For many, letting go of possessions is intensely stressful, even when the clutter puts them at risk. Here’s what you can do
Some messiness is a fact of life for most people. It might be piles of disorganised paper, a box of decades-old cheques, or dirty clothing strewn about a bedroom. Then there’s the mess behind closed doors – in closets and drawers, the attic, or the garage. Messiness is an index of where people are in life. As we age, or when we’re going through a difficult time, our living spaces may get cluttered because we just don’t have the stamina or strength to manage it.
In certain cases, however, messiness sends an important signal about someone’s mental health. You might walk into the home of a friend or family member and find old or dirty items in every room, stacks of things that obstruct your movement, or storage areas that seem troublingly overstuffed. If you have noticed at some point that a person you care about has a severe problem with messiness, it makes sense to wonder if there’s something deeper going on.
You’ve probably heard of hoarding disorder (HD), a psychological condition that is characterised by persistent difficulty with discarding possessions. People with this condition – which is estimated to affect around 1 in 50 adults – feel a need to save possessions regardless of their actual value, and they experience intense distress about letting go of these possessions. Over time, this leads to an accumulation of things, and a person’s living environment can become so highly cluttered that living there becomes challenging and even unsafe.
Messiness builds as a result of the disorder. People with HD collect and save too many things, yet they still need to function in their cluttered environments. As they try to live amid the mess, they move possessions from one place to another in order to sleep, to cook or to brush their teeth. What was once organised, over time, becomes disorganised.
Although we don’t know exactly what causes this disorder, we do know that it tends to run in families. At the same time, hoarding behaviour can be a symptom of a number of psychological and medical conditions. For example, people who have an eating disorder might hoard food, or someone with autism spectrum disorder might acquire and collect items related to an intense fixed interest (such as car magazines, if the fixed interest is cars). Certain medical conditions can include hoarding behaviours too, for example: people with dementia might hoard items because they have trouble resisting impulses to acquire, or because they forgot that they already had the items.
For more than 20 years, I have worked with people who suffer from HD. Generally, I am called in to help by concerned friends, family members, or housing and fire authorities. By that time, the situation has become severe and even dangerous for the person with HD. This is a sad feature of the disorder: people are reluctant to seek help.
Keeping an item is more about avoiding anxious or sad feelings than it is about the item itself
This is where you come in. If you’re concerned that someone you know might have a problem with hoarding, I’ll help you get a better sense of whether that’s the case, and provide some guidance on how to offer support. A deeper dive into HD reveals important distinctions between the messiness of this disorder and the messiness that sometimes comes with other mental health conditions, as well as the routine messiness of life. Helping someone with HD calls for a different approach.
Consider the common signs of hoarding disorder
To get a better sense of whether a person’s messiness might be the result of HD, you can start by asking yourself a series of questions about their behaviour and their situation at home.
Does the person acquire and save items of limited value?
People with HD typically acquire items excessively and persistently, even when they will never use them or when they don’t have a place to store them. They might repeatedly buy the same item (a toothbrush, a watch, eyeglasses) because they’ve lost the original in the clutter. They might pick up free newspapers or flyers, or take home items from other people’s trash. They might keep ATM receipts and cancelled cheques from many years ago. While people with other mental health conditions, such as depression or ADHD, sometimes struggle with mess due to difficulties with motivation or focus, they don’t usually experience the same intense urge to acquire and save. They can walk away from broken furniture on the street, or a sale on soda. People with HD often cannot.
Do the possessions require a lot of extra space?
People with HD often try to manage the level of clutter in their home by storing possessions elsewhere. They might rent several storage units and pay the monthly storage fees even if they have limited financial resources. Similarly, they may store their possessions in the attics and garages of their friends and family members, in their cars, or in their front and back yards.
Is the person unable to organise and let go of their possessions?
People with HD may experience intense feelings of anxiety, loss or guilt when letting go of an item. This can apply even when the item is dirty, broken or of limited value, such as old grocery receipts or damp and mildewed drywall. They tend to keep the items as a way to avoid these feelings. In fact, the keeping is more about avoiding anxious or sad feelings than it is about the item itself.
