How To Let Go: Working With Adult Hoarders
Updated: Mar 2
In the UK, hoarding is not recognized as a disorder in its own right, though the Royal
College of Psychiatrists and the NHS Choices website refers to ‘hoarding disorder’. This is
characterised by clutter interfering with everyday living, when individuals cannot access
rooms in their house, for example. A key element is distress caused to the person or their
family as a result of their accumulation. This article will discuss the characteristics of
hoarders, and how we may best support them in the community.
Hoarding may be defined as the collecting of and inability to discard large quantities of
goods, objects or information. An American publication, the Diagnostic Statistical Manual
of Mental Disorders (DSM) introduced a new mental disorder known as hoarding disorder
in 2013. It identifies individuals who accumulate clutter which compromises the living,
social or work environment. They will have difficulty throwing away items, regardless of
their real value, and this is related to a perceived need to save their possessions and the
anxiety it would cause if they were to throw them away.
Pathological hoarders may see value in objects which others cannot see. For example,
they may accumulate one particular type of object, and may even compulsively buy
several identical objects. They can obsessively accumulate objects such as newspapers,
old clothes, books and papers. At times they may collect animals, without accounting for
their inability to care for either themselves or the animals correctly.
The reasons for hoarding are complex, and are not limited to specific segments of the
population. Factors at play may include loss or trauma, when people may substitute their
feelings of loss with acquisition. Physical or mental illnesses may prevent individuals from
organising their things, especially when they cannot recognise their level of hoarding.
Anxiety is a major factor in many cases, when possessions are sought for comfort. Isolated
individuals may seek predictability when faced with chaos in their lives. According to Lydia
Guthrie, an expert on attachment-based practice, most hoarders have a complex history
related to attachment, and could have unresolved loss and/or trauma. They look to
objects in order to resolve their need for safety, comfort and predictability. Some people
show great anxiety if objects are removed or threatened to be removed.
Hoarding is also related to mental health disorders such as depression, dementia, alcohol-
related disorders, OCD, anxiety/phobias and learning disability/autism. It can especially
affect the elderly population, and personality characteristics such as being suspicious of
others, aloofness and high intelligence. Hoarders are not helped by large-scale clean-ups
without their permission, and even with their permission this may not be effective. They
suffer from ‘clutter blindness’, as they mentally block out their mess. However, when they
start to talk about their clutter, this can be a sign that they are ready to change and
People who hoard animals can often have their house eventually destroyed due to insect
infestation and accumulated animal faeces. These cases are often not reported until
neighbours complain of the smell. In houses with a hoarding individual, only 40% of fires
are contained in the room of origin, compared to 90% of normal fires (‘Myths and Truths’:
Chief Fire Officer’s Association). Unsanitary conditions have obvious health consequences
for hoarders, and can include bagged-up urine and faeces.
According to the Care Act 2014 in England (or section 19 of the Social Services and Well-
being (Wales) Act 2014), people who hoard are given support by the local authority if their
needs arise from a mental or physical disability, or if they cannot achieve two or more of
certain specified outcomes which include living safely in their home, keeping their home
environment habitable and maintain their personal hygiene. Hoarders can therefore be
eligible under section 18 of the Care Act which entitles them to a personal budget and
care and support plan. They may also come to the attention of a local authority as a
safeguarding referral under Section 42 of the act. Decisions are made on a case by case
Visual tools are available to aid in the assessment of a particular property, in order to
identify the severity of hoarding. Each case is different, and an assessment should be
carried out to gauge the persons vulnerability, the severity of their hoarding, the reasons
behind their behaviour, the effect this is having on others, whether the person is subject
to abuse, and the legal framework surrounding the case.