This article is featured in the Yea Chronicle and is republished with permission.
Hoarding is an issue for many in our community. Australia Psychological Society President Dr Sara Quinn kindly provided more information about the phenomenon and the psychology behind it.
She said that hoarding "can occur when individuals in the community go through any traumatic experience [such as Black Saturday] or if there's a sense of emotional deprivation through someone's upbringing, that can increase the likelihood of developing a disorder such as hoarding.
"We know that when attachment bonds, a child's attachment to their adult figures in their lives, are disrupted, people tend to refocus on material possessions as an emotional containment mechanism because that invokes these feelings of control, and identity and safety and security. And we would see the same sort of responses occur through a traumatic experience."
She said that hoarding disorders, "is an ongoing difficulty letting go of possessions, and what we know is when people have difficulty letting go, that can lead to cluttered spaces, and then a disrupted daily life. It's often driven by that strong emotional attachment to their material possessions, real difficulties with decision-making and some unhelpful beliefs about items and, and in general avoidance of distress. So hoarding disorder is actually defined as a difficulty getting rid of material possessions, and that's partnered with accumulation of possessions and cluttered spaces."
She added that all humans experience some attachment to their possessions. "That attachment, when that impairs the person's ability to engage in their normal quality of life, it becomes problematic," she said.
People collect things, and that's normal. When this impacts on a person's quality of life, that it becomes problematic, and this may lead to a hoarding disorder.
Dr Quinn explained, "Unhelpful beliefs are quite quintessential for hoarding.. We know that in particular, some of our clients might hold rigid or unhelpful thoughts around some of the items that you and I might naturally want to throw in the rubbish or donate to others. Some of these beliefs can be 'I might need this one day' or 'discarding of this type of article might be irresponsible' or 'this item is unique and it's irreplaceable'. These beliefs can reinforce a person's need to retain those items, and that's irrespective of whether or not they've got actual utility or value.
"What we see as someone unable to clean up what we might determine as mess is actually being reinforced by those unhelpful beliefs... It can undermine a person's ability to live their day-to-day life. And that`s before we even start talking about behavioural avoidance."
She explained that when people have these unhelpful beliefs, "there's a lot of emotional discomfort and a lot of what we would call cognitive load, so there's a lot of stress and pressure associated with sorting and discarding, which can often lead to people avoiding those very behaviours that others do quite naturally. Avoidance means that they don't have to go through the pressure of having to sort things out and get rid of them, but what it does do over time, is perpetuates that cycle of hoarding and that contributes to that clutter and that mess and then and then this overall sense that people are actually not getting rid of what we would perceive as rubbish. Because the problem is too big at that point."
We know that individuals with hoarding disorder can often form intense, not only emotional connections to their possessions, but the intensity of even the thought of having to engage in any sort of sorting or making decisions around whether or not we keep throw away an item, that in itself can be incredibly overwhelming, and we actually know that there are some deficits in some individuals who develop hoarding disorder around information processing, so they can have difficulties with attention, they might not see what it is that we see, they have difficulties organising their spaces, categorising them, and decision making, which is key. Those sorts of changes can make the actual process of sorting through anything completely overwhelming.
How can someone experiencing challenges with hoarding start to resolve the situation?
Dr Quinn responded, "It's a significant act when we think about all the challenges associated with it, and I think that the impact of this and why people start to resolve it is because it has an impact not just on the individual, but also on family members and if they have pets, and the community. Often if someone is living in the community and you can see some of that behaviour extending out onto the gardens, etcetera. It's also important to note that some people experiencing hoarding don't actually consider that their behaviour is a problem. Additionally, there could be quite an acute sense of shame associated with inviting people into their homes, and that might mean that they're more likely to be isolated in the first place, which can then lead to the problem being exacerbated.
"In particular, when we speak to some of those individuals who do provide support to those with hoarding disorder is that there's a lot of hazards usually that occur in the home for them." These might include trip hazards or an increased risk of fire, and the problem may not be known until people become unwell or repairs are needed to the home. The problem is unlikely to be found until someone alerts that for the person.
In the psychological world, they have found that cognitive behavioural therapy (CBT) is usually the most effective evidence-based treatment, however bringing people to realise that they need to seek and take on board that support is one of the biggest challenges. CBT would involve teaching people how to make decisions on a small scale so that they can then expand out through explorations of beliefs and exposure techniques. This might include clinicians going into the home with the person and starting to get them used to experiencing that distress and those emotional challenges.
