The Compulsive Hoarding Center is a nationally recognized treatment facility offering hope and inspiration for those struggling with clutter and hoarding behaviors.
The behavioral specialist team travels the country helping those who do not have experts in their community who have the expertise or training to address this very complex condition. Individuals who are seeking help will develop a comprehensive understanding of the factors that contribute to their acquiring and difficulty letting go, which may include psychological trauma, distortions in thinking patterns and behaviors, and working to re-train the brain to think differently about their stuff.
Compulsive Hoarding (Disposophobia) or more formally Hoarding Disorder is considered to be a clinical syndrome reported to affect approximately 3 million Americans across the United States. We believe however, that these statistics are highly underrepresented due to the difficulty that those who experience this condition have in asking for help. While some may not know or acknowledge that this is a problem for them, others who do fear asking for help due to a variety of factors. Depending on the degree of hoard in the environment, many worry that if they allow others into their home that they will begin to throw away, or take items without their permission. In more extreme cases, individuals suffering form this condition may have created environments that have health and safety violations, fearing that they, or others in their home, may be removed. While these fears are understandable, with help, these harmful conditions can be improved and ultimately eliminated.
Hoarding Disorder is a syndrome that refers to individuals who acquire items or objects to an excessive degree, which may or may not be of use to them. While this behavior in and of itself may not be a problem, when the items begin to clutter the area so much so that the spaces in which they are intended are not able to be used, that is when this behavior becomes a problem. It is also common that health and safety issues come into play, such as air that becomes contaminated due to elements including feces from animals, or mildew and mold build up.
While Hoarding Disorder is impacted by several factors, the reluctance to either throw away, give up, or return the objects or items collected are some of the key features of this condition. Often times there can be an over-interpretation of the value of the objects, and/or an emotional attachment to them, making it extremely difficult to let go of them. The anxiety that is either anticipated or experienced can be so overwhelming that in the moment it “feels” as if the easier route is to simply keep them. This however is a trap, and, a distortion. The reality is that “the easiest route is not always the quickest route,” and ultimately, these thinking errors only serve to worsen the problem. Consequently, there is a trend in which these behaviors will begin to create interference in several different areas of one’s life, including but not limited to social, occupational, and educational endeavors.
Additional factors influencing Hoarding Disorder include:
- Too much shopping or compulsive shopping
- Fear of waste
- Difficulty processing information
- Fear of losing important information
Needless to say, hoarding behaviors can have devastating consequences for the individual struggling with this condition and likewise, those close to them. Often times as the hoarder is struggling with trying to just keep up with the daily challenges that the environment brings them, family and friends can get forgotten. For those living with the compulsive hoarder, their lives become limited as they too will experience the effects of limited space and the isolative lifestyle that is often times brought on by this condition. This is typically caused by the shame and embarrassment that they feel if someone was to come over to the home and see what their home life actually looks like.
Hoarding Disorder is a condition that is caused by both biological and psychological factors. Because of this, it is critical that individuals facing this condition receive specialized treatment services, which includes Cognitive Behavior Therapy and Exposure and Response Prevention Techniques. While this process does involving talking, traditional “talk therapy” or psychotherapy are not prescribed treatment protocols for Hoarding Disorder. And, the idea is not to try to ‘talk” someone into letting go of their possessions, or engage in a “clean up process.” The key is to start identifying the thinking errors that are leading to the excessive acquiring (whether it be shopping, bringing home free items, or even going through trash cans and dumpsters), and the difficulty organizing and purging what is in the home or other cluttered environment. Basically, when there is too much incoming, and not enough outgoing, problems begin to emerge. So, the Cognitive Behavior Therapy will help an individual to begin to change thinking patterns leading to the acquiring, and the Exposure and Response Prevention Therapy will help them to begin resisting bringing in more items, and learn to let go and tolerate the anxiety that they may experience. By and large, most people don’t seek treatment due to the “anticipatory” anxiety they experience when thinking about letting go of items. Overall however, we have found when people begin to engage in the process that their anxiety of letting go of items was far less than they anticipated.
In addition to helping the person struggling with clutter or Hoarding Disorder, it will be equally important to include any family members, or other support who are impacted by the condition. Often times there is incredible frustration built up, even anger. As these emotions intensify, arguments ensue that only serve to create a more tense and uncomfortable environment. As such, we have a few tips to help guide family members:
- Educate yourself about Compulsive Hoarding Syndrome.
- Participate in the treatment process.
- Be open to understanding, compassion, and patience.
- Do not get into arguments. It will not help the situation
- Be aware of non-verbal expressions (For example, sighing, rolling of the eyes).
- Don’t suggest what they should or should not do. This condition requires professional therapy.
- Encourage your loved one in the therapy process.
- Acknowledge accomplishments for the steps that are taken.
- Remember that the hoarded environment didn’t happen over night, therefore, it won’t be fixed over night.
- Do not attempt to purge or remove items without permission. It will only make things worse.
