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Hoarding and Housing

by Cristina Sorrentino Schmalisch, PhD, LICSW 

Hoarding can lead to a wide range of serious problems as it gets worse. For people who live in the home, these risks include:
  • tripping and falling over things
  • being hurt and even killed when items fall on them
  • developing health problems from mold or pests that live in the clutter
  • delays in receiving emergency care when emergency workers can’t reach them
  • injury or even death when fire fighters can’t enter or control a rapidly spreading fire
  • living for months and even years without vital services like plumbing, electricity, and heating
  • eviction because of a lease violation
  • having the home condemned  due to unsafe or unclean conditions
In addition to these problems that affect people who live in a hoarded home, hoarding presents risks for neighbors, building owners, and for the property itself. These risks include:
  • public health problems (e.g., spread of pest infestation) for adjacent apartments and homes
  • structural problems because of too many heavy items (for example, books) that are too much for the load limits of the building
  • flooding when pipes are in need of repair
  • fire from electrical wiring or heating systems in need of repair
  • lost property value and of rent income for landlords who must make costly repairs due to hoarding or who have to pay legal fees (e.g., to end a tenant’s lease)
Some clients are motivated to seek treatment on their own. Others are pressured to seek treatment by court order after inspections from agencies such as fire and public health departments or the housing authority. Since hoarding can have serious problems, those around the person who hoards may feel pressure to end the hoarding problem quickly. Clean outs, while appealing, usually do not work. In addition, clean outs can create strong feelings of loss, anger, or severe emotional distress, and those who hoard may turn to getting more items to counteract these strong feelings. Since they have not learned to sort and discard items, even those who do not actively acquire new items eventually have a re-accumulation of possessions. Clean outs can also threaten mental health and even life. Three cases of death following clean outs by the Health Department in Nantucket were reported in the Nantucket Independent (2007). Further, clean outs are expensive, requiring many hours of labor. Families and agencies, such as local departments of public health, may spend many hours and thousands of dollars clearing the homes of family or community members with hoarding only to find that the problem returns, often within just a few months. 

Instead of a clean out, resources are better used to offer treatment to fix the problems of acquiring and saving that lead to too much clutter. Family members and friends, as well as housing agency staff and other local agencies that address hoarding problems can help. However, they should only help after learning about why people hoard and what interventions are likely to work best. It is essential to avoid blaming the person who hoards before trying to help. 

After learning to understand hoarding, cognitive and behavioral treatment can be very helpful [see the Therapy section of this website]. In this therapy, clients make all decisions about saving or discarding their possessions and learn skills to help them stand the discomfort of discarding, resisting acquiring more possessions, and organizing their homes. In addition, the person learns to correct faulty thinking and beliefs and to manage strong emotions. At this point they are in a position to set rules for what things can and cannot be gotten rid of and to arrange for disposal of unwanted items. It is at this point in the process that others can be of most help in sorting and hauling items marked for removal.

International OCD Foundation Hoarding Center