Hoarding disorder

The roof in Azimpur leaks again in the rains, and Bithi, 38, a schoolteacher, carries buckets past the stacks in what was once her mother’s sewing room. Ittefaq, Prothom Alo, the Daily Star, tied with jute string by year. The ceiling fan cannot turn because one pile reaches it. Abba, 71, a retired government engineer, stands in the doorway in his lungi, worried about the water, not the room.

“Abba, at least the wet ones can go?” “Wet? Dry them on the roof. That pile has the 1998 flood. History, ma. One day you’ll want it.” Her husband calls from the drawing room that the flat will soon be in the news itself, and Abba laughs too, and nothing moves.

Since Ammu died four years ago it has grown: plastic bags folded inside plastic bags, radios he will repair one day, medicine strips, wedding cards from people long gone. Once, while Abba was at the mosque, a cousin came with a van and cleared a room. Abba did not speak to anyone for a week, and within six months the room was full again.

An illustration drawn from common experience. The people are invented; the pattern is not.

Understanding hoarding disorder

Hoarding disorder is a lasting difficulty discarding possessions, whatever their value, because of a strong urge to keep them and distress at the thought of letting go. Things build up until rooms cannot be used for their purpose. It became a diagnosis in its own right in DSM-5. It is not laziness or untidiness, and people often feel shame and defend the collection fiercely. A review of studies of hoarding in older people found that it usually began before age 40, became more severe after middle age, and was linked with social isolation; depression was present in 14% to 54% of cases, and difficulties with memory, attention and planning were common. That is why a psychiatrist checks memory and mood, and asks about losses, such as a spouse’s death, that may have deepened it.

How common is hoarding disorder?

In a meta-analysis of 11 large studies covering 53,378 working-age adults in high-income countries, about 2.5% had hoarding disorder, with similar rates in men and women. Figures for Bangladesh are not available.

Signs and symptoms of hoarding disorder

• Rooms, stairs or beds that cannot be used because of things
• Great distress, or anger, when anyone tries to throw something away
• Keeping items most people would discard, such as old papers, bags or broken goods
• Refusing visitors or repairs so that no one sees the home
• Risks of fire, falls or poor hygiene building up

Treatment for hoarding disorder

A meta-analysis of cognitive behavioural therapy for hoarding disorder found a large reduction in symptoms, strongest for difficulty discarding, and more sessions and more home visits were linked with better results. Improvement was real but often partial, so goals are kept honest. Therapy works on decisions about objects one at a time, the beliefs behind keeping, and practice in bearing the discomfort of letting go. Clearing a home without agreement does not treat the difficulty behind it, and it can damage trust. Families learn how to support without fighting. A psychiatrist will also assess memory, depression, anxiety and physical health.

What getting better can look like

Progress for Abba might be choosing, with Bithi beside him, to keep the 1998 flood editions in one trunk and let the rest go to the bhangari man, and the fan in Ammu’s room turning again.

Common questions about hoarding disorder

What is the difference between collecting and hoarding?

Collectors usually keep a chosen set of things in order and enjoy showing them. In hoarding disorder, possessions build up until rooms cannot be used, the person cannot discard even things of little value, and the situation causes distress or danger. It is a recognised condition, not a character flaw.

Should we clear out a parent’s hoard while they are away?

Generally not, unless there is an immediate danger such as a fire risk or a blocked exit. Clearing without agreement can be deeply distressing and does not treat the difficulty behind the hoarding. A slower plan agreed with the person, ideally with professional help, is the better path.

When to see a psychiatrist

If a parent’s home is becoming unsafe, if they are cut off from people, or if their memory or mood seems to be changing, a psychiatric assessment can help the whole family. Fire risk or blocked exits need action now.

Care here is personal: built around your history, your health and what you want to change, and reviewed with you as it goes.

If you or someone else is in immediate danger, call 999 or go to the nearest hospital emergency department.

Sources

• Postlethwaite et al., Journal of Affective Disorders, 2019 (PMID 31200169)
• Tolin et al., Depression and Anxiety, 2015 (PMID 25639467)
• Roane et al., International Psychogeriatrics, 2017 (PMID 28162112)