We all have a friend or family member who just can’t seem to get out from under their accumulation of stuff. Their garage, guest bedroom and basement are packed, and you can’t see the top of the kitchen table. But when does “cluttered” become “hoarded?” We have all seen the sensationalized TV depictions of filthy homes that need to be condemned. But is that what hoarding really looks like? And why can’t those folks just throw it all out?

Today’s guest explains myths surrounding hoarding, treatment strategies and why we all might be at risk.


Guest information for ‘Clutter and Hoarding’ Podcast Episode

Elaine Birchall, MSW is the director of Birchall Consulting and the founder of the Canadian National Hoarding Coalition. A hoarding behavior specialist and clutter coach, Elaine provides training, consultations, and counseling to people and organizations across the US and Canada.




About The Psych Central Podcast Host

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, Mental Illness is an Asshole and other Observations, available from Amazon; signed copies are also available directly from Gabe Howard. To learn more, please visit his website, gabehoward.com.

Computer Generated Transcript for ‘Clutter and HoardingEpisode

Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: Welcome to the Psych Central Podcast, where each episode features guest experts discussing psychology and mental health in everyday plain language. Here’s your host, Gabe Howard.

Gabe Howard: Welcome to this week’s episode of The Psych Central Podcast. Calling into the show today, we have Elaine Birchall, who is a social worker and hoarding specialist and also the co-author of Conquer the Clutter: Strategies to Identify, Manage, and Overcome Hoarding from Johns Hopkins University Press. Elaine, welcome to the show.

Elaine Birchall: Thank you for inviting me, Gabe.

Gabe Howard: Oh, it is quite our pleasure. Hoarding, it seems like it is everywhere, I think, in 2019 because of all the media coverage, all of the television shows. There’s just a lot more understood about hoarding today than there was 20 years ago. But I imagine that a lot of this information is incorrect. So starting right off. Can you tell us what the general population doesn’t understand about hoarding that they think they do?

Elaine Birchall: Well, the general population, I think believes that hoarding is necessarily a dirty, chaotic mess, and that’s not true. Hoarding has three criteria, Gabe. And unless each of those three criteria are met, whatever you’re looking at, at that point in time anyway, isn’t necessarily a hoarding situation.

Gabe Howard: What are the criteria?

Elaine Birchall: The first is there is an excessive accumulation. What most people would call an excess of accumulation. And I’d say a failure to resolve that proportionately. Now, that does not mean one thing in and one thing out. What it means is that fundamentally inside yourself, you either don’t have or you have a broken check and balance system that tells you when things are starting to get out of hand so that you can do it when it’s a smaller job, which is easier, obviously. The second is that some or all of the living spaces — now that can be your home, your office, your car, your back yard, your garage, it can be anywhere where you live — those spaces can’t be used for their intended purpose. You can still do the functions in your home, but you are not doing them in the spaces where they were intended to be done. That’s important because you probably don’t have the tools to do those jobs and you’re probably adding to the clutter by leaving things lying around rather than put it away when you’ve got that kind of disruption. The third criteria is somebody is upset, distress, or impairment in functioning. You’re still living there, but now you’re adapting. You’re stepping over things. You’re moving things off of a chair so that somebody has a place to sit. You stop inviting people home because you’re embarrassed about the condition. So half of your social, most of your social life, happens outside your home. Now, there’s one key thing about that stress or impairment in functioning, doesn’t mean, Gabe, that those people have to be distressed right now. You have to tick that box if people who need to know, if they knew the truth about the condition of the property, would have cause to be concerned. That’s your neighbor, who is at increased risk, that’s your family members, your pets, the fire department, children’s services, animal control, by-laws, property standards, if you’re in a multi-unit dwelling. So you can see how hoarding is not an individual problem that happens in isolation.

Gabe Howard: I really appreciate you sharing that because, of course, one of the things that I’ve learned is while my family members may hang on to things longer than I do, they don’t meet any of that criteria. They can still use their kitchen as a kitchen. They can still use their living room as a living room. And they invite people over all the time. So it shows, at least from my perspective, that I see hoarding as hanging on to stuff that I don’t like when in actuality it’s causing this… I don’t want to use the word trauma, but maybe it’s causing distress in their lives? Is that accurate?

