Hoarding and Shame

Working as a therapist, it is not unusual for me to hear clients share stories where they are experiencing feelings of shame, guilt, and sadness. Many clients express feelings of hopelessness and helplessness at least some of the time. But, there is also a sense of shared experience. Therapy is seen as a safe place where they can explore those feelings. Hoarding disorder can test this idea.

When working with clients who hoard, learning about the hoarding can take more trust than you might expect. I have worked with clients for years before they are ready to share what is happening in their homes. Clients who have felt safe disclosing trauma, substance abuse, and their eating disorder have struggled to talk about their hoarding. All the same, it is an equally important issue that impacts them daily. Hoarding may be, to them, their most shameful behavior.

Hoarding Disorder: Statistics

Research shows that individuals experiencing hoarding disorder often feel judged and isolated from friends and family. This happens at rates that are even higher than those experiencing schizophrenia. As a result, it is not surprising that hoarding is a secret that is closely kept.

Hoarding disorder affects between 2 and 5% of the population. It is more common than many people are aware, and there are levels of severity as with any illness. Often times, when working with clients, they will reassure me, “I’m not like the show. I’m not that bad.” I always try to emphasize that no matter the hoard, I will not judge them. This is crucial.

Many times, before the work on addressing the hoarding can begin, there has to be a clear understanding that there is no judgment or critique of what is happening in their home. Rather, there is an understanding and acceptance of the internal distress and frustration hoarding causes. Whether their hoarding is causing health problems, issues with environmental safety, or is a source of embarrassment, the primary concern is the pain it is causing and how to address it.

Hoarding disorder also does not exist in isolation or as a stand-alone illness; rather, it is significantly correlated with anxiety, depression, OCD, and ADHD. These co-morbid disorders can often be the primary reason clients seek out support initially, and clients may be hesitant or reticent to start to address the hoarding, itself. Further, for many, there is a significant discrepancy between their external presentation- professional and put together- and their deeply protected, often completely hidden from others, personal space. When all of these factors are combined, it is clear why hoarding disorder is such a hidden illness and why, for those experiencing it, it can feel so hard to overcome.

What Can Be Done?

In September of 2017, a new group protocol was released to address hoarding disorder in a group format. Chrysalis Center is excited to be among the first offering this “Declutter Class”. The group provides resources, strategies, and hope for change with hoarding disorder. This treatment is research driven, proven to provide results, and addresses 7 “targets” or areas of functioning to reduce the impact of hoarding and improve functioning, overall. While seeking treatment and support for hoarding can be difficult, we are hopeful that this group will offer a safe, non-judgmental space where hoarding can be addressed effectively.


For Follow Up

If you are interested in the group or would like more information, please contact Rachel Hendricks, LCSW at (910) 790-9500. You can also reach her via email at

Rachel Hendricks, LCSW specializes in working with clients who have had their eating disorder for ten or more years, clients with co-occurring substance use behaviors, as well as working with couples and families. She facilitates two groups: Motivation to Change and Declutter Class, and she is currently accepting referrals for both. Rachel is excited to be making the transition to Wilmington from the Center for Eating Disorders in Baltimore, Maryland. She looks forward to continuing her reputation for providing excellent clinical care in the field of behavioral health.

Lisa*, a 41-year-old woman, wakes up at 5:45am to the screeching sound of an alarm clock. She rolls over and slaps it furiously to silence the brain piercing sound. She sighs and says in a determined whisper, “Thirty-six days.” As she begins her daily routine, worries swirl around her mind…”Did I forget to wash my coffee cup before I went to bed last night? If I left it out again, I will get fined by the recovery house manager. What if the bus is running late this morning… they’ll fire me if I’m late again. How am I going to make it to my therapy appointment today? I think my roommate hates me. She’s always so mad that I have to be up before she wants to get up when I work a morning shift. Am I going to have enough money to pay my rent?” Her chest feels tight, and she is filled with dread before the day even begins. Lisa lives in a recovery house. A recovery house is a place where addicts live with other addicts who are working on recovery from addiction. The recovery house provides structure, accountability, and support to those who are willing to comply with the rules of that recovery house’s program and who are actively pursuing recovery. Lisa shares a room with another woman who is in recovery from heroin. She has been sober from heroin for 31 days, and Lisa has been sober from alcohol for 36 days. However, Lisa faces a challenge in her recovery that her roommate does not. Lisa has Generalized Anxiety Disorder in addition to her addiction.

The National Institute on Drug Abuse (NIDA) states that individuals diagnosed with a substance use disorder are twice as likely as a member of the general population to be diagnosed with a co-occurring mental health disorder. In addiction, when an individual stops using a substance such as alcohol or another drug, the body goes through a period of time, called withdrawal, where it is adjusting to the absence of the substance. During this time, it is particularly difficult for an individual to refrain from using since using is the easiest way to stop withdrawal symptoms. These symptoms vary depending on the substance(s) used by the individual and can include extraordinary pain, depression, sweats, goose flesh, vomiting, diarrhea, and seizures. This is considered “acute” withdrawal. Depending on the amount and duration of substance use, this can last for a few weeks. After these symptoms subside, a person will go through “post acute withdrawals” which can include forgetfulness, inability to focus, confusion, emotional disregulation, sleep disturbance, emotional numbness, depression, anxiety and more. This can last up to two years after completely ceasing use and generally lessens over time. During post acute withdrawal, the extreme experience of emotions, depression, anxiety, and feelings of boredom are major triggers to use.

So, as you think about Lisa’s story, imagine what it is like to have used alcohol to cope with anxiety, only to have become addicted to alcohol. Having realized that her life had become unmanageable, she sought help at a recovery house and at a clinic where they treat people who have co-occurring mental health and substance use disorders. She is motivated to “get her life back” and tries hard to follow the advice given by those who know more than she knows about the road to recovery, but she still struggles daily with overwhelming feelings of anxiety, all the while her brain is begging her to fix it the old way… with alcohol. She is also not immune to the emotional effects of post acute withdrawal symptoms that are common at this point in her recovery, and her anxiety can be exacerbated by these symptoms. She can seek medical attention for her anxiety but is afraid of becoming reliant on a pill to cope with anxiety. She only considers this as an option because the symptoms of her generalized anxiety are so severe that she is afraid she will relapse on alcohol if she doesn’t stabilize her mental health.

Individuals who suffer from co-occurring mental health and substance use disorders face the challenge of staying sober while not being able to lean on the substance that they have used for so long to medicate their mental health disorder. They also face the challenge of coping with mental health symptoms complicated by post acute withdrawal symptoms. Structure, accountability and support is often not enough to help them overcome this special challenge. Frequently, medication and psychotherapy are necessary to stabilize their mental health disorder symptoms while they build the skills for living a sober lifestyle. Programs that include this combination offer hope to those who are determined to make a change and willing to work hard to begin a new life.

*Lisa is a fictional character created to represent real circumstances and challenges faced by those who suffer from co-occurring mental health and substance use disorders.

Lillian Hood, LPA, LCAS
Psychologist and Clinical Addictions Specialist
At the Chrysalis Center, I specialize in treating individuals with co-occurring disorders. This includes working with individuals who have trauma, depression, bipolar, anxiety, and/or eating disorders along with an addiction. I use evidence-based practices to help patients develop skills for successfully facing this unique challenge.

National Institute on Drug Abuse
National Association for Alcoholism and Drug Abuse Counselors

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