“Situational Hoarding” is the build up of clutter because situations of life (illness, surgery, caregiving, death, divorce, or other traumas) have prevented someone from dealing with papers or possessions as they normally would. Items pile up to be dealt with “later”. Once the crisis has passed, the amount to be dealt with is overwhelming and people become immobilized and need significant, and often, professional help to dig them out and restore order to their spaces. It’s not that they can’t or won’t get rid of things, but that they need help to physically get the items that can be sold, donated, recycled or discarded removed from their home or yard.
The Diagnostic and Statistical Manual of Mental Disorders – 5th Edition (DSM-5, American Psychiatric Association, 2013) defines Hoarding Disorder (HD) as follows:
1. Persistent difficulty discarding or parting with possessions, regardless of their actual value.
2. This difficulty is due to a perceived need to save the items and to distress associated with discarding.
3. The difficulty discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use. If living areas are uncluttered, it is only because of the interventions of third parties (e.g., family members, cleaners, authorities).
4. The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others).
5. The hoarding is not attributable to another medical condition (e.g., brain injury, cerebrovascular disease, Prader-Willi syndrome).
6. The hoarding is not better explained by the symptoms of another mental disorder (e.g., obsessions in obsessive-compulsive disorder, decreased energy in major depressive disorder, delusions in schizophrenia or another psychotic disorder, cognitive deficits in major neurocognitive disorder, restricted interests in autism spectrum disorder).
The DSM-V also calls for the clinician to specify whether the individual is also experiencing “excessive acquisition” (e.g., do they acquire items that they don’t need and for which they don’t have space in their home?) and to specify the person’s level of insight (good, fair, poor, or absent/delusional). Hoarding disorder is a recognized mental illness and is NOT a character defect. There is help available and hoarding behaviors can be minimized and replaced by new behaviors that create a more functional, peaceful and satisfying life.
The Hoard is not about the stuff. Emotional needs are being met in some way by the hoard. Look ahead, not behind. Past is usually painful and full of loss or traumas, which have triggered or contributed to hoarding behaviors. The person who hoards needs to see that their future can be better and that they have some control over determining what happens next in their life. See the person first, the hoard second. Under all of the “stuff” is a hurting person. Hope is key, and a critical part of changing behaviors. Things can be different. Organize items so that like things are together and easy to find when needed. The primary goal is safety; functionality is important, not necessarily getting rid of items. Professionals are trained to help. Hoarding Disorder is NOT a logical disease and usually logical solutions are more harmful than helpful. Encouragement is necessary for even the tiniest step forward and any progress.