Methods for Addressing Hoarding

Although Hoarding Disorder can create significant stress, impairment, and interference in you and your child’s life, the good news is that there is a treatment* that can help. Below we outline a variety of solution-focused, practical steps designed to help your older child or adolescent, to sift through and organize possessions, so that s/he can learn to let go of unnecessary items cluttering his/her living space. However, for most individuals who have been struggling with hoarding for years, we highly recommend finding a pediatric Cognitive-Behavioural professional with expertise in Hoarding and Obsessive Compulsive Disorder (OCD). Our years of clinical experience dictate hoarding is a challenging disorder to address alone, and having a professional to guide you and your child is advised. To access a list of qualified providers managed by the International OCD Foundation, please click here.

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 literature1. 

Tool #1: Become Your Own Expert

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.
  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 for the individuals including:
  • Impaired physical health
  • Missed work and compromised employment
  • Financial problems
  • Housing instability including threat of, or actual, eviction
  • Social isolation
  • Emotional distress
  • Family stress

Tool #2: Get Motivated

Many youth struggling with hoarding are not always motivated to tackle their problem. Motivation often needs to be cultivated, and the following steps can assist.

  • Step 1: Identify your thoughts and beliefs that might be getting in the way of feeling motivated to make change. The following are some common examples, although this is not an exhaustive list:
    • “It might be important or useful someday.”
    • “Its not that bad of a problem.”
    • “I must not be wasteful.”
    • “Its my responsibility to ensure its used.”
    • “I cannot make mistakes.”
    • “I’m really attached to it. Its part of who I am.”
  • Step 2: Assess the reasons to change your behaviour. Take a sheet of paper and draw a line down the centre. On one side have your child list all the reasons to change, and on the other list all the reasons s/he may not want to change. It can also help to give each item an importance/value rating. Not changing because your child doesn’t have sorting bins should not be weighted the same as, changing so your child can have a better social life.  Is one side weighted more heavily than the other? And if it is the not change side, can some of those items be easily solved so they can be removed (e.g., “I don’t have sorting bins.”)?
  • Step 3: Look to the future. It can help to map out what the future may look like for your youth should s/he choose to begin to make changes, or not. Work with your child to develop the following lists:

1. I want to get rid of hoarding in my life because…. 

2. If I work on my hoarding problem, the following will happen…. 

3. If I don’t work on my hoarding problem, the following will happen…. 

4. My personal goals are…  (Goals can range from small, e.g., I can sleep in my bed again, to big, e.g., I can have friends over). List as many specific goals as you want.

  • Step 4: Supplement your plan. A large number of youth with HD experience significant challenges with their executive functioning. This can result in difficulties with focus and attention, organization and problem solving, and, trouble with impulse control. As their brains are young, and in a stage of growth and development, cultivating motivation may not be enough to help these youth successfully engage in the interventions outlined below. If you believe your youth may be struggling because of executive functioning limitations, you may wish to consult with a pediatric psychiatrist to discuss the option of a stimulant medication. Supplementing your child’s HD treatment with stimulant medication may enable him/her to more fully participate in the following interventions.

Tool #3: Get Organized

Becoming organized is best achieved by taking small, baby-steps, one day at a time. Breaking large goals into small individual steps will help your child to reach his/her goals faster, rather than adopting a do-it-all-at-once approach. Consider some of these ideas to assist: 

Do…

Don’t…

Set specific, measurable goals.

E.g., I’ll clean out one drawer.

Set vague, hard to measure goals.

E.g., I’ll clean my whole room

Establish a small time to work, daily.

E.g., 10 minutes, twice a day

Try to do too much at once.

E.g., I’ll work every morning, this week.

Eliminate distractions.

E.g., Turn the ringer off, keep TV or radio volume low, if on, and focus only on the task before you.

Multi-task.

E.g., Watch a movie, do my homework, text a friend, all as you are sorting, etc.

Be flexible.

E.g., If you planned to clean out one room but you are finding it too overwhelming, set a smaller task. I’ll start with this pile first.

Be rigid.

E.g., I must clean this room otherwise I’m a failure.

Determine the outcome.

E.g., Each possession needs to have a dedicated outcome. Typical options are: Garbage; Recycle; Donate; Sell; and, Keep.

Postpone the outcome.

E.g., I’ll decide what I want to do with the “go” pile later. I’ll make two piles for now- Go and Keep.

Categorize.

E.g., Every item gets placed into a category, which in turn belongs in a specific location. These might include: Papers (desk draw), clothing (bedroom closet), souvenirs (living room shelf), toiletries (bathroom), etc.

Generalize.

E.g., Items are placed in generalized groupings that make minimal sense. E.g. Keeping items from a vacation, in a suitcase in the hallway.

Be systematic.

E.g., Use the OHIO principle. Only Handle It Once. As soon as you lay hands on the item, determine it’s outcome and place it in a category and location. 

Be chaotic.

E.g., Handle items multiple times until you “feel” ready to determine it’s outcome and category.

In order to support your youth’s organizational efforts, locate supports in your area. Many charities will pick up donations from the home. Some recycling centers will make curbside pickup for large items such as electronics. Online stores allow you to post items for sale (e.g., E-bay and Craigslist). And the Internet is a wealth of information about how to handle specific items and situations. For example, a simple search can yield advice on how to dispose of excess pharmaceuticals, what to do with unused cleaning supplies, and more.

Tool #4: Assessing and Balancing my Thinking

Youth with Hoarding, like those with other anxiety disorders, often experience unhelpful and negative ways of looking at things. These ways of thinking can be a contributing factor to accepting new items or avoiding discarding items, or procrastinating on making decisions about how to manage an item. Over time, these thoughts trap your youth into ongoing hoarding. See the Balanced Thinking page to help your child develop a more balanced thinking style.

