Question 1

Are there any books you can recommend for children who have a parent who is a hoarder?

Gail Steketee · Accepted Answer

These are nearly always adult children who recognize a hoarding problem somewhat later in their parent’s life. We recommend Digging Out by Michael Tompkins and Tamara Hartl which was written specifically to help adult family members talk with their loved ones about hoarding problems. We are not aware of books written for young children about hoarding behavior.

Question 2

What is the best thing other family members can do to deal with day to day hoarding challenges?

Christiana Bratiotis · Accepted Answer

Family members should have a private conversation with their loved one about their specific concerns. For example, “Mom, I just can’t leave you alone here with that pile of flammable items so close to the stove.” “Dad, I’m really worried that you will fall on the stairs when your cane catches on one of those piles up there.” Begin the conversation with a focus on health and safety first, and then on how to meet your family member’s needs and improve their quality of life. If previous interactions among family members have been contentious, family members may want to enlist help from others, such as members of a hoarding task force or staff at a local service agency that helps older adults.

Question 3

Why is hoarding more common in older than younger adults?

Christiana Bratiotis · Accepted Answer

In fact, hoarding begins early in life, most often during adolescence or early adulthood, and the clutter worsens gradually over time. Hoarding may seem worse in later life as the clutter accumulates to a level that threatens health, safety, and usability of the home. Older adults may also suffer more health problems and are therefore unable to manage the clutter as well as they did when they were younger.

Question 4

Are CBT treatment models the same for older vs young people?

Gail Steketee · Accepted Answer

Generally, yes, but with some modification of the cognitive parts of treatment for older adults. The treatment model focuses on factors that make people vulnerable to hoarding (for example, family history, early experiences, personal losses, beliefs) and how that reinforces excessive acquiring and saving and difficulty discarding. The treatment plan for adults across the lifespan includes resisting acquiring, learning sorting and organizing skills, and practicing letting go of unneeded items. Younger adults also benefit from modifying their beliefs about objects, whereas for older adults , changing beliefs may be less helpful than learning skills that improve memory, planning, cognitive flexibility, and problem solving. Of course, these skills are useful for adults of any age.

Question 5

When do you think Child Protective Services need to get involved in a hoarding situation? If bathrooms can be used and the kitchen is functioning, is having to step over things enough to call in CPS?

Gail Steketee · Accepted Answer

Clutter is not necessarily problematic, so long as the children are safe and their basic educational, social and emotional needs are met. The important part is to consider the best interests of the child, as there are no clear rules for deciding how much uncluttered space is needed to meet their needs. It is very important to talk openly with the parent or guardian to make sure they understand the specific issues that require the clinician to protect the child’s welfare.

Question 6

Question 7

How is hoarding different from compulsive buying?

Christiana Bratiotis · Accepted Answer

Compulsive buying or shopping may occur among people with hoarding disorder, but it may also be a separate problem unaccompanied by the hallmark features of hoarding which are difficulty discarding and clutter that interferes with using living spaces. Compulsive buying occurs across the life span, but most commonly in young women who purchase excessive amounts of clothing and personal items well beyond their needs. The act of buying feels exciting and may relieve immediate feelings of anxiety and depression.

Question 8

Is hoarding linked to childhood neglect and developmental trauma?

Gail Steketee · Accepted Answer

People with hoarding disorder often report histories of traumatic events, but not usually the types of life-threatening events that lead to a diagnosis of post-traumatic stress disorder. Personal losses, especially of loved ones, may trigger hoarding symptoms among people who are vulnerable, but most cases of hoarding do not seem to be caused by traumatic experiences or childhood neglect.

Question 9

Do you know what might be causing the decision making deficits in hoarding? How can treatment target this?

Christiana Bratiotis · Accepted Answer

Decision-making problems seem to be a hallmark feature of hoarding disorder, although we are not really sure why this cognitive processing problem occurs. People with HD often seem to see usefulness and creative possibilities in objects (“I hate to waste this. I could fix it. One day I could use this in a craft project”) to the point that they cannot decide to get rid of it even when others would do so. They also become emotionally attached to items, worrying that if they discard something they will be disrespecting emotional connections to someone who gave it to them, or magical thinking that as soon as they get rid of it, they will find they need it after all. Thus, avoiding waste and feelings of loss or regret are motivators for keeping things. Cognitive behavioral treatment focuses on making decisions in light of current goals and personal values, taking into account what the person already owns and uses. Practicing decision-making is an essential part of the therapy process.

Question 10

Is hoarding actually about the types of items and collecting the items or is it more about the inability to throw them away?

Gail Steketee · Accepted Answer

Hoarding is about both. Saving items and difficulty parting with them are essential features of hoarding disorder, but people vary a lot in what types of items they save. Some people save ordinary items like clothing, toiletries, newspapers, and everyday household objects. Others save things like food wrappers or things that appeal to them aesthetically. The reasons for saving items provide clues about how to correct the attachment to objects that has gotten in the way of living.

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