How to Help a Hoarder

Educate the individual who hoards. Once you have provided adequate support, psychoeducation of the compulsion of hoarding may be the best first step in helping them.^[7] Understand that hoarding is associated with excessive clutter, difficulty discarding items, and excessive acquisition of new items.^[8] Due to the emergence of hoarding behaviors, a new diagnosis of Hoarding Disorder (HD) was added to the most recent and updated version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is the basis for diagnosing mental health concerns.^[9]

• First and foremost, hoarding can cause health and safety risks. Explain to that hoarding is dangerous because: it may prevent them from being able to escape in an emergency, does not adhere to fire codes, and can lead to mold and other harmful buildup in the home. It can also cause complications in activities of daily living (ADLs) such as walking, moving around, finding objects, eating, sleeping, and using the sink or bathroom.^[10]
• Hoarding can lead to social isolation, disruption of relationships, legal and financial issues, debt, and property damage.^[11]
• Some issues that may coincide with hoarding behaviors include negative and unhelpful thoughts such as perfectionism and fear of regretting removal of information or objects, over-attachment to material items, reduced attention abilities, and lowered capacity to make decisions.^[12]

Use assertive communication. Being assertive means saying how you think and feel while being respectful and appropriate.^[13] Discuss how you feel about their hoarding, and the specific concerns that you have about their health and safety.

• Explain your concerns and set boundaries. Explain that you will not continue to live or be in the house if it is unsafe or unsanitary (if this is feasible).

Offer your help. Tell the person doing the hoarding that you are willing to help them if they are open to assistance. Be aware that people who hoard can have very strong emotional reactions when asked to give away their belongings.^[14]

• Assess the level of openness to your assistance. You could say something like, "I know you've been concerned about your hoarding and I am also. I am here to help if you want it. What do you think?" If the individual responds negatively and says something like, "Absolutely not, I don't want you forcing me to throw away my prized possessions," you may want to back off for a while. If the individual says something like, "I might be open to that," give them some space to decide if they are willing to let you help. You can revisit the conversation at a later time.

Help set goals. Individuals who hoard need specific goals to work toward in order to be successful in reducing hoarding behaviors. This helps them to organize their thinking and plans associated with reducing their hoarding.^[15] People who hoard may need help with motivation, organizing, avoiding acquiring items and removing clutter.^[16]

• Write down the specific goals you have developed with the person needing help. This list might look like: reduce clutter, be able to move through the living room with ease, stop buying new items, and organize the attic.

Develop an action plan. In order to reduce hoarding behaviors, you first need to help the person hoarding to develop skills and a plan for organizing items. Discuss the specifics of this plan and offer suggestions if they is open to them.

• Identify specific criteria for keeping and discarding items. Ask the person who hoards what criteria they would like to create for getting rid of items versus keeping them. You could say something like, "Let's see if we can make a plan that will help us organize our time. Would you be open to making a list of reasons to keep items? What are the types of items that you absolutely need to keep? What are the types of items that you can let go?" Make sure they are still open to receiving help, and if they are receptive to this idea you can move forward with your plan together.
• Make a list of the criteria to keep or discard items. This might look like - Keep if the item is needed for survival or daily life, or if it is a family heirloom. Toss/sell/donate if item is not currently being used or has not been used in the last six months. Categorize and organize wanted items, as well as unwanted ones.
• Talk about storage locations and systems of discarding items. Select interim locations during sorting. Sort items into categories such as: trash, recycle, donate, or sell.^[17]

Encourage problem-solving skills. There are particular skills that are indicated in assisting the recovery of hoarding behaviors such as organization and decision making techniques.^[18] Help the individual who hoards decide on rules for acquiring, keeping and discarding items.

• Do not simply choose which items to trash, have the person with the hoarding problem make their own decisions based on the criteria you developed together. If they are unsure, help them refer back to the list of reasons to keep or discard an item. You can ask questions like, "Is this item necessary to daily life, has it been used in the last six months, or is it a family heirloom?"

