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Hoarded: Local training sheds light on hoarding disorder and options for treatment

What distinguishes hoarding from the ordinary accumulation of personal belongings: the acquisition of items along with extreme difficulty throwing anything away, even items that are useless. Tribune photo illustration by Susan Lunneborg

WILLMAR — If you watch reality shows about hoarding, Janet Yeats has advice for you: Turn off the TV because what you’re seeing is mostly entertainment, not real life.

“There is a stereotype or stigma in our culture about people who hoard. The TV shows have done us no favors,” says Yeats, a licensed marriage and family therapist who cofounded The Hoarding Project and has worked extensively with hoarding disorder.

With knowledge, however, communities can be better armed to address hoarding situations in ways that are effective and that address the underlying mental health issues as well as home safety, Yeats said. “It’s a mental health disorder that has public safety implications. If we’re going to effectively treat hoarding disorder, we’ve got to approach it from both ends. You need to look at it holistically, not just one piece.”

 Yeats spoke at a recent workshop in Willmar, co-hosted by Heartland Community Action Agency and the Minnesota River Area Agency on Aging to provide training on a disorder that, despite the popularity of the television shows, remains little researched and poorly understood. It was only this past year that hoarding was added to the Diagnostic and Statistical Manual of Mental Disorders, American psychiatry’s most widely recognized guide to defining and classifying mental disorders.

Here’s what’s known about hoarding, according to Yeats:

n It affects both men and women, young and old, low-income and high-income, in the U.S. as well as around the world.

n Two to 5 percent of the American population is thought to hoard, but no one knows for sure and the disorder is likely underreported.

n When hoarding’s impact on families, neighborhoods and communities is taken into account, the reach is significant, said Yeats. “What we’re talking about in Minnesota is millions and millions of people who are affected by hoarding. It’s a big problem.”

 In the most severe cases, homes become so cluttered that they’re unsafe to live in. Stacks of belongings might block the exits and make it impossible to use the kitchen, dining room or other rooms in the house. The clutter can turn into a breeding ground for mice, spiders, mold and other nuisances.

Animal hoarding is especially challenging, not only because of the biohazards involved but also because of the suffering inflicted on the animals, Yeats said. People who hoard animals are often middle-aged women and usually have an accompanying mental illness that prevents them from understanding the harm they’re causing, she said.

What distinguishes hoarding from the ordinary accumulation of personal belongings is that it involves what Yeats calls “the one-two punch” — acquisition of items along with extreme difficulty throwing anything away, even items that are useless.

“Underneath everything it’s the fear of losing these things,” Yeats said.

Researchers have identified some of the factors that can lead to hoarding disorder. People who have difficulty with organizing, categorizing and decision-making may be more vulnerable to hoarding, said Yeats. The disorder can coexist with age-related dementia or traumatic brain injury, she noted. In some cases, children who grow up in hoarding situations become adults who hoard.

But after years of counseling these individuals, Yeats sees a distinct common denominator.

“The majority of people who hoard have issues of unresolved trauma and loss in their life,” she said. “If that’s the case, then the work we have to do in treatment has to start with that trauma or loss.”

Organizers of the workshop said there’s a need for local service providers to understand hoarding.

Whether it’s an aging adult or a family struggling to become economically self-sufficient, “we want to keep people living independently in their own homes,” said Deb Brandt of Heartland Community Action Agency. “We need to get some training out into our area.”

When a show of hands was asked for, close to half of the 75 people in the room — mostly social workers, counselors and landlords — indicated they’ve had firsthand experience with a client who hoards.

The real challenge for communities, said Yeats, is how to respond to hoarding. There’s little money available and no established practices for how local agencies should handle a hoarding situation. Although some health plans might pay for counseling, many homeowner policies don’t cover the cost of abating a hoarded home. If local government is forced to get involved, the bill can range from $10,000 to $50,000 for abatement alone, Yeats said.

Moreover, unless the underlying causes are addressed, TV “Hoarders”-style interventions often work only for a short time until the individual begins hoarding again.

The Hoarding Project plans to launch a pilot project this year with the city of Shoreview, Ramsey County and the Minnesota Hoarding Task Force to identify three hoarded households targeted for abatement and offer the option of working with therapists, cleaning companies and professional organizations over the course of one to two years to sort hoarded items, gradually clean out the house and provide counseling.

The hope is to develop effective strategies that help people and reduce the likelihood of rehoarding, Yeats said. If the effort is successful, it can be replicated in other communities.

“It’s a less expensive, longer-lasting treatment,” she said. “This is what I hope is going to become evidence-based best practice. We don’t have to be afraid of this. We actually have some objective ways to manage this.”

Hoarding self-quiz Do you worry that your accumulation of belongings is a symptom of hoarding? Find out by taking this short self-quiz developed by The Hoarding Project.

Are areas of your home difficult to walk through because of clutter?

Are you unable to use any parts of your home for their intended purpose? For example: cooking, using furniture, washing dishes, sleeping in bed, etc.

Do you find the act of throwing away or donating things very upsetting?

Do you have strong urges to buy or collect free things for which you have no immediate use?

Have you ever been in an argument with a loved one because of the clutter in your home?

If you answered “yes” to three or more of these questions, you may have a problem with hoarding.

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Anne Polta

Anne Polta covers health care, business/economic development and general assignment. Her HealthBeat blog can be found at Follow her on Twitter at @AnnePolta.

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