The coming of spring is sometimes associated with the ritual of a thorough housecleaning. Spring cleaning may be connected historically to the Iranians and Chinese, who clean their homes in anticipation of the start of a new year; or to the Jewish culture, in which homes are cleaned prior to the celebration of Passover. Regardless of where the term originated, the thought of any cleaning, much less spring cleaning, creates extreme emotions for families who have experienced hoarding behaviors by a loved one.
Prior to 2013, when the American Psychiatric Association first listed hoarding disorder as a distinct condition in their Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it was considered to be a symptom or subtype of obsessive compulsive disorder. The first widely accepted definition of hoarding was developed in 1996 by Professor Randy Frost of Smith College, working with Tamara Hartl. They proposed three characteristics of hoarding: “(1) the acquisition of, and failure to discard a large number of possessions that appear to be useless or of limited value; (2) living spaces sufficiently cluttered so as to preclude activities for which those spaces were designed; and (3) significant distress or impairment in functioning caused by the hoarding.”
The possessions involved in hoarding are commonly referred to as clutter. How does one know when the amount of clutter progresses from a general accumulation to hoarding? Cluttergone, a company in the UK which provides decluttering and organization services, defines what they call “The three C’s – Clutter, Clots, and Clogs.” Clutter is considered a general disorganization of belongings. These belongings are being used, but not put away afterward. “Clots” are piles of belongings which don’t move for six months or more, and hinder the use of spaces within the home. A suggestion or attempt to move a “clot” can create anxiety for the owner. “Clots” progress to “clogs” when the piles begin to grow and touch each other, creating difficulties in navigating around the home. “The possessions are no longer being used. The person is now serving their things rather than the other way around.” (www.compulsive-hoarding.org).
The accumulation of possessions can occur in several ways. While compulsive shopping is one culprit, some hoarders acquire only free items, and still others may resort to stealing. Other hoarders don’t necessarily acquire excessive amounts of new items, but instead don’t throw anything away, resulting in excessive amounts of trash, such as containers and packaging. Another variation of hoarding includes the acquisition of animals instead of objects. These individuals have a need to acquire and control the animals, which preempts the needs of the animals themselves.
Why do these behaviors occur? The Mayo Clinic lists several risk factors:
- Age: Hoarding can begin in the early teenage years, and when it does, it worsens as one gets older. In general, older adults are more likely to demonstrate hoarding behaviors than young adults.
- Personality: The characteristic of indecisiveness is common among hoarders.
- Stressful life events: Hoarding may become a coping mechanism for those who experience loss through events such as death, divorce, or a house fire; or for those who experience traumatic events such as abuse.
- Social isolation: Two perspectives are to be considered here. Hoarding can lead to social isolation due to the physical difficulties of having guests in the home as well as emotional elements such as fear of judgement and criticism. Hoarding may also be the result of social isolation, as the individual substitutes an attachment to things for absent human contact.
How do professionals diagnose hoarding disorder? The DSM-5 referred to earlier lists the following criteria:
- Throwing things away or parting with belongings is difficult for you, even if the items don’t have monetary value
- Feelings of anxiety accompany your thoughts of discarding belongings
- The acquisition of belongings results in areas of your home becoming unusable.
- The acquisition of belongings interferes with your family and/or social life, or functioning at work.
- The behavior is not the result of another medical condition such as a brain injury or a depression causing lack of energy for daily functioning.
Hoarding is a complex disorder which continues to require research in order to understand its triggers, behaviors, and potential treatments. Older adults are at risk for hoarding disorder due to the greater likelihood that they are experiencing social isolation or have experienced a stressful life event. Next week’s column will discuss how to address hoarding behaviors.
Karen Kaslow, RN