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Held Hostage by Hoarding Part II – Keystone Elder Law

Last week’s column addressed some background information related to the disorder of hoarding. Many people with this disorder do not recognize the health and safety issues which can result from excessive hoarding, or the emotional distress that others in the household may feel as increasing amounts of “stuff” overtake living areas, making them unusable.

This lack of recognition makes hoarding difficult to treat. A form of psychotherapy called cognitive behavior therapy is the primary treatment for hoarding, so an individual must be willing to participate in order for therapy to be effective.  Cognitive behavior therapy will address feelings which surround the hoarding behavior, teach individuals how to sort and organize belongings, help them develop more effective decision-making and coping skills, and learn relaxation techniques.  Participation in family or group therapy may also be beneficial, and the therapist may enlist the help of a professional organizer to assist with the task of managing the hoarded belongings ( Medications such as antidepressants are also beginning to be used as another method of treatment.

Jasmin Harman, whose mother has been a lifetime hoarder, offers some tips on her website ( for “Helping Hoarders to Help Themselves.”

  • Acknowledge the problem (she provides a series of pictures of varying amounts of belongings to help an individual/family determine the extent of the issue).
  • Ask for help. There are professionals and organizations who will be sensitive to the emotions which are being experienced by the individual.
  • Begin with small achievable goals. Instead of an entire room, focus on one box, tabletop, or cabinet.
  • Spend at least 15 minutes once per day working on the one area of focus. As anxiety lessens during cleaning sessions, gradually increase the amount of time each day until the job is finished.
  • Take only 10-20 seconds to make a decision about keeping or discarding an object (the longer it is thought about, the easier it becomes to keep).
  • Avoid just moving items around the home and prevent the temptation change your mind and keep things by having discarded items taken somewhere else immediately.
  • Remember it is not your responsibility to keep things for other people.
  • Stick to a schedule and do not allow yourself to be interrupted during your cleaning sessions.
  • Reward yourself for your accomplishments by taking before and after photos or treating yourself to an activity which won’t contribute to adding to your belongings.
  • Set rules for yourself and your helpers to make the process flow more smoothly.
  • Remember that the negative feelings experienced by discarding some possessions are only temporary (she provides an excellent suggestion to test this theory).
  • Be aware of situations which will tempt you to obtain additional belongings, such as special sales or a favorite store.
  • Take personal responsibility for your progress.

If the individual who is demonstrating hoarding behaviors is not willing to seek treatment, no amount of “begging, bullying, or bribing” (as described by Ms. Harman) will convince the individual to make changes. In cases like this, it is important for loved ones to remember that their own needs must also be addressed. It may be possible to establish some ground rules for certain areas of the home, which all family members must follow. This step allows other family members to have a place of escape.  Some family members may choose to obtain counseling for themselves or to remove themselves from the situation by moving out of the house or only visiting the hoarder at a location other than the home.  If minor children are living in the home, it is essential to assess and ensure their health and safety.

Providing support and encouragement for a hoarder to seek and consistently participate in treatment requires a tremendous amount of patience and self-control. The hoarder must be involved in decision-making and treated with respect if successful outcomes are desired.  When sharing information with a hoarder, communicating factual information and avoiding opinions will promote more positive interactions.  Others should remember that the hoarder has developed an attachment to the belongings and that they provide a sense of security, even though this may be difficult to understand.  Expect the process to move slowly.  For older adults, hoarding behaviors may be the result of physical limitations in addition to psychological factors, so both areas should be addressed.

Karen Kaslow, RN