A psychological perspective on hoarding

Hoarding, now recognised as a distinct mental health problem, has risen in the public consciousness in recent years – though sometimes the portrayal of those with hoarding difficulties are not always favourable. Now the Division of Clinical Psychology has released guidelines providing information and recommendations for people working with those with hoarding difficulties.

The document, A Psychological Perspective on Hoarding: DCP Good Practice Guidelines, has been compiled by clinical psychologists, including contributions from those living with hoarding issues, as well as their carers, and advice to the media in coverage of those with such problems.

Lead Consultant Clinical Psychologist at Sussex Partnership NHS Foundation Trust and lead author of the guidelines Sophie Holmes said it had felt important for psychologists to start a discourse around hoarding, which, she says, is a largely psychological difficulty. She said the report was, in part, the result of her work in assertive outreach teams working with groups of people, including those with a diagnosis of schizophrenia, who often find it difficult to engage with and seek out treatment.

Many people with hoarding problems do not see the full extent of their problem and therefore may not engage with services. Holmes added: 'They often turn up at services having been blamed for their condition, and often people with hoarding problems drop out of treatment. The lack of progress some mental health workers see can lead to them feeling a little hopeless.'

The guidelines recommend, among other things, that mental health and social care groups should provide services for people with hoarding difficulties regardless of how they access them. It also suggests that interventions for people who hoard should focus not just on the individual but also on their wider network, thus supporting the person and the community they live in.

Holmes emphasised the importance for psychologists to add their voices to topical discourses. She said while the DSM-5 now recognises hoarding disorder as a genuine problem, psychologists should be engaging with the media in how it represents those with hoarding problems . She added: 'It's really important that psychologists respond in a timely fashion to things in the media. Even from a general point of view this helps to get out a psychological message which communicates the evidence base and gives a fuller understanding of the field.'

Holmes, who wrote the report along with clinical psychologists Dr Stuart Whomsley and Dr Stephen Kellett (University of Sheffield), said the prevalence of hoarding is difficult to ascertain as many are not too forthcoming in seeking help, but the report puts it at around 4 per cent. She said that in clinical populations who find it difficult to engage with services there should be a change in thought around how such services are delivered.

'I'm passionate about evidence-based treatments but there's a need to marry together the things we know from CBT and what we know from community psychology and we need to be more flexible in how we deliver treatments,' she added.