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Recognizing and Understanding Hoarding Disorders

Patty Underwood, LICSW, a clinician in our Outpatient Center in Newton, presented on hoarding disorder at this year’s Fire & Life Safety Education Conference in Southbridge. Patty is one of Massachusetts’ true experts in treatment and community-wide supports for people with problematic hoarding behaviors.  Her presentation was developed from a mental health perspective, to help fire fighters learn about the issue of hoarding, and how to help and communicate with individuals with a hoarding disorder.

Recognizing and Understanding Hoarding Disorders

Hoarding disorder happens when a person has persistent difficulty parting with items that are useless and worn. This difficulty causes a significant amount of distress for the individual and therefore their home becomes so cluttered that spaces are not able to be used in the way they are intended. Individuals who hoard often know that it’s a problem and feel embarrassed about the condition of their home, trying very hard to hide it. This means first responders are commonly the first to discover the issue when responding to an emergency.

Hoarding disorder affects people from all different walks of life of varied educations, ages, ethnicities, and cultural backgrounds. It is important to know that hoarding is a mental health problem, not an issue of laziness.

Therapists, case managers, in-home coaches, community supports, family, and task forces can all help with individual hoarding cases. Specifically, community-based task forces include support from social workers, police, fire, public health nurses, housing authorities, inspectors, senior service agencies, and mental health professionals. Together, these supports provide education for the community, outreach to those who struggle with a hording disorder, and resources for their family and friends. In many cases, collaboratively supporting the individual can be the best way to achieve success and lasting change.

Here are some tips for communicating with a person who has a hording problem:


  • Use judgmental Language – “You’re lazy, clean this mess up!”
  • Use words that devalue or place negative judgement on possessions – “This is all junk, get rid of it!
  • Let your non-verbal expression say what you’re thinking
  • Try to persuade or argue with the person – “Really, it’s not necessary to have 25 black sweaters, you only need 5.”
  • Touch the person’s belongings without permission


  • Imagine yourself in their shoes
  • Match their language – for example, use “treasures” or “clutter” rather than “junk”
  • Be encouraging and recognize small successes
  • Highlight strengths – resiliency, caring, compassion, style
  • Focus on safety first and organization of possessions, then work on discarding

If you believe someone you know or care about is suffering from a hoarding disorder you can contact the Riverside Outpatient Center at Newton where individual and group treatment for hoarding disorder is offered.  You may also find resources through your local area task force.  A list of task forces can be found on the MassHousing website.

~Patty Underwood, LICSW

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