Until recently, most people believed that hoarders were eccentric people who died surrounded by a lifetime collection of stuff. Hoarding in families was cloistered in a vault of family secrets or passed off as an individual peculiarity. The effects of hoarding on other family members was rarely examined or understood. Only recently have we confirmed that hoarding is more common than we once thought. Hoarding disorder (HD), a diagnosis proposed for the DSM-5, affects an estimated 2% to 5% of the general population.1-5<\/sup><\/p>\n Partly because of attention given through reality television, the general public knows much more about hoarding and its ramifications. The greater awareness about hoarding is sparking an outpouring of concern for its effect on families\u2014especially children. Mental health professionals are starting to address this growing concern with research, education, outreach, and intervention for the benefit of children who grow up in hoarding households.<\/p>\n HD is unique from other disorders because its symptoms are tangible and entail a large accumulation of objects that prevent the use of space for necessary or usual human functions. This abundance of objects results from a pathological failure to discard objects and not accumulate more; that is, more objects come into than leave a home. This imbalance causes undesirable conditions that impede human functioning and cause distress. When hoarding is severe, it presents risk of physical and psychological harm to hoarders and their families. Risk of harm extends to neighbors and their properties.<\/p>\n Mental health professionals need to spearhead strategies for change, which will be most effective when based on an in-depth knowledge of the disorder and its effects on people. My research focuses on the long-term consequences of being raised in the homes of hoarders. I hope that knowledge of these effects will be met with increased outreach, resources, and a plan for moving families from hoarded homes into functional lives. Public confidence in outreach depends on compassionate understanding and available resources to guide well-conceived plans for recovery.<\/p>\n Many adult-children of hoarders communicate with me through email and phone calls. A closer view of the effects of hoarding comes from my intensive work with families during the filming of \u201cHoarders,\u201d an A&E televised, reality series. This summer, adult-children of hoarders traveled from all over the country to participate in a 3-day workshop at my OCD Institute of Greater New Orleans. They shared details about their childhoods and the enduring effects of being raised in a hoarded home.<\/p>\n Workshop attendees joined my staff of 2 psychologists, 2 social workers, and a professional organizer in developing a leadership group with a common mission\u2014to help children of hoarders. The attendees\u2019 ongoing projects in outreach, peer-support and education for adult-children of hoarders inspired new projects to promote public awareness and assistance for children of hoarders.<\/p>\n Since the workshop, networking within the leadership group has been fruitful. The group has produced brochures, authored literature for children, presented to special interest groups, prepared for upcoming professional workshops, developed Web sites, hosted Internet forums, participated in media coverage, partitioned city officials for publically funded task forces, and promoted participation in my research.<\/p>\n A large number of adult-children of hoarders have participated in my research by completing mailed questionnaires, an online survey, and telephone interviews. Preliminary results support that being raised in a hoarded home produces lifelong, deep, and widespread effects, including losses in every sphere\u2014physical, emotional, psychological, social, and familial.6<\/sup><\/p>\n Safety succumbs to stuff<\/strong> Processes that support appropriate growth and differentiation of family members are overlooked. A person\u2019s value becomes secondary to a \u201cgood deal.\u201d As family members struggle through, hoarders often feel criticized, rejected, and shunned, and they turn to objects for safety, success, and the fulfillment of many misguided beliefs or values. Hoarders cannot see that their behavior subjugates the entire family to a life that is permanently altered.<\/p>\n Where severe hoarding exists, families rarely have space for shared activities or they are forced to combine spaces inappropriately\u2014such as when an older child has to sleep in the same bed as a parent. Sometimes children are forced to live in one space that serves multiple functions. A vacant spot on a couch is used for sleeping, doing homework, watching television, and eating.<\/p>\n In some cases, objects that should never be in homes occupy living spaces. Contaminants, rotten food, garbage, and molded piles of newspaper that attract insects and rodents infiltrate the home. Air quality eventually becomes toxic. When pets are in the home, objects often get covered with animal waste. As a result, children suffer health problems, such as asthma, and are at grave risk for being trapped in a house fire or being bitten (and infected) by pests.<\/p>\n Even when the house is unfit, hoarders often view their children as safest under their care. Some hoarders will expose their children to abhorrent conditions rather than face public scrutiny and risk losing them. Children often realize if they talk about their family secrets, they could lose their parents and homes.<\/p>\n Naturally, children will endure a great deal of pain before risking home and family. When they reach adulthood, they see that the disorder has only gotten worse, yet their parents resist treatment or intervention of any kind. What kind of disorder is so gripping that it won\u2019t let go? What kind of disorder takes hoarders, often good and decent people, away from their families, away from any possibility of a truly fulfilling life?