She added, "It's a long process and quite overwhelming for an individual unless they've got good support."
Would it be wise to have someone come in and do some sorting, get rid of the bulk of stuff and then allowing the person to start again? Or do you feel that it's important for the psychological recovery for the person to be doing it themselves with potential support.
Dr Quinn responded, "I think it actually depends on the individual. I think that a lot of individuals will not feel able to be safe to be able to engage in that sort of behaviour without an expert by their side, because I think that even though somebody might have the best of intentions to help... Without familiarity around what the disorder is and some of those unhelpful beliefs in some of the intense emotional experience of the individual, we might see it as, they just don't want to throw stuff out and they just need some help. What we`re not seeing is actually the significant challenges associated with that...
"I would say that it's really important for those individuals to understand the experience of the person that they're trying to assist, because their refusal to engage in that help is not necessarily because they don't think they need it. It's often they don't realise that it's such a problem for them or it might be such a source of embarrassment and shame that they don't want to even go close to accepting some help. The judgement free support that a psychologist has and that knowledge of how it is that we start to untangle some of those really complex beliefs can be quite crucial, not just for the individual, but for people offering support as well."
Should a person seeking to help receive some psychological advice before undertaking that activity?
"Yes. I think when people feel safe enough to speak with their family and their friends about what is going on for them without judgement, then they'l feel more likely to accept that help. When their families and those friends are educated on what hoarding disorder actually is, to provide that appropriate support, that means the support they offer is really helpful.
"Social workers and professional organisers who are experienced working with people with hoarding disorder, they can then work alongside treatment for the individuals. Effectively, it could be a really nice team support as long as everyone is educated in what it actually is, and the person feels ready and able to accept that support," Dr Quinn said.
I imagine that there would need to be a lot of tolerance and not showing external displays of judgement.
"Yes definitely. I think there can often be an ambivalence for individuals who are experiencing hoarding and I think if you're able to actually sit with them in their ambivalence and understand how it is that that occurred for them without judging their experience without you thinking that you can clean them up, which can be very, very distressing for, in particular, a family member or someone who really cares for that individual to want to get this done really quickly, sitting in some of this discomfort can be one of the most difficult yet important strategies to being able to help somebody in the long term," Dr Quinn said.
What other supports are potentially available?
"There are psychologists who are experts in human behaviour, but family members and community members can also be very well placed, especially if they approach it without judgement. Create a solid support system for an individual, especially if there are risk issues attached. If a person is more likely to become sick, sometimes their GP might be able to identify this first, people in the community when they see some of the hoarding extent onto their verge might notice that as well. There are also really well placed social workers and professional organisers who are able to, and very well experienced, working alongside that beneficial treatment as well," Dr Quinn said.
What about industrial cleaners?
"It depends on the individual. Sometimes worst case scenario is we see individuals have been holding for a very, very long time we see the risk of fire, the risk of the associated financial burden, needing to repair a home that might be in disrepair because of hoarding, there are so many risks that occur for an individual living in that sort of environment and the desire to want to clear it out really quickly can be really strong. If that person is in a position to be able to facilitate that, that is best case scenario for an individual," Dr Quinn said.
"However, if the problem is too overwhelming and/or the person is unable to assist with that, there can be a place for someone coming in and actually cleaning it up, but where possible I think involving the individual is going to give them the best sense of agency. Also when, we think of long-term gain, if they're able to be part of that process, then they're more able to start to develop more helpful ways of connecting and attaching themselves to their material position."
Is there anything else that you would like to add on the topic that you think it's important that the community knows about?
Dr Quinn said, "I think the most important part of all of this is that hoarding disorder is a disorder, and it's characterised by a persistent emotional attachment to possessions. We know that that's often linked to past traumas or deprivation, and that in turn interferes with daily life. I think the psychologists are very well equipped to provide that evidence-based support. What I do want to normalise that it's actually a really normal human experience to be attached to our material possessions. So just because someone is a collector of items doesn't necessarily mean that they have a disorder. It is when it starts to impact their ability to function in daily life that we then think, how is it that we could help this individual? Look out for your neighbours, friends and family is probably the most important message."