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Hoarding Disorder: What you should know

Uncategorized Jan 20, 2019

With a new year well underway and Marie’s Kondo’s Netflix debut on tidying up streaming, it is no surprise that many of us feel the need to create a fresh start and revisit our possessions. This can be very positive, but for many of us, possessions are a link to the life that we have led and help us tell our personal story.  For others, there is an even darker side to a lifetime of collecting possessions: hoarding. Hoarding is now officially recognized as a mental disorder under the DSM-5, the Diagnostic Statistical Manual (5th ed.), an international guide on clinical diagnoses. For adult children and families, hoarding can lead to serious health and safety concerns, as well as to legal implications.

Let’s take the case of Mary, who lives alone in a small rental unit. She has been independent for many years. She doesn’t receive care services in her home, and neighbours complain when they detect an offensive odour coming from her unit.  The landlord has legal authority under the lease to enter the apartment, and the scene is dire. There are old newspapers and magazines stacked up, feces (human or animal?) in open view, the smell of urine, and old, broken furniture and kitchen appliances on every surface, and the stove is full of garbage. The plumbing is also clogged with paper towels and newspapers, and what appears to be black mold is seen in the bathroom.

Mary is defensive and distressed.  She is now faced with losing both her possessions and her housing.  Public health authorities are brought in to assist.  Although it is a long process, steps are taken to determine that Mary does in fact have a hoarding disorder.  With the appropriate supports, is able to cleanup and remain in the apartment.  For others with similar stories, it may lead to eviction. 

The DSM-5 treats hoarding as a mental illness. If a senior has a pattern of difficulty with parting with possessions, whether or not they are valuable, this can have an impact on their health and wellness and create hazards both for them and anyone who visits their home. While a senior can say, “this is my home and I decide”, the fact is that if their choices impact on others, whether that is neighbours or others who live in adjacent units in a rental building or care facility. This is going to create strife and may even lead to legal action being initiated. It is also possible that the senior’s “choice” is not a choice at all, because the senior is not cognitively able to make the choice or appreciate the impact of their actions.

The discussion regarding whether a senior is hoarding is a difficult one, and can create family tensions. The senior may become defensive. Tempers may flare, as fights over the living conditions, safety, or possessions ensue. Steps may be taken periodically to do a ‘big’ cleanup in the hopes no further interventions will be needed – until it happens yet again.

It is important to engage clinical supports early, such as a family doctor, mental health professional, or if necessary, public health. Many communities have local resources.  Is it possible that the home is unclean and untidy because of the senior’s current physical limitations? Has their cognitive ability changed? Is it the result of any other mental disorder, such as depression or anxiety?

Hoarding is increasingly being brought out into the light; for many who have the disorder, there can also be a sense of shame.  As a caregiver, if there is a real cause for concern or potential safety and health, not raising the issue may lead to serious consequences.  Try to ask, and not tell.  Listen carefully to the answers you are given, and try to mirror the language that is used.  Be respectful and try to build a working relationship to move forward.  Often you will need outside help – it can feel overwhelming to get started.  You can start with an internet search of hoarding resources in the area where the senior lives, for example, or seek medical advice. Depending on where the senior lives, police or other community agencies may do a wellness check. From a legal point of view, mental health legislation may give some more formal options, but may be a difficult and fairly drastic step which could result in the senior being removed from their home due to the fact a mental disorder is creating a risk to the senior or others and may have repercussions when seeking future housing.

When we talk about hoarding, it is important to remember that it is not about a person who is merely untidy or inattentive. People joke about being a hoarder, but it is a serious mental illness that deserves compassion, thoughtful attention and patience.

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