Elaine Birchall: Yes, it does cause distress, sometimes because the individual themselves realizes this is not a good situation for me or for if you have a family, your family sometimes is in distress. So, Gabe, it’s also or more about I just wish people would get off my back. I don’t think there’s anything wrong with this. I think I have the right to live the way I want to live. Well, that’s true. But up to a point, everything has limits. When you create a hazard for yourself, no matter how big or how small that hazard is, you are probably also creating a hazard, certainly in hoarding situations. It will go on to create a public health and safety hazard as well, because to hoarding is a compulsion. It’s a compulsive disorder.

Gabe Howard: Is there a relationship among hoarding versus cluttering versus collecting vs. hanging on to things? Maybe longer than the average. Is it all part and parcel of the same thing? Or is it just completely separate and I’m barking up the wrong tree?

Elaine Birchall: Not necessarily. So hoarding is, though, to some even a minimal degree, those three criteria got ticked. That’s hoarding. All right. What we don’t know, however, is every single person who hoards has told me that they started out with clutter, but every person who has clutter is not necessarily going to go on to develop hoarding disorder. The difficulty is that at the inception, at the early, early stages of hoarding, it’s hard to tell whether that’s just clutter or whether you are really headed down a path you probably don’t want to go down. I want people to think more about that compulsion, that driving need to have things or acquire things or get the deal or all of those triggers that the people at the other end of the spectrum of hoarding look back and go, “Boy, that was a telling sign. I wish I wish I’d known back then that was a dangerous sign.”

Gabe Howard: Is it possible for somebody to be a hoarder and be super organized, clutter-free? I mean, it seems like it would be right because of your three criteria, but it doesn’t sound right like how can you be clean and organized and also a hoarder? They seem mutually exclusive, but I suspect they’re not.

Elaine Birchall: No. No, they’re not exclusive. Some of the people that I work with are extremely high functioning. Not all my clients, but I have had a number of lawyers. I have had a number of physicians. I’ve even had some practicing psychiatrists who get caught up in that sense of being overwhelmed at work. They are high functioning. They are organized. In this other area of their life, not so much. But I’ve also had people who are just average people, and they are meticulously clean and tidy. They are also very well organized. It’s about the excess of accumulation, though, Gabe. It doesn’t matter how tidy or how neat or how organized you are, if you have an excess of accumulation, then you have a problem. All right. Because we have relationships with our things, each of the things that we make important enough to keep. We form a relationship with those things. So it’s not just a matter of, oh, you have this, that and the other and you don’t really need it. If you start to engage in that logic internally where you can’t decide, no, you don’t need six toasters, but you cannot decide which of the four or five you should let go of and what to do about them. That becomes a problem.

Gabe Howard: As you’re talking about letting things go, I’m reminded of the television shows, the sensational houses that are just filled to the brim where they just do this massive clean out. Just get rid of so much stuff. And one of the things that they talk about on those shows is what’s going to prevent the person from just filling the house back up? Of just reacquiring everything?

Elaine Birchall: Absolutely, I’m happy you asked that question. Unless there is an immediate threat to safety and life, if at all possible, avoid the extreme cleanup. Now, there are occasions when a situation has gone on too long. It is too intensely deteriorated and a cleanup does need to be done. But they always cause additional damage and trauma. Sometimes, however, for the safety of the individual and the community, it has to happen. That is a real pity. That’s why I’m so happy to be on your podcast, helping people understand the sooner you identify it, the smaller the problems, the less distress. If you have the opportunity, if you have the choice, it’s the regular steady progression with the person. Not to get them to get rid of things. That’s not the point. Come at it the other way to help that person. But don’t tell them what the answer is. Only they know the answer of what’s important. Help them find the things that mean the most to them. Because we do have relationships with our things. I’m going to liken it to I guess a metaphor would be your best friend. If you find your best friends among that clutter, it’s going to be much easier for you to identify the other things that are just hangers on. They got caught up in the clutter and in the chaos and the piles. When unimportant is mixed with really important in a pile, the whole pile, whether specific items are of absolutely no importance to you or not, that whole pile feels as important as the most important thing that you believe is in that pile. That’s why slow and steady wins the race. And you are 100 percent correct, Gabe. You do an intensive clean up like that, and the moment that door shuts, it starts again. Because if nothing changes, nothing changes.

Gabe Howard: Can you describe some of the barriers to letting go of things? Why are people so fascinated with hanging on to multiple toasters, multiple televisions, just multiple numbers of the exact same thing?

