Hoarding and the DSM 5

Topics: Hoarding, DSM, DSM 5
Published: June 03, 2013

The DSM V has arrived, and the world is largely unchanged. The new iteration opts for the status quo, which is what happens when you have to please those with competing agendas. If you are looking for something more dramatic you will have to wait another decade for the DSM VI.

For biblical counselors, an overarching principle still applies: psychiatric diagnoses can open our eyes to see real human struggles, and these same diagnoses can distract us from Scripture’s insights and spiritual causes or contributions.

With this in mind, I’ll dive into DSM V and grab one of the new diagnoses—hoarding.

What is hoarding?

Compulsive hoarding is a category that has gathered momentum, especially by way of reality shows. It was once tucked away as a variation of obsessive-compulsive disorder and obsessive-compulsive personality disorder. Now it stands on its own. The description includes:

(1) persistent difficulty with discarding possessions,

(2) discarding these items is distressing, and

(3) decluttering is the result of third party interventions.

In other words, hoarders will not ask for help; their children and other family members will be the ones who sound the alarm. Since hoarders have their reasons, expect that they will not be enthusiastic about an all-paid weekend getaway while the church descends on the junk-strewn and contaminated home with the world’s largest dumpster.

Notice the commonness

How should we think about this? One place to start is by briefly considering how this problem is not either/or, but it is more/less. Some fit the category more, some less. When we locate ourselves on the hoarding continuum, we gain patience. Most of us let some things accumulate somewhere. (The cautions to this approach? Don’t minimize the difficulty hoarders experience. Don’t expect that “let’s get rid of ten things a day for the next month,” which might be appropriate advice for you, will help them).

When we stretch the diagnosis, we can imagine that hoarders are motivated in part by practical matters and sentiment. For example, you never know when you will need that broken lamp, those ten-year-old moving boxes, and those unread books. Maybe you will lose weight and be able to fit into those old clothes, so why spend money on a new skinny wardrobe when you can keep the clothes from two decades ago and be retro-cool? And sentiment has no end. “Those elementary school drawings are priceless.”

Now extend this thought further to: “anything that is my possession is a part of me.” For the person who hoards, these are not just objects heaped up in chaotic piles. Each item has significance. Now we can begin to imagine how the thought of parting with any object is met with visceral pain.

What is important?

From understanding, we move toward help. The challenge with helping hoarders is that they don’t want help and, if you can actually talk with them, they are rarely insightful.

“Could the place use a good cleaning?” you ask gently.
“No, not now.” End of story.

You could try an old fashioned visit to the home. The first time I talked with children of a hoarder, they described the hoarder’s home, but it was almost impossible to take their description seriously—until they produced some pictures. The first showed the exterior. The house was actually bowed from the weight of the hoarded stuff. Then they showed a picture of the inside. There was one narrow canyon surrounded by mountains of debris—mostly trash and garbage. Now I understood.

Assume that the hoarder will not discard anything. If anything is to go, the family will have to do it. You can help the family be patient and gracious during the clean-out process. (Note: The family should call the local police before making plans because they will be moving possessions that belong to another person.)

If you have the opportunity to talk to the hoarder, look for a way into the person’s life. Hoarding will probably not be a fruitful route. When in doubt, aim to know, enjoy and bring Jesus to the person. Evangelism and the knowledge of Jesus Christ is more important than changes in hoarding.

The DSM V will help you to see hoarding, but it might blind you as well. It’s not just about throwing things away. The rescue and encouragement of a person’s soul is the most obvious way to the deepest form of help.