Hoarding Disorder

While there is increasing research in understanding hoarding behaviours in youth, much of the data is based upon adult reporting. As a result, information outlined in this section borrows heavily from the adult literature.

Hoarding disorder is associated with three key features:

1. Ongoing and significant difficulty getting rid of possessions (i.e., throwing away, recycling, selling, etc.), regardless of their value; and strong urges to save and/or acquire new, often non-essential, items, that if prevented leads to extreme distress. Non-essential includes items that are both useless (i.e., broken), as well as those with limited value (e.g., 10 rocks from the street, old homework sheets from previous school years)
2. Living space is severely cluttered, preventing it from being used for its intended purpose.
3. Significant impairment in social, occupational, and other important areas of functioning as evidenced by:

• Impaired physical health
• Missed school or work, and compromised academic potential
• Social isolation
• Emotional distress
• Family stress and impaired parent-child relationship

Two additional specifications include:

1. Whether the youth is also engaged in excessive acquisition (It is currently estimated that upwards of 80-90% of individuals with hoarding also experience excessive acquisition of items through collecting, buying, and even theft), and,
2. Whether the youth has any insight or awareness that his/her behaviour is problematic.

Many cultures worldwide place some emphasis on consumerism, and this often begins early in childhood. Children quickly learn to exhibit preferences for particular items, and can tell you what the current trends are and why it matters to own the latest X. They often delight and gain comfort in having collections of various sorts. During the preschool years this helps children learn about categorization, belonging, and other important concepts. As they mature, collections assist with developmental skills such as organization and problem solving, as well as providing a sense of control and mastery over their own possessions. It is also common for children to develop emotional attachments to items and to struggle to part with items once they are no longer needed. However, in youth with HD all of these factors are magnified. These youth struggle to self regulate, failing to recognize that the number of items or degree of their behaviour is problematic. They lack the ability to sort through items that are useful versus useless, or to predict what will and will not be needed into the future. They engage in extreme behavioural outbursts if asked to discard an item, or if prevented from acquiring a desired object. This is not one small tantrum, but many huge explosions, every time a limit is set. For some children, the bedroom may look like the inside of a chaotic bazaar, with drawers, closets, and other space crammed full. And if this is not the case, then it is due to the ongoing decluttering intervention of an adult. Collecting and having the desire to have items runs on a continuum, and in moderate amounts it can be typical of the culture and time of life (e.g., wanting what other kids have so s/he can fit in). For children, the defining feature is not necessarily the cluttered, unlivable environment as the hoarding often is more contained (e.g., under the bed). However, it is the number and amount of acquiring, and the negative impact on functioning and the emotional reaction to their possessions that is the defining feature of HD in youth.

• Missed school
• Cluttered living conditions especially in the bedroom
• Poor organization and focus
• Impaired relationships
• Social isolation
• Family conflict

How Hoarding impacts the child throughout childhood and adolescence

Saving and collecting is a common pastime for most youth that assists in personality and identify formation.  Items range from dolls, cars, and trading cards, to pencils and stickers in early childhood, to music, clothing, and electronics in adolescence. Despite similar interests in youth who do and do not hoard, children who hoard are distinct due to their extreme focused interest around the items, including excessive discussion, or seeking ongoing reassurance about the items, significant distress discarding the items, and the amount of accumulated clutter relating to these items. Like adults, youth who hoard often lack awareness that their behaviours are problematic or unusual. However, since children live with others, parents and guardians play a significant role in controlling the degree of items and related clutter. Parents often restrict what the youth is allowed to purchase, put limits on what is allowed in the bedroom, remove items from the home when the youth is at school or sleeping, and avoid taking children to locations associated with item acquisition (e.g., specific stores). Yet as the child matures, urges to acquire strengthen and families often find themselves struggling to set and maintain limits. Not surprisingly, parents and guardians will, at times, accommodate or give in to their child’s incessant demands to avoid a public tantrum or to gain some peace and quiet. Unfortunately these intermittent “wins” for the child only serve to strengthen the child’s hoarding behaviours. Furthermore, as children mature, access to disposable income and independence increases, and thus so too does the capacity to acquire more items. Overtime, youth who hoard may encounter peer rejection and social isolation as their peers view the hoarding as “weird” and/or as hoarding takes over as a pastime, alienating the youth from other normative activities including social, academic, and occupational pursuits.

Cite:

1. Rasmussen & Eisen, 1992; Samuels et al., 2002
2. Frost, Steketee, & Tolin, 2011

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