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Is my house too small, or is it me?


A recent survey by RIBA referenced on Radio 4 and in the printed media, highlighted that as a culture, Britons are running out of space and are building homes that are increasingly not “fit for purpose.” This is at one end of a spectrum of the increasingly prominent TV genre of hoarding, popularised in TV hits such as ‘Hoarders’, ‘Hoarding: Buried Alive’, and ‘Obsessive Compulsive Hoarder’.

Hoarding is the phenomenon of the apparently disproportionate, irrational and sometimes dangerous accumulation of personal items in one’s household. Such behaviour can be a source of great distress and even misery, particularly to family members and loved ones who recognise the dangers to health and personal safety such clutter can sometimes represent. Hoarders often seem powerless to change their behaviour.

Inevitably some of the coverage seeks to identify the entertainment angle in this serious condition, which remains poorly understood and often resistant to treatment. There is, however, increasing awareness of the social impact of hoarding and its exposure on TV does shed light on sufferers, and at its best, attempts to offer solutions.

Historically known as Diogenes or Senile Squalor Syndrome, as psychiatrists it is essential that we thoroughly evaluate sufferers when asked to, considering all potential diagnoses, including: obsessive compulsive disorder; depression; anxiety disorders and cognitive disorders. Cognitive disorders – especially those affecting the frontal lobe (responsible for higher or executive functions including judgement, initiative, problem-solving and decision-making) are often implicated.

Management can be extremely challenging but may include a combination of practical interventions, psychotherapy and medication. A collaborative approach is most effective, but never more so than in cases of hoarding, where we need to recognise the boundaries of our expertise and ability to affect positive change. Or should we accept, as clinical psychologist Oliver James suggests, that some hoarding simply represents the most extreme example of acquisitive behaviour endemic in modern western society?

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