Elaine Birchall: So quite often, Gabe, it’s about having, not using and people who are in this mental situation of hoarding disorder, they acquire things because things soothe them. We all need ways to soothe ourselves. And these individuals have lost track of the ability to self-soothe. They also believe that increasing number of things are important or valuable. Sometimes it’s just the process of decision making. It’s extremely difficult, particularly when you’re as overwhelmed as these folks are to make decisions that you can live with. And if you just get rid of things and some people do that, they try to remedy the situation just by pell-mell, getting rid of things. What happens is you create a void in yourself and then you fill that void and generally you fill it with things.

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Gabe Howard: And we’re back speaking with Elaine Birchall, co-author of Conquer the Clutter: Strategies to Identify, Manage, and Overcome Hoarding. One of the common tropes on the television shows is that hoarding is related to grief and loss. Is that true? And if so, why?

Elaine Birchall: It can be, but hoarding is a lot more than trauma or grief and loss. Anything in the human experience that makes you vulnerable and creates a state of mentally being overwhelmed. There are three paths basically to hoarding. One is genetics. All right? We do know that, depends on the study, anywhere from 50 to 84 percent of individuals who hoard have a first degree family relative who hoard, that’s mother, father, sister, brother who hoards. We know that there are 4 chromosomes with markers in common. Now, we don’t know enough about that for it to be predictive, but that we know about after the fact with studies. The second path is that if you have a high risk co-morbid factor, that’s another condition. It could be a mental health condition or it could be a physical condition. And there’s a whole list of them. And they’re well known. That if you have that co-morbid… bipolar is one, ADHD, another is social anxiety, OCD. There’s quite a long list. It puts you at a higher risk for also developing hoarding disorder. The important thing about that, Gabe, is that if you get the OCD straightened up and you’re managing it better, or bipolar or ADHD, it’s not going to make much of an impact on the hoarding disorder. It might make you, however, more available to do the unique work you need to do to resolve the hoarding. And the third path is particularly scary because I believe most of us aren’t immune from this, and that is that if you are not the most organized individual, you’re kind of chronically disorganized. You know, every so often take the phone off the hook and lock the door and you spend the weekend getting things back to the way you want them to be. But that happens repetitively. Then they become vulnerable. You have a loss, you have a trauma, you have a health crisis. You lose a job, someone dies, your pet dies, there’s some disruption. You become vulnerable. You are at a higher risk of also at that point, starting to developing hoarding disorder. And that third one I think most of us are vulnerable to hoarding.

Gabe Howard: During the research for this show, I looked over your web site and read the book, etc. and one of the things that I was surprised that came up was online shopping addiction. I wouldn’t think that hoarding and online shopping would go hand in hand, but they do. Can you talk about that for a moment? Because you identify three factors that make people vulnerable to online shopping addiction that I was just fascinated by.

Elaine Birchall: Absolutely. There’s a thing about online shopping is there’s no shame, there’s no, I’m going with a basket and I’m filling the basket and paying for the basket. I’m taking all those things home. And then I have to physically bring them back the next day because I couldn’t afford them. Online shopping, I just hit items one at a time. Generally, when I’m alone or I’m feeling vulnerable or I’m feeling something that’s not positive. And it’s so easy. It’s so accessible. And all I have to do is return it anonymously. But it’s a little like playing at the slots. You know how that turnover of serotonin and dopamine when you find the right thing. You know, you’re on certain sites where you win the auction or it’s the last item. And get a deal.

Gabe Howard: It’s exciting.

Elaine Birchall: That’s like crack cocaine to some people.

Gabe Howard: Wow.

Elaine Birchall: I’ve had people literally, this is not an exaggeration by the slightest bit, I’ve had people who, when they give me a tour of their home, have a double garage full of unopened shopping channel boxes. So clearly it wasn’t for these folks, and probably for many others, it wasn’t about what’s in the box. It was about the excitement of the arrival, the achievement of acquisition

Gabe Howard: Wow.

Elaine Birchall: And it also causes you go bankrupt.

Gabe Howard: This has just been absolutely fascinating, and I really appreciate you helping me and our listeners understand what hoarding is, because, again, the media has done a really good job of convincing us that it’s just one very specific thing. And that sort of leads me to my final question. Is hoarding disorder curable? Is there hope?

Elaine Birchall: Yes, there is hope. That’s why I do this, yes there is hope. It depends on how early the onset occurred, how long you’ve been doing it and how many other, I’m going to call them balls in the air, you’re trying to keep going. I met a woman yesterday, for instance. And even though it’s not the worst situation as far as accumulation, her life is legitimately so complicated, you know, disabled children, health issues, untreated trauma and abuse, social anxiety. There’s a list that it’s going to take quite a while.