- Telling them to stop bringing items into the home, to clean up, or throw away items will not be effective. If they could, they would!!
Understanding the difference between saving, collecting, and Compulsive Hoarding
While there are overlapping features in saving, collecting, and compulsive hoarding, there are distinct differences in them as well. At its basic level, all three of these behaviors involve acquiring items and keeping them. Most people, at very young ages, develop saving behaviors to hold on to items for various purposes. They may see use for it either in the immediate or later future. Whether it be a rubber band, scarf, plastic bag, or even a piece of foil, they anticipate use for it. And, typically they will use it and if not, perhaps discard it because at some point, they recognize that they have not had use for it. The saved items in no way cause distress or interfere with the persons functioning, or those around them.
Saving items can also stem from a desire to recall memories. Many of us can relate to keeping items such as pictures from childhood, shirts from a special vacation or trip, or even a napkin from a restaurant that was particularly enjoyable. Typically there will be a place to organize those items as a means of having access to them when needed. If it is the rubber band or foil, perhaps they will be located in a drawer in the kitchen. If it is a picture or napkin, placed inside a scrapbook. If it’s a scarf or other clothing item, folded in a drawer in the bedroom closet.
Collecting occurs when an individual owns a grouping of items (even several groups), in which they are organized in a manner that allows them to enjoy, use, or even admire them. Although they can have many items in their collection, typically there is room or a place to display them, allowing both themselves and others to view and appreciate them. There will typically be a system in which the item is purchased, for example, books in a series, limited edition paintings by an artist, or figurines from a favorite sculptor. An individual who collects will often times feel proud of what they have acquired and experience great pleasure.
Hoarding behaviors do not typically involve an organized system, both in acquiring the items, and when bringing them into the home or stored environment. The items acquired are to such a degree that they begin to overrun areas in the room to a degree that they can no longer be used for the purpose in which they were intended. For example, the couch may be covered in clothing, the kitchen counters flooded with food or packages (full or empty), or the floors might be covered with items that make it difficult to navigate getting from one place to another.
Many people who compulsively hoard will describe holding on to items to retain a memory, just as we described in someone who might save. The difference however, is the amount of items that the person is holding on to and the fear that if they give up the item, they will forget the memory. Additionally, individuals who compulsively hoard will also talk about the pleasure they experience when they acquire items just as the collector, however the difference is that they will ultimately experience distress from all the items that are taking over the house.
Our Treatment Options:
The Center for Compulsive Hoarding offers treatment services including individual, group and family therapy, in addition to an Intensive Outpatient Treatment Program.
There are several phases to the treatment process:
Phase 1: An initial evaluation is conducted to gather information to determine the specific needs of each individual person. Factors to consider include the number of items collected or hoarded, health and safety issues, and impact on self and family. A history of the problem is obtained and assessments are given to determine the severity of the problem, as well as the specific items that are being acquired and saved. A treatment plan will be discussed which will include one or more of the following modalities:
Individual Therapy: One-on-one therapy with a behavioral specialist anywhere from 1 to 3 times per week, depending on the client’s needs. This is for those that are experiencing a mild level of symptomatology who can benefit from applying the Cognitive Behavioral Therapy tools and Exposure and Response Prevention Techniques on a more independent level. This treatment would allow for clients to bring in items to the office setting for therapist assisted support, and if necessary, home visits.
Group Therapy: This is for individuals who would like to augment their individual treatment with a therapist led group setting. It can also be used to transition from individual therapy or the Intensive Outpatient Program. This group requires a six week commitment from all participants to offer continuity.
Family Therapy: Family therapy is highly recommended for those who have loved ones that have been affected by the hoarding behaviors. Whether involved in individual therapy or the Intensive Outpatient Program, this modality offers care in addressing the family’s needs as a whole.
Partial Hospitalization and Intensive Outpatient Treatment: This level of service is for those who have moderate to severe levels of clutter or hoarding behaviors. Typically, individuals who enter into this level of treatment will require the assistance of a behavioral specialist to help with the purging process in a more intensive manner, which also provides increased support at a higher level of care. This program is offered Monday through Friday from 9am to 1pm, and Monday, Wednesday, and Friday from 1pm to 4pm. These extended time frames allow for the therapist to do treatment within the home and community setting (office, storage unit, and so forth).
Phase 2: The treatment process will begin with one or more of the services noted above. Within those treatment services, all individuals will participate in the following:
- Education to further understand the condition of Compulsive Hoarding; biochemical/genetic and environmental contributors; and discussion on how the treatment process will work for them.
- Cognitive Behavioral Therapy training and application to self
- Exposure and Response Prevention Training and application
- Mindfulness training
- Self-care and healthy living restructuring
- Stress reduction and relaxation skills
- Communication and assertiveness training
- Family therapy, as needed
Collaboration with other health care providers will occur throughout the treatment process. Additionally, external factors, whether emotional or physical, which may exacerbate one’s struggles, will be addressed. This includes grief and loss issues; work; school; family related stressors; and other co-morbid conditions. The latter refers to those who may have other diagnoses such as Depression, Obsessive Compulsive Disorder or Obsessive Compulsive Personality Disorder, Attention-Deficit Disorder, and other anxiety disorders such as Social Phobia.
