Hoarding disorders are more easily hidden in rural communities and getting treatment is more challenging

A hoarding disorder can be less visible in rural places.
(Photo via RHIHub)

Some people have a lot of stuff, but too many piles of too many things may be evidence of a hoarding disorder. For rural residents, who skew older and have more available storage space, hoarding can mean "unseen" health and safety risks," reports Gretel Kauffman for Rural Health Information Hub. "About 2% percent of the general population experiences hoarding disorder. Among older adults over 55, the prevalence rate jumps up to more than 6%, making people increasingly vulnerable to the disorder as they age."

Hoarding disorder is a relatively new diagnosis. It was added to Psychiatry's Diagnostic and Statistical Manual of Mental Disorders in 2013. The DSM defines hoarding disorder as "persistent difficulty discarding or parting with possessions, regardless of their actual value. . . due to a perceived need to save the items and to the distress associated with discarding them. . . . It causes clinically significant distress or impairment . . . including maintaining a safe environment for oneself or others."

Letting go of things can be emotionally charged, and as people age, they may become physically unable to move items from their homes, which can add to distress. "Left untreated, the disorder can lead to health risks, such as an increased risk of falling, fire hazards, food contamination, poor sanitary and hygienic conditions, trouble keeping track of medications, and infestations of mold, insects, or rodents. It may exacerbate other conditions such as depression and anxiety," Kauffman explains. "In rural settings, identifying and reaching people struggling to part with their possessions can be extra difficult . . . . And getting someone into treatment in the first place can be a challenge."

Because remote areas offer so many unique "homes" for saving things -- barns, smokehouses, sheds, unoccupied houses, and even corn cribs -- sometimes family and neighbors have no idea how much stuff is being hoarded. Catherine Ayers, a professor of psychiatry at the University of California, calls the diagnosis "unseen." She told Kauffman, "It's not bothering other people, because there's so much space. They don't have a neighbor that is having roaches or bedbugs come over, so there's no urgency yet."

It's important for family, friends and providers to keep in mind that a hoarding disorder is harmful. Kauffman adds, "To identify and treat hoarding disorder early on, Ayers recommends that primary care providers ask all of their patients a few simple, non-stigmatizing questions, such as, 'Does the number of possessions you have in your home make it difficult to use the rooms in the way they're intended?' or 'Have friends and family members complained that you have too many items in your home?'" For people seeking treatment in more remote areas, telehealth and remote learning can be treatment options.