Sooner or later, every first responder will encounter a hoarded environment. These situations will come whether or not your community is prepared. The sights and smells of these environments can be overwhelming, and first responders may not know how to react, personally or professionally.
It is expected that 2% – 6% of the population suffers from hoarding disorder. The unique challenges for first responders working in hoarded environments require a specialized response.
Individuals suffering from hoarding disorder are likely to experience a great deal of shame about their behavior, leading them to be unlikely to ask friends or family for help. So, as a second-line family, emergency responders and communities at large need to be prepared to help individuals who cannot manage their environment to protect their own personal safety.
This article will help first responders to better understand what defines hoarding disorder, what causes hoarding disorder, and how to best face those unique challenges brought on by this disorder.
What is Hoarding Disorder?
Hoarding Disorder is defined in the DSM-5, the leading psychiatric resource for official definitions of mental health disorders, as the “persistent difficulty discarding or parting with possessions, regardless of their actual value.” Hoarding disorder is categorized as a type of obsessive-compulsive disorder.
Obviously, as with all human behavior, hoarding occurs on a spectrum. For hoarding disorder to be diagnosed in an individual, these criteria must be met:
- The difficulty with parting with or discarding possessions is due to a perceived need to save the items and the distress associated with discarding them.
- That difficulty and related distress result in accumulating possessions that congest and clutter active living areas and substantially compromise the individual’s intended use of those areas (without third-party intervention).
- The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- The hoarding may not be attributable to another independent medical condition.
- The symptoms of another mental disorder do not better explain the hoarding. This can be difficult to identify because around 75% of individuals with hoarding disorder have a co-occurring mental health illness.
Hoarding appears to affect women and men equally. Hoarding is also seen equally across races and cultures. Older Americans are three times more likely to be diagnosed with hoarding disorder than younger adults, although hoarding behavior can also be seen in children.
Individuals with hoarding disorder may have different levels of insight into their behavior. Some individuals with hoarding disorder will report that they are aware of the harm their behavior is causing to their lives or that it is at least problematic. Others may be in complete denial, believing that their hoarding is good for them or benefitting them in some tangible way.
Identifying and treating hoarding disorder as early as possible is vital because symptoms will escalate if left untreated. Symptoms typically appear around ages 11-15 years old. By the mid-20s, the hoarding symptoms begin interfering with everyday functioning. By the mid-30s, a clinically significant impairment is likely evident.
What Causes Hoarding Disorder?
Like many other mental illnesses, medical professionals have not yet identified a singular cause or trigger that leads an individual to display hoarding-type behavior. However, many commonalities and themes exist in the lives of individuals with hoarding disorder. Some of the most commonly reported causes of hoarding disorder are using hoarding as a coping mechanism, adverse childhood experiences, or family history of hoarding.
Some individuals report that they use hoarding as a coping mechanism to deal with other complex feelings or traumas that they cannot face in their lives. For some individuals, hoarding may be spurred on by a loss or tragedy. Others may use hoarding as a distraction from anxiety, depression, or other negative feelings.
Other individuals exhibit hoarding disorder as a result of experiencing childhood poverty, abuse, or neglect. Living through experiences of neglect, hunger, or having to do without necessary care in a person’s childhood can often bring about a sense of comfort from hoarding items later in life.
Finally, other individuals with hoarding disorder have personal experiences with other family members having this same disorder. This is very common in people with hoarding disorder. It is not known whether this behavior is learned through observation in childhood or passed down genetically, so both theories are considered viable possibilities.
Unique Dangers to First Responders Posed by Hoarding Disorder
Hoarding disorder, specifically a hoarded environment, poses unique challenges and dangers to first responders. Let’s discuss some of the most prominent concerns.
The most prominent issues for first responders in a hoarding environment are limited access to living areas and decreased visibility. Access in and out of the residence may also be compromised. Narrow passageways and cluttered floors can make removing a patient for medical attention much more difficult for emergency personnel. Firefighters are also challenged by the cluttered environment in their ability to identify fire sources and determine when all fire sources have been put out. It is an unfortunate reality that many people have perished in their hoarded homes because they could not be located quickly enough by responding firefighters.
Other dangers include toxic airborne contaminants such as black mold from poor sanitation, dust, and allergens from a lack of cleaning and Toxoplasma gondii, a parasite found in cat feces. These conditions require communities to equip their first responders with proper N-95 masks and hazmat suits when necessary. Bugs, insects, and other animals are also expected risks when entering a hoarded environment.
Even without contaminants, the air quality in a hoarded environment will likely be compromised. Bacteria from waste, rotting food, pet waste, and backed-up toilets can breed bacterial infestations, leading to gastrointestinal health issues for individuals in that environment. Dust mites can also contribute to respiratory symptoms such as coughing, sneezing, and wheezing.
How to Respond to a Hoarded Environment
The most crucial aspect of any response to a hoarded environment is compassion. First responders must recognize that individuals living in hoarded environments most likely do not want to live this way. They likely feel great shame and loss of control over their lives due to their behavior. Expressing judgment or ridicule will do nothing but encourage someone to continue using hoarding as a coping mechanism.
After a baseline of compassion has been established and immediate medical needs have been addressed, the primary goal of responding to a hoarded environment is to identify the steps needed to resolve unsafe and unsanitary conditions in the home. Acknowledging who will take responsibility for these steps is also necessary and requires identifying available community resources.
Best Practices for Community Response to Hoarded Environments
The risks of hoarding disorder have typically fallen to local fire departments, as many jurisdictions see this issue as best handled by fire marshals and firefighters. However, fire departments have limited enforcement tools for private dwellings that have become hoarding environments. Firefighters also receive limited training in handling an individual with a hoarding disorder diagnosis.
In Michigan, the Grand Traverse Metro Fire Department handled 100% of the community’s hoarding issues, typical for many communities. But about a decade ago, they shifted their focus to a community-led response. Recognizing their shortcomings in resources and training, the Grand Traverse Metro Fire Department chose to incorporate reliance on community-based organizations that specialize in responding to hoarding environments.
Fire departments and law enforcement officers can only do so much, often very little, to remedy a hoarding situation, especially within a private home. Very few states allow temporary eviction from a private dwelling by a fire marshall if specific fire codes are not met. Without these legal mechanisms, first responders have limited options. However, some mental health professionals specialize in how to respond to and assist with hoarding situations. Professional organizers, therapists, and psychiatrists may be among a few other professionals who could better support the remedy of a hoarded environment.
Therefore, communities are best supported by embracing a collaborative approach to hoarding situations. Communities that utilize a co-responder program may easily incorporate on-scene mental health care to guide an individual to seek additional help for a mental health disorder.
Some communities have gone a step further in creating a hoarding task force. This is a multi-disciplinary risk reduction strategy used to address hoarding. Some hoarding task forces, also known as hoarding coalitions, have been formally organized by law enforcement, fire departments, social workers, and other medical professionals. Others are grassroots community organizations that work to make their services available to these professionals and first responders.
If your community is considering incorporating a hoarding task force or referrals to hoarding services agencies into your emergency response or co-responder program, consider how your programs will be supported by Julota’s cloud-based data system.