Phase 3: Transitioning toward discharge includes several important factors to consider. If from out-of-town, we will work to find someone in each individual’s area to follow up for support and continuum of care. If local, we will coordinate with their previous therapist prior to entering the program, or if they would like, can continue on with their their therapist assigned to them in our program. While progress and accomplishments will be monitored throughout the treatment process, a review of areas to address following discharge will be covered.
Phase 4: Discharge and Aftercare. Several of the assessments administered at the beginning of treatment will be completed again to measure the progress in both subjective and objective ways. Collaboration will occur with any follow up mental health professionals and appointments scheduled.
Understanding, Compassion, and Kindness
Why would one acquire so much “stuff,” much of which they couldn’t possible use, or even find? Why would someone go into financial debt, to just buy more stuff? Why would someone bring in so much “stuff” into their home that could pose health or safety hazards? Why would someone risk losing family and friends to keep their “stuff?”
If we look at this logically, I think most can agree that hoarding behaviors are hard to understand and comprehend. So, to try and use logic would clearly not be helpful. However, if we accept that Hoarding Disorder is driven by brain chemistry, often times exacerbated by life circumstances, then perhaps we can come to a place of understanding, compassion, and kindness. It is probably safe to say that people are not choosing to live in these environments, rather, there are issues influencing and extenuating the factors maintaining them.
These factors do not take away from the responsibility of how important it is to begin addressing the problem. For some, the reality is they truly did not recognize it as being a problem. Keep in mind, the hoarded environment did not happen over night. Most likely, the symptoms began in childhood, took years to culminate, and like many, get used to and adjust to changes in the environment, even though it is becoming more and more destructive. For others, they know there is a problem, yet may not know what to do about it. It’s also possible that there is another group of people who acknowledge, yet deny to others that there is a problem, as this might mean they would need to take responsibility for it, which can feel quite frightening.
Whatever the circumstances might be, this center offers hope and inspiration to those who are ready to take the first step, or, are just ready to start exploring what the treatment options are. Either way, we understand the difficult decision it can be to finally venture into beginning to let go and make change. We understand that to blame and judge, even when the condition can produce frustration, serves absolutely no purpose. We understand that healing comes from acceptance of the problem, and the solutions to begin to address it.
Frequently Asked Questions
Will staff come to my home or do I work entirely at the center?
Often times it will be a combination of both. For some who have mild hoarding issues, it may be possible for smaller items to be boxed and transported to work on at the center. For others, this may not be possible and it will require the therapist to begin going to the client’s home once they have exhausted the work they can do at the center.
What if I live out of town?
It is possible for staff to travel, especially given that there are limited specialists and resources available for individuals who are struggling with cluttering and Compulsive Hoarding.
Does insurance pay for these services?
There are many factors involved while working with insurance companies such as each individuals policy, benefits of the plan, and so forth. However, we do work with many different insurance companies and make every effort to maximize your benefit options.
What if I am cluttering in other areas than my home?
We can address any and all hoarding situations that are present. For instance, it’s not uncommon that people can begin to acquire storage units when the house gets overrun with items. Likewise, compulsive hoarding can occur in the work environment, or even in a car. We recognize that in order for one to be successful in treatment, it is critical that we address all the areas of one’s life that are being impacted.
Is getting help to clean my home the solution to the problem?
No, in fact, this will solve nothing. And, it that was the solution, you would not need a therapist or treatment center. The treatment protocol is to begin addressing the emotional factors, thinking distortions, and anxiety which contribute to Compulsive Hoarding Syndrome, which can then help one to address the physical environment. This includes a combination of Cognitive Behavior Therapy and Exposure and Response Prevention Techniques.
If my home environment poses safety hazards will I be reported?
Our goal is to help individuals address their hoarding symptoms in a way that will eliminate any hazards that may be present. If reports have previously been made, we will work together with any agencies involved to work as a team.
Since my family has been impacted by the hoarding behaviors, will they be involved in treatment?
Yes, it is important that we treat all individuals who are involved so that we can provide education and understanding about what has led to the problem, and how family members or others can learn how to be a support during the treatment process.
I don’t believe that I am a compulsive hoarder, however, I do have strong attachments to some of my “stuff.” Is this something that I should seek help for?
The key is looking at how the attachments are impacting your life, and whether it is causing what we might call “emotional clutter” in your life. We would want to find out further information to get a better idea of how you are being impacted.
What if there is more than one person compulsively hoarding in the house?
In this case, we would want to help all of those who may be contributing to the hoarded environment, providing comprehensive care to all involved.
What if I have other issues that I would like to address in treatment other than my hoarding issues?
It is common that there are a number of factors that contribute to hoarding behaviors. A key aspect in the treatment process is to address them so that they don’t continue to impact your life.