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Deconstructing the Hoarding Spectrum: A Holistic Approach
Lisa Wessan, LICSW, CLYL, RM
“Anything that you cannot relinquish when it has outlived its usefulness possesses you, and in this materialistic age a great many of us are possessed by our possessions. We are not free.”
—Mildred Norman Ryder1
(aka the Peace Pilgrim, 1908-1981)
Is it possible that we are all living on the Hoarding Spectrum? According to a recent study paid for by Rubbermaid storage products, 91 per cent of people are overwhelmed by their clutter some of the time. Of that group, half of them feel they can’t allow visitors at home because of it.2
For this article, let’s refer to clutterers and hoarders on the same hoarding spectrum. Both clutterers and hoarders suffer from Clutter Blindness, a perceptual-distortion phenomenon. Picking a behavioral label is often just a matter of degree,3 since many symptoms and behaviors are identical in the two groups. To help you make your initial diagnosis, I would like to distinguish hoarders from the more common clutterers in three ways.
Hoarders suffer from CHAOS (Can’t Have Anybody Over Syndrome). When a hoarder reaches this point, regardless of how much stuff is actually in the home, we understand that social isolation, depression, anxiety and other imbalances are crippling the client’s life.
Usually, a hoarder will not ask for help until the situation becomes critical, e.g. an eviction notice is received, nursing home placement is required, there is a pending relocation, or when the sale of a home is infeasible due to hoarding complications. To reach this crisis point, the client situation has gone beyond CHAOS to another level.
For example, some of my elderly clients have suffered from upper respiratory illnesses and rashes, due to black mold and other contaminants in the home. Elderly hoarders are especially at risk for injurious falls, and being crushed or immobilized by the hoarding pile is another common risk. In the end stages, vermin and dead animals are often found in the hoard. It may be very difficult for the hoarder or for family members to recognize that such physical conditions are actually life-threatening.
The new DSM-5 has recognized this by making hoarding a stand-alone behavioral diagnosis, where in the past it was lumped broadly into obsessive and compulsive behaviors.4
It is very common for the hoarding client to be eligible for a dual diagnosis, as well as possessing a strong codependent streak. Hoarders often have very good intentions, “saving this for someone who might need it.” This exaggerated tendency to rescue and save is complex, and has psychodynamic and attachment issues that should be uncovered in treatment...
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