If you’re worried about the person’s safety in their home, then the situation is likely more than messiness
Accordingly, people with this condition often are unwilling to accept help. They may fear that someone who promises to help will discard items without permission. They may feel deeply ashamed or embarrassed about the state of their home and their inability to manage the problem. They may feel paralysed by indecision and unable to move forward with anything, including asking for help. They may have tried repeatedly to declutter and now feel hopeless that you or anyone can help them. Last, they may have had repeated arguments about their possessions and grown mistrustful of those who want to help but end up only shaming them more.
Does the person have trouble living in their home?
Living in a highly cluttered and disorganised home is nearly always difficult. People with HD sometimes have trouble maintaining their hygiene because they’ve filled the tub or shower with possessions. They may have trouble preparing meals or cleaning dishes because the counters are piled with items, the microwave is broken, or the stovetop is covered. In the event that a shower or toilet no longer functions, they might avoid hiring someone to repair it because they don’t want the person to discover the state of their home.
Does the person recognise the risks they face?
Finally, and this is baffling for many friends and family members, the person with HD often doesn’t appear to recognise how unsafe they are in their living environment. Some may recognise that they have too much stuff and that their home is difficult to live in, but few recognise the risks they face. And the list of risks can be extensive. Fire that starts and spreads quickly. Mould, infestations or decomposing food that make the living environment unsanitary. Then there is the risk of slipping and falling in the clutter, particularly if the person is an older adult. Last, there is a risk of losing one’s housing altogether if the home is condemned by authorities. In spite of risks that are so very apparent to you, the person might reassure you that they’re safe, that you’re exaggerating the risks, that you shouldn’t worry. But if you’re worried about the person’s safety in their home, then the situation is likely more than messiness.
Talk to the person about what you’ve noticed
The first step in helping someone who doesn’t see that there’s a problem is to compassionately share your concerns with them. Tell them that, in spite of their reassurances that they’re fine, you are worried about them living safely in their home. Focus on concerns about their safety, and be specific. You might say: ‘I’m worried that you might fall and hurt yourself trying to get around your home because it’s so cluttered’ or ‘I’m concerned that a fire could start because there are so many of your things near the stovetop.’
The goal in this initial step is to open the door to help and to keep it open. Your positive relationship with the person is the only leverage you have, so use it wisely.
Don’t argue with them, and don’t threaten them by withholding visits with you or other special family members, such as grandchildren. In addition, you might highlight the benefits of a less cluttered home, such as opportunities for visits from friends and family (if the person values this) or easier days because they can prepare meals, bathe and do their laundry without the burden of moving accumulated objects from one place to another.
Decluttering the bed so the person can sleep comfortably is pointless if they are at risk of dying in a fire caused by newspapers on a hot stovetop
If they are open to treatment, certainly offer to find help for them. However, psychological treatment, such as cognitive behaviour therapy (CBT), requires a willingness to engage in the treatment, and that follows from a recognition of the personal consequences of the problem. Don’t suggest treatment too quickly. Remember, the person may not yet understand the extent of the problem and likely will not view treatment as necessary. Not only that, pushing treatment too soon may close the door to your help, too.
Offer to help declutter and organise
If the person with HD is open to your assistance, in the beginning, stay laser-focused on minimising risk and enhancing safety. Once the person’s home is safe – or safer – you can help them improve their comfort. Over time, as the living situation becomes safer and more comfortable, the person may become willing to accept other help, such as treatment from a qualified mental health professional who is knowledgeable about how to treat HD.
As you prepare to help the person declutter and organise their possessions, consider these steps that you can take together.
Decide where to store items
Prior to decluttering, designate how and where the possessions will be stored. Use clear plastic boxes if you can. Clear containers reassure the person that the stored items are safe and make it easier for them to retrieve an item if they want it later. In addition, identify a secure place to store important documents and items (eg, cash, chequebook, birth certificate, passport, car keys). As you declutter, you’ll discover important items mixed in with useless items, and you’ll want a plan to store important items safely.
