AMA Hoarding: 1 Challenging Question and the Answer You’re Going to Hate
One of the most enjoyable parts of advocacy work is offering website visitors the opportunity to ask me anything about hoarding. Most of the questions submitted come from family members of persons who hoard (PWH). I hope that in the future, professionals and those with their hoarding disorder diagnosis will also submit questions.
Here’s one of the earliest questions I received.
What do you say to someone who has hoarding issues that are becoming severe, yet they have a list of reasons to keep their items?
My answer might surprise you. Hoarding disorder, after all, isn’t just about the stuff. We start where we can, and it might not be where we’d like.
As a professional and a family member, I sometimes struggle with the knowledge that to shift someone’s perspective about their hoarding behaviors, I must stop addressing the stuff. It’s certainly counterintuitive. Yet I find this strategy helpful in getting buy-in from someone who doesn’t see the condition of their home and the volume of their possessions as being problematic.
Focusing first on the person and what they might be interested in changing is grounded in motivational interviewing (MI). Once we build a relationship with them, focus on their values, and engage them in change talk, we can often align health and safety goals with their overall objectives. By partnering in this way, we become safe people who assist but don’t force certain actions upon them.
This can be very difficult for family members to accept. I get that! Forced interventions backfire. One study showed that large-scale cleanouts had a six-month rebound effect, with up to 125% of the home refilled with clutter and possessions. Yes, in just six months. The PWH is resentful, often emotionally dysregulated, and turns to new acquiring to assuage their “negative” emotions.
Are there times when we have to intervene in hoarding anyway?
Absolutely. That’s when rebuilding and maintaining our relationships with the PWH is critical. When the PWH doesn’t acknowledge their high clutter as problematic or is unwilling to engage in mental health treatment to address it, harm reduction is an effective strategy to make the PWH’s home safer without stopping the acquiring and saving behaviors. Harm reduction is best planned and implemented by a team, but family members can engage in harm reduction without outside agency support when necessary.
Harm reduction (HR) has a long history of being applied in mental health and substance use contexts. The primary goal of HR is not to prevent individuals from acquiring new items or to compel people with hoarding (PWH) to discard a large quantity of their possessions. Instead, HR focuses on minimizing risks, such as fall and trip hazards, as well as addressing fire safety and code compliance issues.
(Want to learn more about harm reduction and HD?)
More tools and resources on hoarding…
Have a question you’d like answered? You can submit your question here.
Another great post for family members of people with hoarding disorder addresses how families may get sucked into the disorder, also known as accommodation. When family members begin to recognize where they are changing their actions to reduce the PWH’s distress, they have identified areas where they can (sometimes) alter the dynamic by reducing or stopping their actions that may be enabling a loved one’s hoarding.
Looking for support as a survivor of parental hoarding? Monthly, small group, virtual support is available through SOPHMI.
Thanks for reading and learning more about HD. Together, we can help our communities understand the need for mental health treatment to address HD!