The 5 Stages/Levels of Hoarding: Helping Yourself or a Loved One
Hoarding is a complex and often misunderstood disorder that affects at least 6% (but likely more) of the Canadian population.
Understanding the levels of hoarding is crucial, not only for those directly affected but also for their friends, family, and caregivers. Let's delve into the intricacies of hoarding disorder, answer the question "What are the levels of hoarding?", dispel common misconceptions, and offer practical advice for each stage.
Whether you're seeking help for yourself or looking to support someone you care about, we want you to have insights into each level of hoarding, along with actionable steps, resources, and counselling towards recovery.
Levels of Hoarding
What is Hoarding Disorder?
Hoarding disorder is a mental health condition characterized by persistent difficulty discarding or parting with possessions, regardless of their actual value. Many people wonder, "How many levels of hoarding are there?" The answer is that experts generally recognize five distinct stages of hoarding behaviour.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), individuals with hoarding disorder experience distress at the thought of getting rid of items and accumulating possessions to the point where living spaces become cluttered and unusable.
It's important to distinguish hoarding from collecting. While collectors typically organize and display their items with pride, individuals who hoard often feel embarrassed about their possessions and the condition of their living space. Collectors find joy in their collections, whereas hoarding often leads to distress and impaired functioning.
Hoarding can affect individuals of all ages, genders, and socioeconomic backgrounds, though it often becomes more noticeable in older adults.
Common Misconceptions about Hoarding
Hoarding is simply a result of laziness or messiness.
In reality, hoarding is a complex psychological disorder that goes far beyond personal habits or cleanliness.
People who hoard are just greedy or materialistic.
The reasons for hoarding are often deeply emotional and psychological, stemming from factors such as trauma, anxiety, or depression. Individuals who hoard may form strong emotional attachments to objects, viewing them as sources of comfort or security.
People who hoard could "just clean up" their space if they really wanted to.
This is one of the most damaging beliefs and oversimplifies the profound emotional and psychological challenges faced by individuals with hoarding disorder.
For someone struggling with hoarding, the prospect of discarding items can provoke intense anxiety and distress, making it extremely difficult to simply "clean up."
The 5 Different Levels of Hoarding
Stage 1: Mild Clutter and Difficulty Discarding
Stage 1 hoarding is often the most challenging to recognize, as it can appear simply as mild clutter to the untrained eye.
At this stage, all living spaces are accessible and functional, but there may be some excess clutter. The key characteristic is a growing difficulty in discarding items that others might consider unnecessary.
To recognize Stage 1 hoarding in yourself or others, look for:
Reluctance to throw away items that appear to have little or no value
Emotional attachment to seemingly trivial objects
Slight anxiety when considering discarding items
A tendency to acquire free items, even if they're not needed
Stage 2: Moderate Clutter and Acquisition Issues
As hoarding progresses to Stage 2, the clutter becomes more noticeable, and acquisition issues begin to emerge. One or more rooms in the home may have cluttered surfaces, making them partially unusable for their intended purpose.
The progression from Stage 1 to Stage 2 often involves:
Increased difficulty in resisting the urge to acquire new items
Growing emotional distress when attempting to discard possessions
More visible clutter in living spaces
Beginning to withdraw socially due to embarrassment about the home's condition
Stage 3: Visible Clutter and Impaired Functioning
At Stage 3, hoarding begins to significantly impact daily life. Clutter obstructs doorways, hallways, and stairs, making navigation through the home difficult. This stage marks a crucial point where professional intervention becomes increasingly necessary.
The emotional toll of Stage 3 hoarding can be severe, including:
Increased isolation
Avoidance of social interactions
Heightened anxiety and depression
Feelings of shame and embarrassment about the state of the home
Conflict with family members or landlords over the condition of the living space
Stage 4: Severe Clutter and Poor Hygiene
Stage 4 hoarding presents serious health and safety concerns. At this stage, rooms can no longer be used for their intended purposes, and hygiene becomes a significant issue.
There may be infestations, mold, or other biohazards present in the home.
The challenges of helping someone in Stage 4 are considerable. There is likely:
A high resistance to intervention
Safety concerns for both the hoarder and any helpers
Potential legal issues, especially if children or vulnerable adults are in the home and extensive clean-up is required
Stage 5: Extreme Clutter and Hazardous Living Conditions
Stage 5 represents the most severe form of hoarding, where living conditions become extremely hazardous. The home may lack basic amenities such as running water, electricity, or functioning bathrooms due to extreme clutter.
