. Treatment doesn’t "cure" the disorder, but it can help you learn to manage the disorder so that it doesn’t control your life.
Getting Help for a Loved One
Many compulsive hoarders don’t regard their behavior as unusual or abnormal. This is especially true if they are socially isolated. The greater the isolation, the more difficult it can be for hoarders to recognize just how unusual or serious their behavior really is.
Other hoarders, however, strongly suspect or are keenly aware that they have a problem. However, the shame they feel prevents them from reaching out for help. They live their lives in quiet despair, doing their best to hide their disorder while hoping that no one ever finds out.
Sadly, many hoarders never seek help for these reasons. If someone you love is a compulsive hoarder, you may need to intervene in order for them to get the help they need. This is especially important if their hoarding behavior is causing significant distress or impairment, or if there are potential safety or health risks.
To do this, it’s almost always best to try to talk to your loved one first. Express your concerns in a gentle, non-blaming, and non-judgmental manner. This is a highly sensitive issue, so you don’t want to put them on the defensive. If talking to them directly doesn’t work, then you may want to talk to your doctor (or your loved one’s doctor if possible) for a referral and suggestions. You can also consult with a mental health professional. He or she can help you determine the best way to approach the topic so your loved one will be more open to treatment.
One of the greatest obstacles is the fear that someone will come into their home and take everything away. While you may be able to assure them that this doesn’t happen in many cases, the situation may warrant some changes if their safety and health or if the safety and health of anyone else is at risk due to their hoarding.
Addressing Safety and Health Hazards
If there are legitimate safety and health concerns, those must be addressed even if your loved one is unwilling to get into treatment. A fire hazard should not be ignored. It not only endangers your loved one, it also endangers anyone else living in the home (including pets) as well as immediate neighbors. If your loved one is hoarding a large number of animals, the animals will likely need to be removed from the home. This is for their wellbeing as well as that of your loved one.
Again, it’s usually best to try to first work with your loved one to try to alleviate any risks as much as possible. Frame things in terms of how it will benefit him or her. Be aware, however, that your attempt may be met with significant resistance. There is always a degree of irrational and distorted thinking that accompanies abnormal behavior like hoarding. Don’t expect your loved one to see things logically. So be sure to have a "plan B" in place.
Before talking to your loved one regarding safety hazards and health risks due to the hoarding behavior, talk to a mental health professional – preferably someone who is very experienced in dealing with hoarders. You may also need to talk to an attorney regarding your loved one’s rights (e.g. with regards to hoarding animals, safety hazards, etc.). You don’t want to give your loved one false assurance only to have the authorities intervene regardless in order to ensure everyone’s safety.
The sad reality is that your loved one may be forced to make some serious changes. Should that happen, it’s important that you be as supportive and helpful as possible. Your loved one may end up getting very angry at you for intervening in the first place. Should this occur, however, remind yourself that you’d rather have him or her alive and mad at you, rather than dead or seriously injured because you stood back and did nothing.
If your loved one agrees to get into treatment, then continue to be supportive. Don’t expect miracles; as mentioned above, hoarding is a very difficult disorder to treat. Your loved one may improve a little or a lot – or not at all. Encourage him or her to stay in treatment and work with his therapist or other treatment provider.