Practice getting rid of items. Focus on one step at a time. Instead of trying to clean out the whole house in one day, try starting with a room that seems to elicit the least amount of anxiety. Develop a plan that moves systematically by room or type of space or object.^[19]

• Start with easy items first then move to harder ones. Ask the individual where will be the easiest place to start; the place that they feels will be easiest for them to deal with emotionally.
• Always ask permission first before touching any item that the individual is hoarding.

Ask or hire someone to help. Sometimes getting rid of clutter can be a time-consuming and emotionally draining process. Fortunately, there are organizations that specialize in cleaning, hoarding coaching and removal of items. Check your local newspaper or do a quick internet search to find an organization in your area.

• If you find that hiring help is out of your budget, you can attempt to get other friends or family members to assist you. Try asking by saying, "Sam needs our help with their hoarding, do you think you can spare a day or two to help clean the house and get rid of some of the items?"

Assist in avoiding acquiring new items. Help the person with hoarding tendencies identify problems with obtaining new items.^[20]

• Work with them to develop a hierarchy from easier to harder situations to deal with such as: driving by a shopping center, standing at the entrance of a store, walking through a shopping center/thrift store/mall, browsing a store, seeing an item you desire, physical contact with said item, and leaving the store without the object.
• Ask questions that may help to develop alternative thoughts about the usefulness or necessity of the objects they may want to obtain. For example, you can inquire by asking, “Do you have a specific use for this item? Can you survive without it? What are the pros and cons of having this object?”
• Assist in making rules for obtaining new items such as having a direct use for the item, needing the financial means to purchase the item, and requiring enough space to house the item.

Help the person who hoards take small steps toward recovery. Once the therapy has begun, the individual may be assigned small tasks to perform in between sessions, such as cleaning out one corner of a room or clearing out a single closet. Offer to help with this process by holding the box or bag that will receive the discarded items, but do not take on the task of cleaning out the closet yourself. Part of the recovery is that the individual who hoards must be the one to make the decision of what stays and what goes.

Expect setbacks. A person with a hoarding issue who successfully cleans out a closet one day may be incapable of tossing anything out the next day. Depending on the severity of the condition, the recovery period may take anywhere from a few weeks to a year or more before significant and consistent progress is made.

Try a keep, use or display approach. No item has to be trashed, simply keep it in storage, put it where it will be used or store it for display at a later date when there Is cleared display space on shelves or book cases. Box up items in hygienic containers labeled keep or display, items for use should be kept where they will be used, e.g. pens are kept in a desk drawer or plates in a kitchen cupboard. If there is no room to store "use" items they can be boxed up for "keeping". The aim with this approach is to de-clutter, not dispose of items as a start. Boxing up clutter can clear space so it can used for it's intended purpose - clearing a table of all the loose items for example, by the categories keep, use or display, can be a great start providing the person with hoarding tendencies with a space to eat a meal. This can build trust between you and the person you're trying to help showing that it's not your intention that they throw everything they have collected away. Down the track, the items for keeping and display can be reevaluated. Keep track of duplicate items, allow only one item for use, e.g. a can opener or a phone charging cable, can be used at a time, duplicate items can be stored for keeping.

Recognize the possible causes of hoarding. Hoarding affects 2-5% of people above the age of 18. ^[21] Hoarding is associated with, “alcohol dependence; paranoid, schizotypal, avoidant, and obsessive-compulsive personality disorder traits; insecurity from home break-ins and excessive physical discipline before 16 years of age; and parental psychopathology.”^[22] Hoarding behaviors can also be a result of the individual wanting to hold onto items that remind her of individuals who have passed away, or to keep special memories from the past alive. Hoarding behaviors also tend to run in families, especially for women.^[23]

• Individuals with Hoarding Disorder may have brain abnormalities that result in difficulty identifying the emotional worth of an object, having normal emotional reactions and regulating emotions while making a decision (whether to buy, save, or throw out an object). ^[24]

Know the negative effects of hoarding. People who compulsively hoard may be more likely to: be evicted or threatened to be evicted, be overweight, miss work, and have medical and mental health concerns.^[25]