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Once you have provided adequate support, psychoeducation of the compulsion of hoarding may be the best first step in helping your loved one. Understand that hoarding is associated with excessive clutter, difficulty discarding items, and excessive acquisition of new items. Due to the emergence of hoarding behaviors, a new diagnosis of Hoarding Disorder (HD) was added to the most recent and updated version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is the basis for diagnosing mental health concerns.  First and foremost, hoarding can cause health and safety risks. Explain to your loved one that hoarding is dangerous because: it may prevent you from being able to escape in an emergency, does not adhere to fire codes, and can lead to mold and other harmful buildup in the home. It can also cause complications in activities of daily living (ADLs) such as walking, moving around, finding objects, eating, sleeping, and using the sink or bathroom.  Hoarding can lead to social isolation, disruption of relationships, legal and financial issues, debt, and property damage.  Some issues that may coincide with hoarding behaviors include negative and unhelpful thoughts such as perfectionism and fear of regretting removal of information or objects, over-attachment to material items, reduced attention abilities, and lowered capacity to make decisions. Being assertive means saying how you think and feel while being respectful and appropriate. Discuss how you feel about your loved one’s hoarding, and the specific concerns that you have about your loved one’s health and safety. Explain your concerns and set boundaries. Explain that you will not continue to live or be in the house if it is unsafe or unsanitary (if this is feasible). Tell your loved one that you are willing to help her if she is open to assistance. Be aware that people who hoard can have very strong emotional reactions when asked to give away their belongings. Assess the level of openness to your assistance. You could say something like, "I know you've been concerned about your hoarding and I am also. I am here to help if you want it. What do you think?" If the individual responds negatively and says something like, "Absolutely not, I don't want you forcing me to throw away my prized possessions," you may want to back off for a while. If the individual says something like, "I might be open to that," give your loved one some space to decide if she is willing to let you help. You can revisit the conversation at a later time. Individuals who hoard need specific goals to work toward in order to be successful in reducing hoarding behaviors. This helps them to organize their thinking and plans associated with reducing their hoarding. People who hoard may need help with motivation, organizing, avoiding acquiring items and removing clutter. Write down the specific goals you have developed with your loved one. This list might look like: reduce clutter, be able to move through the living room with ease, stop buying new items, and organize the attic.
Educate the individual who hoards. Use assertive communication. Offer your help. Help set goals.