Just about everyone has possessions he or she holds near and dear, and if not, there’s likely some just sitting around just begging to be given or thrown away. Clutter is a problem for many people, but once saving items has crossed over into hoarding, the act and the attachment to the items take on a different meaning that has little to do with the items themselves.
The American Psychiatric Association offers guidance on how to determine if someone has hoarding disorder. People with this condition excessively store items and find it persistently difficult to get rid of or part with them. This inability to give away things leads to clutter that spirals out of control and disrupts work and living spaces, relationships, social activities, and other areas in life. The disorder is believed to occur in an estimated two to six percent of the general population and is more common in males and older adults who are age 55 to 94 years old.
Hoarding and collecting are not synonymous
Hoarding is not the same as collecting, as APA notes. Collectors search for specific items and may organize them for display, it says. But hoarders save random items because they feel they need them for future use.
They may find comfort in having those items around them, even if others view them as having little value. Sometimes, it is discomfort that keeps people holding on to stuff.
Hoarding disorder can lead to problems with functioning, according to the APA. Some people with this disorder have trouble parting with things because of the distress that comes with the idea of giving something away.
Over time, this excessive saving of things winds up in piles and piles and more piles of clutter, making their environment unsanitary, hazardous, and unsightly to family, friends, and others. Hoarding items often makes living and working spaces unusable, and severe amounts of clutter can threaten personal safety and cause health problems or structural damage.
Getting rid of possessions is challenging for hoarders because they may experience:
- Negative feelings such as fear, anger, or guilt when considering decluttering items
- Strong beliefs that items are “valuable” or “useful,” even when the opposite is true
- Strong positive feelings when accumulating new items
- Strong attachments to inanimate objects, even to the point of naming them
Paper, mail, clothing, plastic containers, and bags are among the items people with this disorder collect. But it can always go a step further, which should raise concern. When people start to hoard garbage, rotten food, human waste, animals, and things that are out of the ordinary or unreasonable, it is time to take serious notice and action.
Possible causes of hoarding disorder include a stressful life-changing event, such as a loved one’s death, and having a relative who is also a hoarder. Brain injuries, which are found to cause symptoms of hoarding.
The APA lists specific symptoms of hoarding disorder, which are:
- Lasting problems with throwing out or giving away possessions, regardless of their actual value.
- The problems are due to a perceived need to save the items and to distress linked to parting with them.
- Items fill, block, and clutter active living spaces so they cannot be used, or use is hampered by the large number of items (if living spaces are clear it is due to help from others).
The questions below can help determine if you or your loved one has hoarding disorder.
- Do you have trouble discarding (or recycling, selling, or giving away) things that most other people would get rid of?
- Because of the clutter or number of possessions, how difficult is it to use the rooms and surfaces in your home?
- To what extent do you buy items or acquire free things that you do not need or have enough space for?
- To what extent do your hoarding, saving, acquisition and clutter affect your daily functioning?
- How much do these symptoms interfere with school, work or your social or family life?
- How much distress do these symptoms cause you?
Source: The American Psychiatric Association
Hoarding disorder and substance abuse
Some hoarders have problems with substance abuse and addiction. When hoarding disorder and substance abuse are combined, the picture becomes more complicated. If both are present at the same time, then the person has co-occurring disorders, a condition also known as dual diagnosis. Substance abuse treatment needs to address both conditions at the same time.
An overwhelming amount of stuff that crowds others out leaves many hoarders facing their mounds of stuff alone, physically, and emotionally. Because of this, people with this condition often are isolated from others, and that state of being can cause anxiety and depression. To numb these feelings, a person may drink alcohol or use drugs or other addictive substances. Excessive and uncontrollable use to the point of self-harm or harm to others indicates that the problem is a substance use disorder that requires professional treatment.
Determining substance abuse disorder
According to The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), substance use disorder occurs when the recurrent use of alcohol and/or drugs causes clinically and functionally significant impairment.
These include health problems, disability, and failure to carry out major responsibilities at work, school, or home. SUDs can be mild, moderate or severe, but before that is determined, a person must undergo an evaluation to see how many diagnostic criteria are present so the proper diagnosis can be made.
The DSM-5 has retired the terms “substance abuse” and “substance dependence,” and combined them all into the term “substance use disorder.”
Symptoms of substance use disorders can affect a person’s physical health and appearance, emotional health, psychological health, and their social environment. The following list is from the U.S. Department of Health and Human Services.
Behavioral changes include:
- Drop in attendance and performance at work or school
- Frequently getting into trouble (fights, accidents, illegal activities)
- Using substances in physically hazardous situations such as while driving or operating a machine
- Engaging in secretive or suspicious behaviors
- Changes in appetite or sleep patterns
- Unexplained change in personality or attitude
- Sudden mood swings, irritability, or angry outbursts
- Periods of unusual hyperactivity, agitation, or giddiness
- Lacking of motivation
- Appearing fearful, anxious, or paranoid, with no reason
Physical changes, such as:
- Bloodshot eyes and abnormally sized pupils
- Sudden weight loss or weight gain
- Deterioration of physical appearance
- Unusual smells on breath, body, or clothing
- Tremors, slurred speech, or impaired coordination
Social changes, such as:
- Sudden change in friends, favorite hangouts, and hobbies
- Legal problems related to substance use
- Unexplained need for money or financial problems
- Using substances even though it causes problems in relationships
There are a variety of treatments and services available to help people with substance use disorders.
They include inpatient and residential treatment, outpatient treatment, partial hospital programs, individual and group counseling, 12-step groups, recovery support, and relapse prevention treatment. Pathway to Hope can help you figure out which ones best fit your situation or that of your loved one.
Is there a link between hoarding and OCD?
People with the anxiety disorder called obsessive-compulsive disorder, or OCD, are also found among people with hoarding disorder. And people with OCD also have been found to have substance use disorders.
According to the Anxiety and Depression Association of America, about 20 percent of Americans with an anxiety or mood disorder have an alcohol or other substance use disorder, and nearly 20 percent of those with an alcohol or substance use disorder also have an anxiety or mood disorder.
So, it is possible that one hoards items because of having OCD, and the person may abuse substances to try to deal with OCD and hoarding disorder. To get the proper diagnosis, see a licensed physician or mental health professional.
According to the International OCD Foundation, compulsive hoarding was commonly viewed as a type of OCD. The foundation also says, “Compulsive hoarding is also considered a feature of obsessive-compulsive personality disorder (OCPD) and may develop along with other mental illnesses, such as dementia and schizophrenia.”
The foundation says compulsive personality disorder can be treated but not with the methods used to treat OCD. It is believed there are no medications to treat hoarding disorder. If substance user disorder is in the picture, then medications may be used to help treatment for that, but that is determined after a person has undergone detoxification and assessment to see what treatment program best fits their situation.
Do you struggle with hoarding disorder and substance abuse?
People with hoarding disorder often feel like they are in control of their “stuff,” and are in denial that their saving things for future use has gotten beyond manageable. It is the same kind of refusal to address the issue that also holds back people who are struggling with substance abuse disorder.
However, you don’t have to be in this group. If you feel your challenges with hoarding disorder and/or substance abuse disorder are what’s holding you back from living your best life, call Pathway to Hope’s 24-hour helpline at (844) 557-8575.
Our call representatives can help you find treatment programs that fit your needs, including dual diagnosis treatment options. We will guide you every step of the way both in and out of addiction treatment, so start your recovery today.