ADHD and Hoarding Disorder 101

Conquer the Clutter book

Hoarding Disorder often coexists with other mental health disorders. The other disorders don’t CAUSE hoarding, but they do significantly impact the additional challenges that a person living with hoarding disorder must deal with.

United Nations estimates that the current North American population is 367,034,717[1]. Healthline statistics[2] indicate that 4% of the adult population is living with Attention Deficit Hyperactivity Disorder (ADHD). This means that approximately 14,681,389 people are currently living with ADHD or Attention Deficit Disorder (ADD).

Birchall Consulting conducted a random snapshot of cases over the past 10 years and found that only 2.8 % of those who sought help had been diagnosed with ADHD or ADD[3]. This is concerning, because the symptoms of ADHD/ADD are also risk factors for hoarding disorder. Could this mean that there are many more individuals with ADHD/ADD who are hoarding but are not getting help?

With better information, our hope is that those individuals in need of help and not seeking it, come to understand that the symptoms and difficulties that they are experiencing may be attributable to an additional undiagnosed disorder—that being Hoarding Disorder.

What is Hoarding Disorder?

Here is a thumbnail outline of the criteria for Hoarding Disorder:

  1. Excessive accumulation and failure to discard proportionately (things and/or animals).
  2. Activities of daily life are impaired by spaces which cannot be used for the intended purpose.
  3. Distress or impairment in functioning to the person hoarding or others. Even if “others” don’t know about the hoard, they would have reason to be concerned.

It also important to note that

  • Hoarding is found in all cultures, income, education levels, and for different reasons.
  • Hoarding situations continue to deteriorate until the health and safety of the individual and community are put at risk.

In a situation that meets the standard for Hoarding Disorder, the only difference between an excessive accumulation of perceived valuable things and non-valuable things is the price tag on the items. The key factor is the excessive accumulation and the failure to resolve that excessive accumulation because of the risk it creates.

Those who hoard are not homogenous, even though the optics of a hoarded environment may appear similar.

Types of Hoarding

There are three types of hoarding disorder:

  1. Standardized hoarding, with three subtypes:
    Indiscriminate Hoarding

    • Anything can be hoarded; e.g., human waste to valuable items
    • Items are what most people save
    • Insight and motivation fluctuate greatly
    • Usually results in chaotic piles

Discriminate Hoarding

  • Save one or more specific categories of items; for example, books, figurines, art, paper, clothing
  • Items have high attraction value for the person and are given high importance
  • Usually not displayed as “collections”

Combined hoarding generally occurs when discriminate hoarding exceeds the person’s ability to keep these items separate and apart from the general, everyday clutter in their environment.

  1. Diogenes Syndrome – is often found in our aging population and is hallmarked by three criteria:
  • Self-Neglect – lack of clothing, poor nutrition, medical, and dental care even when they can afford it
  • Domestic Squalor— makes residence unhealthy
  • Hoarding makes residence unsafe
  1. Animal Hoarding – Accumulation of animals to the extent that there is:
  • Failure to provide minimal nutrition, sanitation, and veterinary care.
  • Failure to act on the deteriorating condition of the animals or the environment.
  • Failure to act on or recognize the negative impact of the collection on your own health and well-being.

Animal hoarding is an extremely complex facet of the disorder. Local bylaws aside, there is no exact number of animals that represents the threshold for Animal Hoarding. One must apply the definition and when that definition is exceeded, you have a situation of impending animal hoarding.

Those who end up creating an animal hoarding situation are often not the villains that they are portrayed to be. In part, our society needs to accept some responsibility for not consistently caring for and neutering our animals, thereby not taking responsibility for controlling the overpopulation.

Three Paths to Hoarding

  1. Genetics. Inheriting the vulnerability to hoard, either genetically or environmental. Estimates range between 50% and 80% of those who hoard having a first-degree family relative who hoards. We also know that there are four chromosomes with markers in common in those who suffer from Hoarding Disorder. The chromosomes are 4, 5, 17, and Johns Hopkins conducted an OCD Collaborative Genetics Study and identified chromosome 14 as linked by an autosomal recessive pattern to OCD.
  2. Having a high-risk comorbid factor. This speaks directly to the characteristics and challenges of those living with ADHD/ADD daily.
  3. Being (even mildly) chronically disorganized and then becoming vulnerable. You can see that with the three paths, those living with ADHD/ADD tick off two of the three boxes, which places them at significant risk of developing hoarding disorder.

So, the question remains— What to do about it?

I always begin by helping people restore their self-respect and self-esteem. My belief is that no one ever accomplished anything by feeling less about themselves. I suggest that you

  • Know your disorder and own it unapologetically.
  • Keep a list of strengths and achievements, as well as areas you have goals to improve, and keep that list at hand.
  • If today has been a bad day, reflect and regroup. Tomorrow is a fresh start.
  • Take responsibility for managing your own needs.
  • Get help when distress continues and get the help you need.
  • Therapists are like shoes. Not everyone is a good fit. When you find a good fit, remember this. The times you LEAST want to go, are probably the times you MOST need to go. So go!
  • You are worthy of success. Everyone in this world has a challenge to live with. ADHD/ADD is yours.

With respect to hoarding, here are three principles to remember:

  1. Don’t put it down, put it away! Try to have the item’s home no more than four steps away from where you use it.
  2. There is no “JUST FOR NOW”. That just delays you from doing it anyway and it is what creates piles.
  3. Just do it now! It never gets easier. It really is the 15 minutes you do every day that will get you to where you need to be and keep you there.

Elaine Birchall MSW RSW, and Suzanne Cronkwright Hons.BA are the authors of “Conquer the Clutter: Strategies to Identify, Manage, and Overcome Hoarding,” published by Johns Hopkins University Press and available on Amazon. Written for people with vulnerabilities to hoarding disorder, those whose care about them, and individuals in the helping professions, the book details Elaine’s holistic approach to treating hoarding disorder with strategies that will enable sustainable success. For more information, visit www.hoarding.ca.

[1] https://www.worldometers.info/world-population/northern-america-population/

[2] https://www.healthline.com/health/adult-adhd#1

[3] Birchall, Elaine, and Suzanne Cronkwright. 2019. Conquer the Clutter: Strategies to Identify, Manage, and Overcome Hoarding. Baltimore, MD: Johns Hopkins University Press.

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