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'Your Outer World vs Your Inner World'...

"Does your outer world reflect your inner world or is it your inner world that reflects your outer world?" - Hoarding Disorder

Recently at home we decided to have a sort out and remove any items no longer being used, broken or not bringing us joy.

In the Western world we have, in my opinion ‘too much stuff’; clothing, shoes, books, magazines, ornaments, paperwork, old carrier bags, CD’s, DVD’s, garden pots, electrical gadgets that were bought and used once and now collect dust in the back of an over-filled and expanding cupboard - this type of cupboard used to be known as ‘the cupboard of death’ in our house because we would open it and everything would avalanche on the unsuspecting door person!’

We no longer have that clutter and choose to live more minimalistically allowing the energy to flow through our home and offer a spacious, peaceful, creative and loving place to live. A space that is good for the mind, body and soul.

Hoarding in the extreme can be a very damaging habit, it is different from general household clutter which is the result of general mess or untidiness, hoarding is more serious. Hoarding is what happens when somebody is suffering from a hoarding disorder.

According to Dr David Matrix-Cols, Ph.D. ‘Hoarding is highly prevalent (approximately 2 - 5% of the UK population, that is potentially between 1.3 and 3.3 million people), and when hoarding is severe, is associated with substantial functional disability and represents a great burden for the sufferer, their families and society’.

The World Health Organisation (WHO) announced recognition of Hoarding Disorder in 2018 in its International Classification of Diseases (ICD-11). Definition as follows…

“Hoarding Disorder is characterised by accumulation of possessions due to excessive acquisition of, or difficulty discarding possessions, regardless of their actual value”. It adds “Accumulation of possessions results in living spaces being cluttered to the point that their use or safety is compromised. The symptoms result in significant distress or significant impairment in personal, family, social, educational, occupational or other important areas of functioning”.

The effects of hoarding go beyond just the mess as issues arise for the hoarders and those living in the home as emotional, physical, social and economics can result in decisions being made by those concerned about mental wellbeing and safety for the occupiers. Not only are hoarders the victims in the situation, but their loved ones are as well.

An irrational compulsion to save and store things that are of little to no value or will come in useful one-day, can impact all ages and demographics but is more often seen in older age groups. In my work, I have seen people fill their homes with more and more stuff as each child leaves to start their own life. It is as if they are filling the emotional emptiness of their once bustling home filled with love and joy of family life. In severe cases, individuals can eventually become reclusive and isolated from family, friends, and other social interactions as they become blinded by their environment.

The National Study Group on Compulsive Disorganisation, in America developed a scale to define the levels of hoarding to help professionals and family members understand the various situations of hoarding. I was unable to find anything similar in the UK however really like the ease and simplicity of the ICD’s scale. There are 5 categories and 5 levels of hoarding and each progressively defined as more severe.

The 5 categories of Hoarding include:

Structure and zoning

  • Animals and Pests

  • Household Functions

  • Health & Safety

  • Personal Protective Equipment (PPE)

The ICD have supplied this really useful scale which can be used as an assessment / guidance tool only. The link for their quick reference guide can be found below this article.

The 5 levels of hoarding explained in brief…

There are 5 progressive levels indicating the degree of household clutter and, or hoarding… Level I as the lowest, and Level 5 the highest. ICD considers Level 3 as the pivot point between a household that might be assessed as cluttered, and a household environment that may require the deeper considerations of working in a hoarding environment.

Level 1

Level 1 is the least severe level of hoarding…

  • All doors, stairways and windows accessible, all plumbing, electrical, HVAC (heating, ventilation and air conditioning) systems fully functional.

  • Appropriate animal control (behaviour and sanitation) with no evidence of non-pet rodents or insects

  • No excessive clutter with all rooms being used for intended purposes

  • Safe and maintained sanitation conditions with no odours from animals, food or natural gas

  • PPE is optional, this includes First aid kit, hand sanitiser, torch and insect repellent.

Level 2

Household environment would benefit from professional intervention

  • One major exit blocked

  • One major appliance or HVAC device not working for longer than one season

  • Some plumbing or electrical systems not fully functional

  • Animals: evidence of inappropriate animal control (behaviour and sanitation) with evidence of visible or odorous pet hair, feathers, fur

  • Clutter obstructs some functions of key living areas

  • Odours related to dirty dishes, food preparation surfaces, laundry, toilets; mildew in bathroom or kitchen.

