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Hoarding disorders have increased during the pandemic. Here’s how to help a loved one who hoards.

(Sonia Pulido/for The Washington Post)

Hoarding is not a new issue, nor is our fascination with it. Reality television shows have been chronicling extreme cases of hoarding for years: “Clean House” debuted in 2003, for example, and “Hoarders” in 2009. But, according to a study published in the Journal of Psychiatric Research in November, hoarding disorder symptoms have “significantly worsened” during the pandemic, perhaps because of heightened stress or extra time at home — in some cases, alone.

Now that the pandemic is easing, friends and family members may become more aware of loved ones whose hoarding tendencies intensified over the past two years. Unfortunately, however, another thing that is not new about hoarding is the difficulty treating it or helping a loved one who has that tendency.

“In general, over the years, I’ve found that most people who want to help really don’t have the tools to do so,” said clinical psychologist Gregory S. Chasson. “A lot of family members tend to see hoarding from a moral standpoint, but individuals are really struggling.”

That led Chasson, who was working in Baltimore at the time but is now an associate professor of psychology at Illinois Institute of Technology, to develop Family-As-Motivators training in 2014. The program empowers people to more effectively intervene with loved ones who hoard.

Hoarding disorder — a mental health condition in which people have trouble getting rid of possessions because of a perceived need to save them — affects about 2.6 percent of people worldwide, according to the American Psychiatric Association. There are higher rates in those over 60 and people who have other psychiatric problems, such as anxiety or depression, but its frequency doesn’t seem to be affected by country or culture. Despite the cat lady stereotype, it affects men and women equally.

Friends and family members of those who hoard can find it difficult to control their feelings of anger and helplessness. “Hoarding can cause profound distress for family members,” Chasson said. “Lots of frustration, lots of anger, lots of just completely not understanding what’s going on and how to help. It can be a really difficult dynamic between individuals and their loved ones, with fighting and arguing” that sometimes leads to estrangement.

There are several major defining characteristics of hoarding, said Randy O. Frost, professor emeritus of psychology at Smith College in Northampton, Mass., and author of “Hoarding Disorder: A Comprehensive Clinical Guide,” which will be published in June. The first difficulty is discarding possessions, regardless of their value. “Second is that these things are saved due to a perceived need to save them and distress that’s associated with discarding them,” he said. Next, “these things accumulate to such an extent that they clutter the living areas of the home, making the space difficult or impossible to use.” Although some people compulsively acquire new items, that’s not true of everyone with hoarding disorder.

People who hoard often feel an attachment to objects that’s motivated by loss, Frost said. That might mean loss of an opportunity or of a fantasized future. For example, someone might fancy themselves a fixer, so they save old appliances, convinced that, one day, they’ll refurbish them, but that day never comes. Or the motivation could be the “preservation of some kind of idealized past where people keep things because they’re triggers to memories,” he said. Childhood toys fall into this category.

Some people hoard because of a fear of waste, Frost added. He’s seen people save cereal boxes to use as stationery, for example. Others anthropomorphize their objects and believe that if they throw them in the trash, the objects will be badly harmed — an unbearable thought.

It is possible to hoard just about anything, said Marla W. Deibler, a licensed clinical psychologist and executive director of the Center for Emotional Health of Greater Philadelphia. Some of the most commonly hoarded items include papers, such as receipts, newspapers, magazines and bills that have already been paid.

Hoarding is considered a chronic condition, Deibler said; although it might wax and wane over time, those who struggle with it typically report having some tendencies during their adolescence. People who have the disorder tend to isolate, because “they become [ashamed], frustrated and embarrassed, and they’re afraid to have people see what’s going on,” she said. “They’re concerned that something will happen that’s unwanted. Somebody coming and clearing out their home would be really traumatic for them.” Still, they usually don’t seek treatment or assistance until they’re in their mid-50s, and even then, it’s often only because a loved one forces the issue.

Cognitive behavioral therapy can be effective, said psychologist Gail Steketee, who developed a specialized CBT model for hoarding. But it takes time. “We’re really talking a minimum of a year,” she said. “The person has to learn how to work on the beliefs that they hold about their objects, and then be able to make choices that are initially very difficult for them and gradually get easier.” Professional help will often take place in the home at least some of the time, and experts will work with the person who hoards to begin to clear out their space.

Family support can be crucial during that process — and before. Here, experts share strategies for helping a loved one who hoards:

Educate yourself. This is the first and most important step, Deibler said, “because there are a lot of misunderstandings about what the person is experiencing, and why they’re stuck in this manner, and that they are struggling and suffering.” To become as informed as possible, consider scheduling an appointment with a mental health professional who specializes in hoarding, or read a book about the disorder. Deibler recommends “Buried in Treasures” by Frost, Steketee and David Tolin.

Never throw away the loved one’s items. That will only create agitation and defensiveness.

Explore what the objects mean. “In some ways, I think of these folks as having a special gift to see the value in possessions that most of us don’t,” Frost said. Find out what their belongings mean to them, and try to appreciate that meaning. Nurturing an empathetic environment and engaging your loved one in conversation is one of the most effective ways to eventually make progress.

Frame the conversation around concern. If you’re worried a parent is hoarding, Steketee suggests broaching the topic like this: “Mom, when was the last time you had one of your friends over for coffee?” Then you can note that it looks like it would be difficult to serve coffee, because the counter space is covered with papers. Ask your mom how she feels about that, then tell her you’re worried. You might mention that you’re concerned she’ll trip over a stack of boxes and break her ankle, or that the pile of papers next to the stove will catch on fire. “The concerns expressed by family members can be about physical harm, and about isolation and the inability to be social,” Steketee said.

Be liberal with praise. Criticism and negative comments “don’t serve the purpose of moving your loved one toward accepting assistance,” Deibler said. Instead, be positive and praise every bit of progress. Even if they’ve only discarded a few items, tell them they’re doing a great job, she advised.

Offer to track down help. Once you’ve broached your concern with your loved one, offer to help them locate a professional who specializes in hoarding, such as a psychologist or psychiatrist. “And offer to go with them. That’s a very helpful role for a family member to take,” Steketee said. Her clients usually want to find “other people in their lives who can help with the necessary hard work” that goes into clearing out and organizing a home.

If there is a local hoarding task force, reach out. Some communities, including Philadelphia, have task forces designed to assist people who hoard — and their families. Such organizations typically bring together social-services and health-care professionals, Deibler said. “It’s a nice network of connected services to help these individuals.”

Find a support group. Caring about someone with hoarding disorder is synonymous with frustration and pain. There’s no need to grapple with those feelings alone: Support groups exist both online and in person, Steketee said. They offer a terrific sounding board and way to learn about tactics that have helped other families. “It’s often helpful because this is a slow process,” Steketee said.