Registered social worker Elaine Birchall tackles hoarding

by Reuel S. Amdur

In 2013, the American Psychiatric Association came out with their fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5.  The manual is used world-wide among mental health practitioners to identify and characterize mental disorders.

The DSM-5 added a new diagnosis, hoarding. Well, that was nothing new to social worker Elaine Birchall. She encountered a case when she was an Ottawa welfare worker back in the 1990’s and has been involved in treating the condition even before DSM-5 came out. Her firm, Birchall Consulting, was established in 2007. 

Her first experience with a full-blown instance of hoarding was with a welfare recipient, but she wants to be clear: “People who hoard may be found in all social classes.” The common stereotype of a hoarder is that of an old lady with a filthy house full of cats. Birchall demurs on various grounds. To begin, she rejects the term hoarder. It simply reinforces the stereotype. Instead she prefers to refer to people who hoard. The cat lady’s level of dysfunction is hardly typical. “Some of the nicest people I’ve ever met hoard.” 

Hoarding is categorized by the DSM as an obsessive-compulsive and related disorder. It “is characterized by persistent difficulty discarding or parting with possessions, regardless of their actual value, as a result of a strong perceived need to save the items and to distress associated with discarding them.” Hoarding can result in the accumulation of large quantities of stuff “that congest and clutter active living areas.” The person who hoards is apt to engage in “excessive collecting, buying, or stealing items that are not needed or for which there is no available space.” 

Birchall describes some of the types of hoarding. The person who hoards discriminately hoards types of things and often categorizes them. Hoarding is not the same as collecting. For one thing, collecting does not impede the actual living space in the home. Things are organized and often are meant to be displayed for others to admire. That is not to say that some collectors could not become hoarders. 

With indiscriminate hoarding, the need is to acquire, fear of not having enough. A person picks up litter with the object of recycling, but the recycling never happens. In some cases, these two types may be combined.

Besides animal hoarding, another extreme form is the Diogenes syndrome. Diogenes was an ancient Greek philosopher in Socrates’ time who lived solitarily and in poverty, but in fact he did not hoard. Nevertheless, the syndrome is characterized by hoarding, as well as severe self-neglect including of personal hygiene, filthy surroundings, chronic isolation, and a lack of awareness and self-awareness of the situation. One finds the syndrome most often among older people. This condition is extremely difficult to treat. Many with the syndrome have other major mental health problems.

So, where does hoarding come from? In some cases it seems to be genetic, running in families.  Also, traumatic life events may lead to the condition, for example, adverse childhood experiences (ACE). Then, people whose personality is indecisive are more likely to take up hoarding.

She emphasizes that in treating the problem the client is not confronted but is led to self-identify elements of discomfort on which action can be encouraged. People with hoarding disorder are often reluctant to seek help. If things are taken away, the person may simply replace them. Prognosis is related to the level of insight. Better insight gives better promise, while lack of insight and delusions are indicative of real challenges in treatment. Cognitive Behavioural Therapy (CBT) is one approach to the treatment of hoarding, one that is among the techniques Birchall uses.  

Here is an example of how CBT might be used in treatment for hoarding disorder. The therapist asked the client to put items in piles: to keep, to sell or donate, and to throw out. Discussion was then held on follow-through with regard to specific items and the client was given the homework to carry out the plan. As can be seen, this is a long, slow process.

On the other end of the process, the client needs to stop adding to the clutter. He may be encouraged to visit places where he has acquired stuff by purchase or otherwise and simply to not acquire. This activity may be repeated. 

The person could be encouraged to move forward with this program because it might make it possible to have visitors and improve his social life. This is just a snapshot of one approach.

We have talked about the psychological aspects of hoarding, but hoarding is more than a treatment-oriented psychological problem. It is as well a problem of public health and safety, law, and fire protection. Hoarding can create health problems because the clutter and rotten food could bring rodents and cockroaches and other insect infestations. If rodents chewed on electrical wiring or if heaters were in contact with combustibles, fire safety would be an issue. As well, law becomes involved in enforcement. Law is called upon if neighbours complain about the infestations or odors. The clutter could also run into problems with social housing regulations. Hoarders may experience eviction. 

Serious hoarding is, Birchall explains, a severe psychological condition requiring the long-term assistance of a hoarding-informed mental health professional. In general, those with the problem of hoarding have other mental health problems, especially related to anxiety and depression, besides its DSM identification with obsessive-compulsive disorders (OSD). The OSD characterization in some cases becomes more pronounced. More serious mental health issues such as schizophrenia and Alzheimer’s or other dementias may also be encountered. 

Birchall is founder of the Canadian National Hoarding Coalition and co-author of Conquer the Clutter, published by Johns Hopkins University Press. She describes her therapeutic work as “helping you to take back your life when things are taking over.” She lectures across North America and consults world-wide. She has appeared on VoiceAmerica.   

Even if you do not have a hoarding disorder, you may still have reason to call upon Birchall Consulting. For example, you are downsizing and need help sorting things out to move into a retirement facility. Or you are a lawyer dealing with a property matter, a real estate agent wanting help in presenting a property, or the administrator of an estate. Any of these or other “normal” citizens may benefit from the assistance of Birchall Consulting in controlling or fitting things into spaces. She can also put property in its most attractive presentation.

There are, of course, costs involved in many of her services but, because she is a registered social worker, personal counselling is covered by insurance in many cases and is characterized as a medical expense for tax purposes.

For more information visit Birchall Consulting’s website at: | Hoarding help and support