Why do people hoard and is it treatable?

Q. I think my dad is a hoarder. He is 69 years old and has dementia.

He has lost his job and feels slighted by his company. He spends most of his time reading newspapers and often leaves the TV on.

It appears that he tends to keep items when he is stressed or feeling financially insecure.

When I am at home, I try to keep his mind active. I talk to him and ask him questions that will make him try to recall things, so as to stimulate his brain and prevent his dementia from getting worse.

My dad does not think he is a hoarder. He does not want help for hoarding or dementia, though both conditions affect the family a lot.

What causes or triggers hoarding? Is it curable or treatable? Is it hereditary?

A. Hoarding or syllogomania is defined as a psychiatric disorder.

Those who hoard have difficulty discarding their possessions, or have strong urges to save them. When the condition is clinically significant, the person’s home may become so cluttered that living space is restricted and becomes a hygiene and fire hazard.

Hoarding was previously thought to be related to obsessive compulsive disorder and obsessive compulsive personality disorder.

However, this behaviour is also seen in those with conditions such as dementia, schizophrenia and intellectual disability. Symptoms of hoarding may be seen among immediate family members of hoarders.

Someone with dementia may exhibit memory loss, language difficulties, personality changes and other cognitive impairments.

Hoarding is often seen in those with dementia. There are several reasons behind this. They may hoard things because they fear their possessions may go missing.

Current events may also trigger memories that involve a need to stockpile items of value. For example, they may recall past incidents where strangers took their things, or have memories of more meagre times. A fear of being robbed may also lead people to hide their valuables. Or it could be a response to losing roles, responsibilities and significant others in their lives.

Those with both dementia and a hoarding disorder also exhibit a higher prevalence of repetitive behaviour, excessive eating and, sometimes, stealing.

There is very little evidence that medication is helpful for those with a hoarding disorder. If the hoarding occurs as part of another psychiatric disorder, then the latter needs to be addressed by seeking help from a mental health practitioner.

As a family member, what you can do is to find out what and why your father is hoarding, and whether there are triggers that may worsen the behaviour.

Try to understand the emotions behind the behaviour and address them in a reassuring manner. It may be pointless to argue or use logical reasoning. Offer practical solutions, such as helping to organise the clutter and labelling boxes for your father to store things.

Providing your father with adequate activities, for example, physical exercise during the day, may help to engage him and reduce his hoarding tendencies.

Your father should be formally assessed to see if he indeed has dementia, so that appropriate help can be rendered to him and your family to address his problematic behaviours.

Dr Marcus Tan

Associate consultant in the department of geriatric psychiatry at the Institute of Mental Health

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