Living and Wellness Hoarding Disorder: The Silent Struggle You Can’t Hide By Aging Institute, June 23, 2015 We often see news stories featuring people known as “hoarders.” Photos and video depict unsanitary and often unlivable conditions and the frustrated tales from family and friends who are struggling to understand why their loved ones let things get so bad. What most don’t realize is that hoarding disorder is a lot more than a messy house and an abundance of things. What is Hoarding Disorder? Hoarding disorder is defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM V) as persistent difficulty discarding or parting with possessions, regardless of the value others may attribute to these possessions. The behavior usually has harmful effects — emotional, physical, social, financial, and even legal — for the person suffering from the disorder and family members. For someone with hoarding disorder, it’s not as simple as throwing the items away. They have an emotional attachment to their possessions and discarding them can cause them significant mental anguish and emotional distress. Mary Brodland Runevitch, LCSW, LSW, and senior social worker in geriatrics for UPMC explains the silent struggle that hoarders endure. “For people with hoarding disorder, they can feel extremely isolated in their struggle,” she says. “There may be real feelings of fear, shame, and guilt, which make it difficult to ask for help. There may also be an inability to have insight into the situation meaning they lack the ability to understand there is an issue, which can cause misunderstanding between the individual who is hoarding and their loved ones or concerned friends.” Hoarding: Degrees of Severity Like many disorders, hoarding varies in degree of severity. Randy Frost, Ph.D., professor of psychology at Smith College, created a rating scale called the Clutter Image Rating Scale, which helps patients and clinicians determine the level of severity of the hoarding disorder. The scale, which ranges from levels 1 to 9, shows images of different rooms in a home with various amounts of clutter. Patients are then encouraged to choose a picture which best reflects their own home. This helps to determine where on the spectrum the patient falls. The study of hoarding disorder is still relatively new and researchers are learning new things all the time about people who are dealing with this disorder. “We know that all people with hoarding disorder have a lot of difficulty discarding their belongings,” Brodland Runevitch says. “Studies have shown that in people who hoard there is different activity in the areas of the brain responsible for detecting mistakes, doing risk assessment and making emotional decisions during the act of discarding items and decision making.” Older Adults and Hoarding When it comes to senior citizens and hoarding disorder, it can be even more difficult to help. Often family realizes the extent of the disorder when it becomes necessary to move their loved one out of their home and into a skilled care facility. When dealing with a geriatric patient, it’s important to consider their background to figure out the root cause of the problem. “Often with our seniors we will learn through counseling that they’ve experienced a sort of trauma in their past,” Brodland Runevitch says. “Perhaps they lived through the Great Depression and their tendency towards hoarding stems from that experience. If we can get to the root of the problem, we have a better chance of helping them.” Research has also shown that there is a familial link found in hoarding disorder. For every hoarder in a family, there is usually at least one other family member with the same struggle, whether from the same or different generations. “Hoarding is an intergenerational disorder,” Brodland Runevitch says. “Whether hoarding disorder manifests through nature or nurture is still a huge debate. If you see an older adult in your family struggling with this, it may be good to keep an eye open for signs in younger generations. The sooner you can start to treat someone for the disorder and teach them skills to help combat it, the better.” How to Help a Hoarder Fortunately, there is help for people who are struggling with this condition. If you feel your friend or loved one might have hoarding disorder, considering the following options: Reach out to them in a comforting and gentle way. While it may seem like a simple solution of removing items from a home, hoarding is a serious psychological disorder that causes distress for patients. Try to listen to them and be understanding. Don’t judge them or make them feel embarrassed. Common characteristics in hoarding patients are disorganization, an inability to complete tasks, and perfectionism. It will be difficult for them to follow through with looking into counseling so being the person to help them through the process can be very beneficial. Offer to find them a counselor or help them discover resources that are available in their community. Know what resources are available and utilize them. The OCD Foundation has a large section dedicated to hoarding where you can find information and get support from national groups. Allegheny County has a Hoarding Task Force to help people who have loved ones struggling and don’t know how to help. The Aging Institute of UPMC can also aid in connecting people with community resources that may be of assistance. If you or a loved one is struggling with hoarding disorder or suspect someone else might be, visit the Aging Institute of UPMC website or call the Help and Referral Line at 1-866-430-8742 to find out how you can get help.