<\/p>\n Hoarders have poor insight into their problem and underestimate its severity.7<\/sup> They fear societal repercussions such as public scrutiny and consequences that could dramatically change their lives. If reported to governmental agencies, they could face an eviction or loss of home and its contents, and have their children taken away by a child welfare agency. Hoarders often think that neighbors should mind their own business and do not realize that a hoarded house is a community concern. They simply want to be left alone\u2014and being alone seems to be the inevitable result of unchecked hoarding.<\/p>\n Early in life, children of hoarders are confused by their parents\u2019 behavior. Parents can show clear signs of devotion, especially in areas that do not compromise hoarding. They will work tirelessly to support their children\u2019s opportunities but refuse to get rid of the objects that most jeopardize their lives. For example, at work, a mother cheerfully organizes treat bags to celebrate every holiday; at home, she confines food preparation to microwave meals. Fearing a report to the authorities, parents avoid calls for repair services.<\/p>\n Children learn how to live without basic comforts and relinquish all hope for a home-cooked meal shared at a family table. Attachment to the hoarding parent is commonly secured by participating in the gathering process. A trip to the zoo is replaced with a trip to the flea market.<\/p>\n While parents acquire objects, their children fail to live a normal family life\u2014a huge cost for a parent\u2019s distorted relationship with objects. Children of hoarders witness their parents and family slipping away, one object at a time. Boundaries are often blurred because a hoarder\u2019s choices overshadow or dominate those of other family members. A hoarder\u2019s need to decide what everyone will have and keep restricts children\u2019s personal choices.<\/p>\n As objects invade spaces in homes, they block usual pathways to intimacy. Relationships occur in a vacant spot on a couch and the remaining edge of a table. In cases where only one parent is a hoarder, the non-hoarding parent runs the risk of eventually becoming disabled in one way or another; s\/he ceases to function, expires like cans of inconsumable food, becomes a hoarder, overfunctions to compensate for the disorder\u2014or simply disappears.<\/p>\n As the disorder intensifies, family members feel devalued, broken-hearted, angry, helpless, and exhausted. Psychological risks abound because life is defined by restricted space and the hoarder\u2019s need to control the home. Children abandon their own needs for change or help and learn to accept the unacceptable. When nothing else works, children hide what is too painful to acknowledge. Helplessness and hopelessness replace celebrations of life\u2019s journey.<\/p>\n The boundary between these families\u2019 private and public worlds widens, a usual course for this disorder. Fear, shame, and embarrassment lead children to hide their living conditions from outsiders. This affects all social relationships. Children find refuge in other people\u2019s homes and outside activities. Some just stay inside and isolate. Sometimes concerned relatives take in these children.<\/p>\n Secrecy about the home is supported by fear of parental reactions. Parents get angry at the slightest confrontation, so revealing the family secret could have huge emotional consequences. Parents\u2019 reaction to interference or complaints about the hoarding ranges from disapproval to emotional abandonment. Parents emotionally collapse when they feel misunderstood, unloved, and judged. So, children learn to maintain a boundary between the family and the outside world.<\/p>\n Adult-children of hoarders<\/strong> As one person said, \u201cHow can you feel worthy when your own parent chooses garbage over you?\u201d When they are old enough and can no longer tolerate the disorder, they leave, sometimes moving far away to get the psychological distance they need. Other times, they are enveloped by the family dysfunction and stay.<\/p>\n When adult-children of hoarders attempt to battle the \u201cclutter monster,\u201d they usually find themselves rejected by their parents. Confronting the hoarder too harshly or intervening without permission can deepen mistrust, intensify psychological pain, and ignite interpersonal conflict that deepens already pathological family dynamics.<\/p>\n Sometimes parents pit siblings against one another and the one that does not interfere with the hoarding behavior is usually preferred. At times, the hoarding behavior worsens when parents feel that they have lost control over the hoarded items. Forced \u201cclean-outs\u201d of parents\u2019 homes are usually countered with wrath and permanent exile for violating the hoarder\u2019s need for control.<\/p>\n When forbidden to enter the home again, adult-children lose the ability to help the endangered parents. So, sneaking in a few disposals of objects or freeing the home of some filth, squalor, and rotting food is about all they can do without serious emotional repercussions.<\/p>\n Hoarding continues to affect family members, even when adult-children do not enter the hoarded home. By living far away, they miss out on family experiences and celebrations. The whole family is unable to share the family\u2019s evolution over generations. Grandchildren cannot visit their grandparents\u2019 homes, and family traditions are lost or never established. Reunions with parents are in hotel restaurants, and holidays are in other people\u2019s homes. Sometimes holidays are designated for helping aging parents by carefully reorganizing their belonging so that the home is safer.