Over the next few months, we will be interviewing professionals who work with the hoarding population. We are asking them to share their insight on people who hoard and people who think they have the hoarding disorder.
We recently interviewed Dr. Roberto Olivardia. Dr. Olivardia is a Clinical Psychologist, Lecturer in Psychology in the Department of Psychiatry at Harvard Medical School and Clinical Associate at McLean Hospital. He maintains a private psychotherapy practice in Lexington, Massachusetts. He is co-author of The Adonis Complex, dealing with various manifestations of male body image issues. He has appeared in publications such as TIME, GQ, and Rolling Stone, and has been featured on Good Morning America, CNN, and VH1. His blog, “Psychology in Sync” is featured on the Psychology Today website.
We are looking forward to his presentation, Obsessed and Distracted and Impulsive, OH MY!: Helping Clients with ADHD and /or OCD at The Institute for Challenging Disorganization conference (ICD) in Orlando this September.
Questions & Responses
Since the DSM-5 was published, have you diagnosed anyone with the hoarding disorder?
Yes, but not a huge amount. I am working with a couple of cases now.
If you are working with someone with hoarding tendencies, do you or a designated professional go into the home?
Some I do. I used to do a lot more home based, especially working with Obsessive-Compulsive Disorder (OCD), but now we depend more on Skype.
Do people accurately report the severity of their hoard?
In my eyes, people vastly underestimate. But if they say, “I’m a hoarder,” then yes, they are usually right. Quite often a family member will call in expressing concern for their loved one who hoards. When the family calls, we look at it more closely.
How do you treat hoarding problems?
When possible, we have the person bring samples of what they hoard into the office to go through. For example, if the hoarding situation deals with papers and files, we have the clients come into the office with the items and we go through it. One client had boxes and boxes of clippings. None were related in any way to him – just informative pieces – which as you know you can now access easily on the internet.
What common comorbidity issues do you find?
I see specifically OCD and Attention Deficit Hyperactivity Disorder (ADHD). Most common in ADHD are severe executive functioning deficits. They are looking for the most perfect organizational systems which they don’t find so they can’t organize.
We also see Obsessive Compulsive Personality Disorder (OCPD). Someone with OCPD is often very rigid. They have a hard time making decisions because, for them, there is a right way and a wrong way. These are individuals that others might refer to as being “anal” . They feel they are right about how they are doing something and can’t budge. For example, an OCD person fears throwing something away because they might need it while an OCPD person won’t throw something away because it not the right thing to do and may actually think you are wrong and immoral if you throw that same thing away of yours.
We also see Depression, Bi-Polar Disorder, and a history of trauma, including emotional abuse, neglect or loss. With trauma we see emotional abuse and emotional neglect or loss. I had one client who had both of his parents take their lives at an early age and his hoarding was based on this trauma.
Do you feel that once you get one issue taken care of, then the hoarding is easier to work with?
Yes, although it depends on each situation. Unresolved trauma and loss – if you process that first then it is easier to let go of items. One client was hanging on to an old, broken clock. It was not a valuable clock but for him it was a memory and he stated that he wouldn’t have any more memories so this one was important to hold on to.
One client with ADHD was also an impulsive spender. We had to deal with how much he was spending before we could deal with what was already in the house.
Another client had enough flatware and dishes for 40 people and lived alone. But he hated washing dishes and silverware and only wanted to do them once a month. He also spent a lot of money on clothing because he hated to do laundry. He tried to do the same with food as he hated grocery shopping, but he couldn’t maintain it because when he bought a month’s supply of food some would go bad. These treatments are different from treating Bi-polar Disorder or psychosis.
What do you think about task forces like the one in San Francisco?
Task Forces are great. Anything that brings awareness to the challenges faced by those who hoard is very positive. After all, studies show that 3 – 4% of the population has hoarding problems. For people who are local to the Boston area, I refer them to Boston University. Gail Steketee does amazing work there.
What was your most difficult hoarding situation?
I work primarily with eating disorders in men. I had a client who would binge on food and then vomit. It was a hoarding problem because he then kept his vomit in jars. The jars let him know that he had gotten rid of the food he had binged on. He became quite ill. The good news is that with treatment, his bulimia was resolved. He also hoarded food because he was afraid others might eat it. This caused problems with rot and with bugs.
This was a very layered treatment.
Can you share something you learned from experience?
Often one issue is a sign of other issues. If there is a food hoard, I try to find out where this problem comes from. I get into their own space and hear how they describe it. I wonder about the hoard – is it something the client is trying to work out or is it something he is using to avoid working something else out. This shows that as human beings we don’t all work through issues the same way. Everyone has a story.
Are groups like Clutterers Anonymous or Overcoming Hoarding Together helpful?
I have found that they are helpful. Participating in these groups helps people eliminate a lot of shame. Some go to support groups and some participate online. They might hear someone’s hoarding story and extract pieces that they can relate to. They may find some common core.
Do you have a shareable list of resources for people challenged by hoarding or their families?
The Boston University Hoarding Research Project has good information and pamphlets.
The International OCD Foundation hoarding link has information for both those who hoard and their families.
Professional Organizers who have experience in the area of hoarding are a good resource.
There are books to recommend for hoarders and for their families;
Thank you very much for this fabulous time spent together learning more about the work you do.
If you are or if you know a professional who works with people with hoarding tendencies, please feel free to get in touch with us. We’d love the opportunity to talk with you, too!
Be sure to check back with us to see who we interview next in this series!
Diane N. Quintana is a Certified Professional Organizer, Certified Professional Organizer in Chronic Disorganization, ICD Master Trainer and owner of DNQ Solutions, LLC based in Atlanta, Georgia. Diane teaches busy people how to become organized and provides them with strategies and solutions for maintaining order in their lives. She specializes in residential and home-office organizing and in working with people challenged by ADD, Hoarding, and Chronic Disorganization.
Jonda S. Beattie is a Professional Organizer and owner of Time Space Organization based in the Metro-Atlanta area. As presenter, author of three books as well as a retired special education teacher, she uses her listening skills, problem solving skills, knowledge of different learning techniques, ADHD specialty, and paper management skills to help clients tackle the toughest organizational issues. Jonda does hands on organizing, virtual organizing, and moderates a Zone Plan Teleclass for those who prefer to work on their own with organizational coaching.
This wonderful interview with Dr. Olivardia helps to highlight the complexity of challenges that people with hoarding behavior encounter. And it’s also clear that a multi-stepped approach to help from professionals that are expert in this area are a necessary part of the equation. Realizing that issues are multi-layered and that certain diagnoses might need to be treated before others is critical to understand. Fascinating post and series!
Thank you very much! I am thoroughly enjoying the encounters with the variety of professionals Jonda and I have interviewed.
Very helpful and eye-opening interview. I think it is important to understand how different behaviors can overlap. Untangling them is difficult. I know that sometimes I touch a situation in only one corner of the person’s life, and it is hard for me to bring about change when so many other things are at play. I am thinking of a client who had mild dementia and lived alone. We would make great progress, but then have to “re-do” time and again. I felt the situation was well managed during this phase, before a new living situation was needed, but I also remember feeling that I wasn’t doing enough. For a variety of reasons, I was not invited into relationship with the family or other care providers, which I ultimately believe is the best model; everyone working together.
Thank you, Seana. I agree with you. Working together with family members and/or a therapist is the best model.