Examining Hoarding and
Cluttering Behavior
Matthew Soderquist, MSW
Adult Services Supervisor/CRC
Otsego/Crawford/Oscoda DHS
Overview
Diagnosing Hoarding Disorder
Underlying Beliefs and Impacts of Hoarding
Assessments
Interventions
Rules of Interventions
Goals of Interventions
Measuring Success
3 Case examples
Diagnosing Hoarding Disorder
 Persistent difficulty discarding or parting with possessions,
regardless of their actual value.
 This difficulty is due to a perceived need to save the items
and distress associated with discarding them.
 The symptoms result in the accumulation of possessions that
congest and clutter active living areas and substantially
compromise their intended use.
 The hoarding causes clinically significant distress or
impairment in social, occupational, or other important areas
of functioning.
Diagnosing Hoarding Disorder
In addition the DSM-5 lists two “specifiers”
(features that may or may not be present):
Excessive acquiring
Level of Awareness
 Good or fair Insight
 Poor insight
 Absent insight
 *Medical condition
 *Another mental disorder
Underlying Beliefs
Overestimation of Catastrophe or Loss
Perfectionism
Responsibility
Need for control
Emotional Comfort
Sentimental
Security Based
Connections, Social Ties
Impacts of Individuals with
Hoarding and Cluttering Disorder
 Isolation
 Impedes development of relationships
 Safety issues in their homes
 Fear of eviction
 Problems in their family relationships, loss of contact,
divorce, and custody.
 “My wife left, My children don’t visit”
 “I lost custody of my daughter because of hoarding”
 “My family has completely abandoned me”
 “My husband hurt himself while walking through the
house…he has no place to relax”
Impacts of Children of Hoarding
and Cluttering Behavior
 Loss of space
 Developmental delays
 Hygiene problems (access to bathrooms, loss of
utilities)
 “Doorbell Dread”
 One child of a hoarder would strategically arrange for
her friends to visit while she was visiting her fathers
home
 Financial strain
 Poor eating habits
 Physical and Mental Health Issues
 Impact on social lives
 CPS involvement, Divorce and Housing Instability
Impacts of Adult Children of
Hoarding and Cluttering Behavior
 Strained familial relationships
 Resistant to allowing grandchildren to visit
 Grandparents become isolated from grandchildren
 Adult children are ashamed to bring significant
others to visit parents.
 Limited ability to determine the proper value in
objects
 “Abandon all hope that the parent will reform
Assessments
Hoarding Assessment Tool
HOMES- Health, Obstacles, Mental health,
Endangerment, Structure and Safety.
Hoarding Rating Scale
Savings Inventory Revised
Savings Cognitions Inventory
Clutter Image Rating Scale
TACC- Tufts Animal Care and Condition
Interventions
What doesn’t work
Quick Cleanouts
Throwing things away in secret or lying
about what you will do with an object
Forced discarding often increases
distrust of others and increases
attachment of the object
May cause increase of collecting as fear
of losing is increased
Interventions
Professional Counseling or Therapy
Cognitive Behavioral Therapy
Exposure Therapy
Themes of CBT for Hoarding
Building a legacy of trash?
Everything goes to the dumpster eventually
Build relationships with people not things
Things are here to serve us not the other
way around
How does this item add to my life?
Interventions
Education
Buried in Treasures
BIT Workshop
Support Groups
Children of Hoarders
Adult Children of Hoarders
Interventions
 Practical Methods
 Cut of paper flow
 Fowl the trash and avoid dumpsters
 Involve family members
 Non-shopping trips
 Practice getting rid of objects
 Develop guidelines for Keep vs. Toss
 Safe vs. Unsafe
 Rotten Wood
 Pest infestation
Rules for Intervention
May not touch or throw anything out without
explicit permission
All decisions regarding saving, discarding
and organizing are made by client
O.H.I.O- Only Handle It Once
Focus on client goals and standards NOT
ours
Goals of Intervention
Client safety by uncluttering living space
Harm Reduction Model
Increase appropriate use of space
Improve decision making skills and
develop organizational plan
Reduce accumulations of new
possessions
Clean, Cull and Connect
Measuring Success
Small Steps
Safe, healthier environment for the client to
live in
Housing secured
Client’s motivation increases
Creation of a system for managing items
that client can manage on their own
Use of photos, CIR, HOMES
References
 Bratiotis, C., & Schmalisch, C. S. (2011). The hoarding
handbook: a guide for human service professionals. Oxford:
Oxford University Press.
 Diagnostic and statistical manual of mental disorders: DSM-5.
(5th ed.). (2013). Washington, D.C.: American Psychiatric
Association.
 Frost, R. O., & Steketee, G. (2010). Stuff: compulsive hoarding
and the meaning of things. Boston: Houghton Mifflin Harcourt.
 Lokers, L. M. (2013). Identifying and treating hoarding
behaviors. University of Michigan. Anxiety Disorders Program
 Steketee, G., & Frost, R. O. (2013). Treatment for Hoarding
Disorder Workbook. (2nd ed.). Oxford: Oxford University Press,
USA.
 Tolin. D.F. (2014). Buried in treasures help for compulsive
acquiring, saving, and hoarding (Second ed.). Oxford: Oxford
University Press.