Tool #5: Making Behavioural Change: AKA Clearing Out!

Once you and your child have worked through tools 1-4, you are likely ready for the final, and perhaps most important tool, clearing out! There are two methods to support your youth in making behavioural change towards clearing out his/her clutter. The first involves establishing a hierarchy, or list, of easiest items to discard, to hardest items to discard, and gradually moving up this hierarchy or list, item by item. The second method can be used alone, or in tandem with the first method. This method involves developing a behavioural experiment, to test out beliefs that might be preventing your child from discarding an item for fear of the consequences, even though feared consequences are not guaranteed. These methods are outlined here:

Method #1- Exposure: Discarding and non-acquisition Practice

Begin by helping your youth create a list of the items s/he wants to discard but is having trouble doing. We advise creating multiple lists, for example, by room or by category. This will allow your child to focus on one area at a time and reduce feeling overwhelmed or giving up. Once you have your lists, pick a first list and rank order each item from 0-10. Assign a 0 for the item that is the least scary or difficult to discard, to 10 for the item that is the most scary or difficult to discard. For example, if your child has developed a toiletries list, wrappers may be a 1/10 on the ladder, whereas a hand held mirror from great aunt Susie may be an 8/10 or 9/10.

Climbing the fear ladder. Once your child has built a fear ladder, s/he is ready to face his/her fears by putting him/herself in situations that brings on the fear or discomfort (exposure). In this example, your child will be are exposing him/herself to the act of discarding items. Feeling anxious when trying these exercises is a sign that your child is on the right track.

  1. Bottom up. Start with the easiest item on the fear ladder first (i.e., fear=2/10) and have your youth work his/her way up.
  2. Track progress. Track your anxiety level throughout the exposure exercise in order to see the gradual decline in your child’s fear or discomfort of a particular situation.
  3. Don’t avoid. During exposure, try not to let your child engage in subtle avoidance (e.g., thinking about other things, talking to someone, planning to get an item back or to replace it.). Avoidance actually makes it harder to get over your fears in the long term.
  4. Don’t rush. It's important for your child to try to do one item at a time and not take on too many to feel overwhelmed. Youth can sometimes feel a sense of relief once the item is gone - the anxiety peaks during the discarding process and can decrease quite quickly once the item is gone.  

TIP: Regardless of its intensity, a fear will peak and then level off. If you do nothing about it, the fear will eventually go away on its own.

How to move on. Once your youth experiences mild anxiety or discomfort when getting rid of items on a specific step of the ladder (e.g., 4/10), s/he can move on to the next step (e.g., 5/10). For example, after discarding all her grade 2 papers (2/10), your child might feel very little anxiety and be calm. She can then challenge herself to tackle her grade 3 papers (3/10). Again, have her engage in this practice until her anxiety drops and the process seems easier or more manageable. This is a good guide to know when she is ready to go to the next step on her ladder. 

Exposure for Non-acquisition Practice: You and your youth also can develop a hierarchy, and engage in exposure, for non-acquisition of items in addition to discarding items. S/he will engage in the same steps outlined above, except the items on his/her list will not be items to discard, but items/situations to exposure him/herself to, with a plan NOT to obtain them. For example, it may be relatively easy to drive past an expensive sports store and not allow your youth to go in and buy something (2/10), medium hard or uncomfortable to go to a clothing swap and not purchase or acquire (5/10), and most hard/uncomfortable to decline a gift from a friend (9/10). 

*For more information on How to do Exposure see Facing my Fears.

Method #2- Behavioural Experiments

This method involves creating an experiment to test out beliefs about discarding or non-acquisition. Many kids and teens with hoarding have developed beliefs that are inconsistent with their values. For example, “my stuff is what makes me happy”, yet valuing social engagement with others, which is prevented due to excessive clutter in their room. Following this example, an experiment might involve having your child gradually remove clutter from her bedroom floor, and then inviting a friend over for a sleepover. Predictions about what might happen would be made, as well as discomfort ratings generated for discarding clutter.

The following questions can help design your own experiment: 

  1. My experiment (What I will do): Discard old papers from floor
  2. What I predict will happen (What I am afraid of?): I will regret it. I might need papers.
  3. How strongly do I believe this will happen (0-100%): 75%
  4. My initial discomfort (0-100): 85%
  5. What actually happened? After a few hours my # dropped to 40%. After a few days I realized I’ve never used those papers again and probably never will. I had a friend over to play and that felt really good.
  6. My final discomfort (0-100):    5%.
  7. Did my prediction come true?    Not really. I still occasionally wonder about those papers, but the space is totally worth it and I love having sleepovers.

Tool #6: Rewarding Bravery

It takes courage, perseverance, and hard work to make behavioural change, which for your youth means learning how to discard items and resist urges to acquire new items. As your youth starts to take important steps towards getting his/her hoarding under control, s/he will start to feel good, which can give your child further encouragement to continue with the tools outlined in this section. However, for some youth, taking the first important steps in this “battle” can be hard. As a result, you may decide that it’s necessary to create a points plan to incentivize and reward hard work. A points plan is a great way to create some initial incentive to have your youth feel more motivated to take the first steps. To learn more about how to create a points plan link here {*link to* Rewarding Bravery}.

 

Cite

1. Tolin, D. F., Frost, R. O., & Steketee, G. (2007). Buried in Treasures: Help for Compulsive Acquiring, Saving, and Hoarding. New York, NY: Oxford University Press