<\/p>\n Some adult-children simply walk away from their entire family knowing that separation is the only hope for a better life. Even from afar, they wonder: Will I have to raise my younger siblings? Will my children ever know my father? Will he lose his livelihood because of hoarding at work and depend on me for support? Will my nonhoarding parent have to endure the hoard for the rest of her life? Will my parents need assisted living because they cannot safely navigate the clutter? Will I find my aging parent dead in a pile of trash? Will we have to clean up the mess after they die?<\/p>\n Parents rarely prepare for being disabled or too old to hoard. Their children\u2019s ultimate inheritance is salvaging the remains of a hoarded house. Hoarders\u2019 children often fear that they, too, will become hoarders.<\/p>\n Therapeutic interventions<\/strong> Adult-children of hoarders who seek help from mental health professionals are baffled by the facts of their parents\u2019 lives and grateful for any information that increases understanding, even if the advice is not <\/em>to help. Not helping ends when young siblings or severely impaired and\/or dependent adults live in severely hoarded and dangerous houses. When hoarding parents refuse family intervention, adult-children feel compelled to file reports with code enforcement, health departments, and protective services. These reports can be less traumatizing to families when compassionate, coordinated, and effective resources guide them into a safer life.<\/p>\n \u201cHoarding task forces\u201d\u2014services provided by mental health providers, professional organizers, and public agencies and departments (eg, fire, police, housing inspection, public health, and human protection)\u2014provide assistance by coordinating multiple resources for families affected by severe hoarding. Given the shortage in public resources, task forces also draw on charitable donations, such as trash removal, pest control, property rehabilitation, and furnishings.<\/p>\n The cumulative burden of hoarded households on public resources and safety are reduced when all concerned parties work together. Management of coordinated resources to address severe hoarding through publically funded task forces is a civic responsibility and need. Effects of severe hoarding are far-reaching and enduring. When not efficiently addressed, these effects are costly and threatening, not only for individuals but to communities. As mental health professionals, we can help support funding of by showing the need for positive and expedient intervention.<\/p>\n We are in the pioneer days of finding solutions for a tenacious disorder that strikes millions of people and affects families and communities. We will more likely explore hoarding in families when we have effective strategies for intervention. Armed with these, we can promote outreach in communities and institutions, especially ones that bring children out of hiding and into safer lives. We will more confidently inquire about hoarding when we know that resources for remediation exist. A strategic coordination of services will best produce positive results for people damaged by hoarding, especially children who need us to affect change in their lives.<\/p>\n [Editor’s Note: Dr Chabaud encourages adult-children of hoarders to complete her online survey by first contacting her through her website <\/em>www.drchabaud.com<\/em><\/a> or directly at her email <\/em>schabaud@msn.com<\/em><\/a>.] <\/em><\/p>\n<\/div>\n References<\/strong> <\/p>\n <\/p>\n
\nInside hoarding homes, cultural norms of family life are squeezed out as parents become entrenched in the flow and placement of objects. With a need to feel in control of a process that is clearly out of control, hoarders are unable to distinguish between healthy and unhealthy, unneeded or just \u201ctoo much.\u201d3<\/sup><\/p>\n
\nAs children get older, the psychological cost of accommodating the disorder becomes more apparent. They become more conscious of their own vulnerability, worthlessness, helplessness, hopelessness, disgust, embarrassment, and social isolation. Their psychological pain seems most connected to feeling less valued than the stuff being hoarded.<\/p>\n
\nMany patients never reveal that they have lived and\/or are living in hoarded homes. Increasing disclosure about hoarding can curtail its long-term effects. Mental health professionals can ask children suspected of living in hoarded homes several questions [Table<\/strong><\/a>], keeping in mind that many are frightened to tell the truth. Adults are more likely to share about conditions of childhood homes and ones they currently manage.<\/p>\n<\/a>We can help adult-children address the effects of hoarding on their lives and, when possible, devise a plan to involve parents and siblings in therapy. Family therapy can often start the process. Other mental disorders associated with hoarding can be addressed with medication. Professional organizers experienced with hoarders can help us with in-home interventions.<\/p>\n
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\n2. <\/strong>Mataix-Cols D, Frost RO, Pertusa A, et al. Hoarding disorder: a new diagnosis for DSM-V? Depress Anxiety.<\/em> 2010;27:556-572.
\n3.<\/strong> Samuels JF, Bienvenu OJ, Grados MA, et al. Prevalence and correlates of hoarding in a community sample. Behav Res Ther.<\/em> 2008;46:836-844.
\n4. <\/strong>Iervolino AC, Perroud N, Fullana MA, et al. Prevalence and heritability of compulsive hoarding: a twin study. Am J Psychiatry.<\/em> 2009;166:1156-1161.
\n5.<\/strong> Mueller A, Mitchell JE, Crosby RD, et al. The prevalence of compulsive hoarding and its association with buying in a German population-based sample. Behav Res Ther.<\/em> 2009;47:705-709.
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\n7.<\/strong> Tolin DF, Fitch KE, Frost RO, Steketee G. Family informants\u2019 perceptions of insight in compulsive hoarding. Cognit Ther Res.<\/em> 2010;34:69-81.<\/p>\n
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