Level 3

Considerations at Level 3 to be the pivot point between a household environment that can be assessed as cluttered and a household assessment that may require the deeper considerations of working in a hoarding environment. Considerations include Professional organisations working with level 3 household environments should have access to a community network of resources, including mental health professionals…

  • Outside clutter of items normally stored indoors

  • One part of home exhibits minimal structural damage (having occurred in preceding six months)

  • Inappropriate animal control, light insect infestation

  • Clutter obstructing functions of key living areas, clutter around exits, entrances, hallways and stairs with substandard housekeeping and maintenance

  • Evidence of non-maintained sanitation conditions (food preparation surfaces heavily soiled, dirty dishes, visible mildew in bathroom or kitchen) with obvious and irritating odours, and the presence of accumulated dust, dirt and debris.

Level 4

Household environment requires professional support which may include Multi-Agencies such as mental health professionals, social workers, financial counsellors, pest and animal control officers, licensed contractors, cleaners and handy-persons…

  • Excessive outdoor clutter of items normally stored indoors

  • Structural damage to home existing longer than six months

  • Damaged walls and foundations, broken windows, doors or plumbing, mold and, or mildew obvious

  • Evidence of poor animal sanitation; destructive behaviour, excessive spiders and webs, bats, squirrels, rodents

  • Diminished use of and accessibility to key living areas, several rooms cluttered to extent they cannot be used for intended purposes, e.g., items stored in shower and, or bath; limited bed access or space and clutter inhibits access to exits, entrances, hallways and stairs.

Level 5

Household environment will require intervention from a wide range of professionals…

  • Extreme indoor/outdoor clutter; foliage overgrowth; abandoned machinery

  • Irreparable damage to exterior and interior structure

  • Key living spaces not usable, not used for intended purposes with exits, entrances, hallways and stairs blocked, hazardous conditions obscured by clutter

  • Pervasive mold and/or mildew

  • Beds inaccessible or unusable due to clutter or infestation

There appears to be a number of factors associated with hoarding, these being neurologically based conditions; mental health issues, addictive tendencies, ageing issues , life crises and lack of life skills.

Over the years of working with families living in such conditions I have come to see a pattern of their outer world reflecting their inner world and vice-versa which isn’t spoken about by medical professions, many of whom don’t know how their patients live and don’t have time to sit and ask them about family life anymore.

The average time spent with a GP in the UK was less than 9 minutes in 2018, pre-Covid and post Covid 2021, patients report that they have to wait 3 weeks to even speak to their GP on the phone and more than two years for certain hospital appointments. I guess if you are ticking boxes and making commission on big Pharma drugs; it’s easy to ask for symptoms, type a prescription and move quickly on to the next patient, without really addressing the issues.

When I work with clients & families, I investigate as many areas as possible in their lives. This can be issues from childhood; programming from the early years. It can be their plethora of physical, emotional, spiritual and behavioural modalities. In my opinion, it is important to look at your client holistically, for when you investigate what is going on emotionally (on the inside), you can help find out why their outside world is a reflection of their inner. Once the outer world of the hoarding is addressed or even eased somewhat, the inner world of emotional, physical, mental and spiritual wellness is hugely improved.

Some people don’t want to address their situations, they have feelings of overwhelm, anxiety, embarrassment, and they need to be ready for change and in a space where they will ask for and, or accept help. Other times it takes professionals to step in and take charge and that isn’t a nice feeling for anyone involved.

Where did it all go so horribly wrong? When did people stop caring about people and rather than support someone, take photos of the hoarder’s situation and make judgements, jibes and gossip on social media platforms in order to get a few likes!

Sometimes I despair at what I see and hear and wonder why being altruistic is now such a crime.

Be kind, be loving, understanding and practice concern for your fellow human beings. You maybe able to help someone to address issues surrounding hoarding and ill health, for it isn’t just a case of over-collecting and it certainly shouldn’t be something to make crass jokes and assumptions about!

'Resolve to be tender with the young, compassionate with the aged, sympathetic with the striving, and tolerant of the weak and the wrong. Sometime in life you will have been all of these'.

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