Identify a small area to start with
Select a small area where the clutter presents a risk. Perhaps a quarter of a kitchen counter, the first three steps of the stairway, stacks of paper near the stovetop or on the radiator, or piles of newspapers and clothing behind front and back doors. There are several reasons for this approach. First, the most important thing is that the person is safe in the home. Decluttering the bed so the person can sleep comfortably is pointless if they are at risk of dying in a fire caused by newspapers on a hot stovetop. Second, in a highly cluttered home, you might spend several hours decluttering a kitchen and bedroom but see little or no progress. To maintain your motivation – and, more importantly, the motivation of the other person – focus on small, high-risk areas. You and they will see the progress.
For people with HD, this process is taxing. Often, they cannot do it for more than 30 minutes at a time, particularly when they’re just getting started on decluttering their home. Working on a small area and seeing progress helps to prevent burnout.
Develop ‘keep’ and ‘discard’ rules
In these early stages, it’s important to explicitly take discarding off the table at first
Each of us has unwritten rules about whether we keep or discard our possessions. For example, we keep passports and driver’s licences until we renew them, family heirlooms until we pass them to a friend or relative. We keep titles to our cars as long as we own them. We might discard newspapers after a week or so, magazines after a month or more. We discard clothes that are too big or too small, torn or worn out. You likely follow these rules without even thinking about them. People with HD, on the other hand, have great trouble deciding what to keep and what to discard. The default when they cannot decide what to do with an item is, unfortunately, to keep it.
‘Keep’ and ‘discard’ rules make it much easier to decide quickly what to do with an item and therefore increase how much decluttering you can accomplish. So, see if you and the other person can develop ‘keep’ and ‘discard’ rules together before you begin the decluttering. Post the rules on a wall near where you’re decluttering. Work with the person to follow the rules, but don’t push or argue with them. Instead, if needed, pivot to expressing your concern for the person and reminding them of the benefits of a less cluttered and better organised living space.
Sort possessions into categories
Once you’ve prepared to declutter, help the person sort their possessions into categories. Reassure them that you’re not going to discard possessions, only sort them. In order to encourage the person to accept your help in these early stages, it’s important to explicitly take discarding off the table at first. Even just sorting possessions is difficult for people with HD. Sorting with the immediate goal of discarding is nearly impossible for someone with HD to tolerate in the early stages of helping.
Usually, you’ll sort into categories such as ‘keep and store’, ‘recycle’, ‘sell’ and ‘discard’. If sorting into these categories feels too difficult for the person, help them sort into ‘keep’, ‘discard’ and ‘maybe’ categories. For now, these are just for sorting; later, once the person is comfortable with sorting possessions into the ‘discard’ category, you can then encourage them to actually discard the possessions placed in the discard box, using the ‘keep’ and ‘discard’ rules developed earlier.
Initially, the sorting will go slowly. You’ll observe that the person places many items in the ‘keep’ and ‘maybe’ categories. Use the ‘keep’ and ‘discard’ rules you developed to help them move an item from the ‘maybe’ category to the ‘keep’ category, or vice versa. Resist telling the person how to categorise an item, and never push or pressure them to move faster. Over time, you’ll likely see that they begin to sort more quickly. Remember, these early steps are to help the person feel more comfortable sorting – an essential step in organising possessions. As the person becomes more comfortable, you can work with them to move items from the ‘maybe’ category to the ‘discard’ category.
Final notes
Helping someone who hoards is a marathon, not a sprint. Take the long view in the helping process and keep your eye on safety. Set aside your own beliefs about how you think they should live and instead focus on respecting their right to live the way they wish, as long as they are safe.
It’s essential that you maintain a positive and trusting relationship: you cannot help someone if they refuse to let you enter their home. So, keep the door open to future visits. What they need from you now is compassion, understanding and ample patience.