The dangers present in Stage 5 hoarding include fire hazards from blocked exits and flammable materials, structural damage to the home from the weight of accumulated items, severe health risks from unsanitary conditions, and potential for injury from unstable piles of possessions.
Professional Treatment Options for Hoarding Disorder
Now that you know the different levels of hoarding, you’ll see that professional help like starting therapy is often necessary, even beyond someone cleaning it up one time. Here are some professional options for help for yourself or your loved one in a safe and non-judgmental space.
Therapy (CBT & Anxiety Therapy)
Cognitive Behavioural Therapy (CBT) is widely recognized as one of the most effective treatments for hoarding disorder. CBT specifically tailored for hoarding focuses on helping individuals understand and change the thoughts and behaviors that contribute to their hoarding tendencies.
The components of CBT for hoarding typically include:
Cognitive restructuring: This involves identifying and challenging the beliefs and thoughts that drive hoarding behavior. For example, a therapist might help a client question the belief that every item has potential future value.
Exposure therapy: Gradually exposing the individual to the anxiety of discarding items or not acquiring new ones. This helps reduce the distress associated with these actions over time.
Skills training: Teaching organizational and decision-making skills to help manage possessions more effectively.
Motivational interviewing: Helping the individual find their own motivation for change, rather than feeling forced by others.
Anxiety therapy is also a popular modality for individuals who struggle with hoarding disorder, as anxiety often plays a significant role in the development and maintenance of hoarding behaviours.
Some key aspects of anxiety therapy for hoarding include:
Mindfulness techniques: Teaching individuals to be present in the moment and observe their thoughts and feelings without judgment. This can help reduce the anxiety associated with decision-making about possessions.
Relaxation strategies: Introducing methods such as deep breathing, progressive muscle relaxation, or guided imagery to manage anxiety symptoms when dealing with clutter or the prospect of discarding items.
Exposure and Response Prevention (ERP): Similar to CBT's exposure therapy, ERP gradually exposes individuals to anxiety-provoking situations (like sorting through possessions) without engaging in anxiety-reducing behaviors (like keeping items "just in case").
Cognitive reframing: Helping individuals identify and challenge anxiety-provoking thoughts related to their possessions, such as catastrophic thinking about the potential consequences of discarding items.
Medication Options and Their Effectiveness
While there is no medication specifically approved for hoarding disorder, certain medications can be helpful in managing symptoms or treating co-occurring conditions that may contribute to hoarding behavior.
Common medications used in treating hoarding disorder may include:
Selective Serotonin Reuptake Inhibitors (SSRIs): These antidepressants can help reduce anxiety and obsessive thoughts that often accompany hoarding.
Anti-anxiety medications: For some individuals, anti-anxiety medications may help reduce the distress and anxiety associated with discarding items.
Stimulants: In cases where hoarding is associated with ADHD, stimulant medications may be prescribed to improve focus and decision-making abilities.
Note: The effectiveness of medication can vary from person to person, and it often requires patience and collaboration with a psychiatrist to find the right medication and dosage. Regular follow-ups and honest communication about side effects and symptom changes are crucial for successful medication management.
Support Groups and Community Resources
Support groups can play a vital role in the treatment of hoarding disorder. These groups provide a safe, non-judgmental space for individuals to share their experiences, challenges, and successes with others who truly understand what they're going through.
Joining a hoarding support group can help:
Reduced feelings of isolation and shame
Opportunity to learn coping strategies from peers
Motivation and encouragement from others' progress
A sense of community and belonging
In addition to support groups, various community resources may be available to help individuals struggling with hoarding, including mental health organizations, adult protective services, professional organizers, and cleaning services.
Explore the National Directory for Hoarding Support Resources for groups in your area.
Address the Different Levels of Hoarding: Hoarding Recovery with Access Therapy
Professional intervention can be a helpful method for those experiencing anxiety, depression, or other specific diagnoses that can lead to hoarding. If you’re recognizing the levels of hoarding as something prevalent in your or a loved one’s home, our specialized therapists here at Access Therapy would love to help you or your loved one explore hoarding recovery.
Book a free consultation today and start your journey towards a more organized, less stressful, and more fulfilling life!