Gabe Howard: When we talk about getting better and recovering from hoarding, what are realistic goals for people?

Elaine Birchall: Every single person, if they are willing to do the mental work, right? Because if the head and the thinking doesn’t change, if you don’t change your relationship to your things, your hands can’t help you. So every single person is capable of learning to manage at a minimum with the right resources. Right? And many people, many people the later the onset. So it didn’t start in childhood. It hasn’t gone on 50 years untreated. Later the onset, the more you reach out, when you identify the clutter isn’t working for you anymore. You realize how overwhelmed you are. We showed at that point, you can turn this around. But if you have the vulnerability towards it. Like being on a diet, Gabe, you have to understand where your triggers are and you have to learn how to either avoid them or manage them, or when you trip and fall, reach out again sooner and get back, recover what you’ve lost.

Gabe Howard: And just to boil this down to a timeframe. Is it reasonable to think that you’re going to have this under control in a couple of weeks, a couple of months, or is this a long term kind of commitment?

Elaine Birchall: Depends on the person and it depends on how long they’ve been doing the behaviors that have created the hoarding environment. I’ve had people who needed six sessions and they got the concepts. They had quite an issue with clutter and it was hoarding disorder, but they got it and they worked together. It was a couple. They worked together and they’ve made significant improvements. I’ve had other people that required a year and a half. A very, very few people, generally, those people who began hoarding at a very young age, you know, ten, eleven, twelve, thirteen in that pre-teen and got no help for it. And now they’re 50 or 60. And in addition, they have another co-morbid factor. Maybe OCD, maybe a touch of Asperger’s, other issues. Depression, bipolar, those cyclical disorders that you really have to manage. They didn’t get any help with any of that. They didn’t even know that that was part of their reality. Those people are probably going to need very long term. But the interval between changes. You’re not with them every week. Now, maybe you’re with them every month now maybe you’re with them every three months. I had a woman one time. Really interesting. It was the first time this ever happened. And I’d worked with her for about maybe eight or nine months. And she was doing really well. And I said, you know what? Let’s revisit whether you need to continue seeing me now. What do you think? And she said, well, I think I can manage on my own now, but I want to see you once a year. And I thought to myself, once a year? What good is that going to do? But I learned something. And she said, I want to see you once a year mainly because every day when I make decisions, I will know that in a year I’m going to be seeing you, and I want to use you as my own personal accountability. The people do use the skills you teach them and they do really unique things with them to help themselves. Those people make it.

Gabe Howard: Elaine, thank you so much. This has been very illuminating. And I think it will help people understand exactly what hoarding is, what it isn’t, and really add just an incredible amount of knowledge to a misunderstood disorder. So thank you for being on the show. Where can folks find you, your web site, and where can they buy Conquer the Clutter: Strategies to Identify, Manage, and Overcome Hoarding?

Elaine Birchall: So go to my Web site http://hoarding.ca/. I’ve got all kinds of free resources on there under the resource tab. There’s a quiz there. Are you a hoarder in the making? Now, I’ve developed that quiz specifically around the risk factors and the criteria. Go and take my quiz and identify, am I at the point that really I need help now? Because if you have a few of them, you have a compounded risk that might be expressing a vulnerability to go on and go way over the line. Once you’re over the line, Gabe, you’re overwhelmed,all right? Like you can’t move in a straight line. It’s extremely and becomes more extremely difficult to make the decisions you’re going to have to to resolve this. You can get Conquer the Clutter on Amazon.com, in Barnes & Noble bookstores; if you’re in Canada, you can get it in Indigo’s Chapters. You can go on my website. You can order it from Johns Hopkins University Press directly. Thank you, Gabe, for the opportunity. It’s really great to get a positive message out there that puts things more in a true perspective.

Gabe Howard: You’re very welcome and thank you for being on the show. And to our listeners, do you want to interact with the show on Facebook? It’s really easy. All you have to do is join our Facebook group and you can do that by going to PsychCentral.com/FBshow. And remember, we live or die by reviews. Wherever you downloaded this podcast, give us as many stars as you feel appropriate and use your words. Tell people why they should listen. And while you’re at it, share us on social media. Email a friend and tell your colleagues. We don’t have a million dollar advertising budget, so our listeners are our best chance to gain following. And remember, if you’d like to get one week of free, convenient, affordable, private online counseling anytime, anywhere, simply visit BetterHelp.com/PsychCentral. We will see everybody next week.

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