By Fairley Parson, LCSW–
I believe that hoarding disproportionally impacts LGBTQ older adults. Unfortunately, we don’t have research that reports on hoarding behavior in the LGBTQ community. Still, given available research and my clinical experience as a psychotherapist working in the community, I propose that LGBTQ older adults are at higher risk for developing and maintaining hoarding behaviors, while also facing unique barriers to receiving help.
Clinically, hoarding disorder is characterized by difficulty discarding possessions—a perceived need to save items and marked discomfort with discarding them. Hoarding results in the accumulation of objects that congest living space and cause significant distress or impairment in functioning.
Many people casually throw around the term “hoarder” with self-deprecating humor—for example, saying things like, “Oh my god, I’m such a hoarder!”—but without significant distress, you’re not. In fact, due to pervasive stigma and popular misunderstandings about hoarding, many who exhibit hoarding behaviors prefer other descriptors such as “difficulties with stuff.” Advocates, and people who hoard, often caution against using the word “hoarder” because it is stigmatizing and labels the person and not the behavior. Hoarding, on the other hand, is a behavior that can be changed. Or, as one of my clients quipped, “I’m simply an exemplar of ‘queer excess!’” His smile led to a long pause before he said, “Okay, I don’t want to say I’m a hoarder, but it’s a lot.”
At the same time, some have reclaimed the word. Said one client: “I am a hoarder! Coming out as a hoarder was scarier than coming out as lesbian. I felt more shame about my apartment than I ever felt for my sex life, but I am a hoarder! Naming it is my first step through the shame.”
Shame can be a primary obstacle to seeking help. Hoarding isolates. While physical objects may serve as an emotional touchstone to those we have loved, “stuff” can also serve as a physical and emotional barrier to connection. Our stuff may also represent unrealized pursuits, creative imaginings and possibility. Unfortunately, the sheer amount of stuff can preclude such possibility. Still, for many who hoard, giving up stuff can feel like giving up on dreams for the future and connection to the past. Stuff feels protective and familiar. It can feel safe while presenting real danger.
Depending on severity, hoarding behaviors can present profound health risks for older adults, from increased risk of falls, accidents and injuries, to homelessness and eviction. It is also positively correlated with anxiety and depression. But why would LGBTQ older adults be at higher risk for hoarding than their straight or cisgender or younger counterparts? It may help to consider that hoarding is a progressive problem, positively associated with advanced age.
Other risk factors include:
Research shows that LGBTQ older adults are more likely to meet each one of these characteristics than their straight and cisgender counterparts.
LGBTQ older adults are also less likely to have children to pass things down to or to receive help from, and are more likely to be estranged from their biological families. This, of course, includes survivors of the AIDS crisis, many of whom lost most, if not all, of their friends and chosen family. It is understandable that such survivors may feel particularly attached to the physical objects of those who passed. It may be all that they have left, belying clear-cut strategies like, “If you don’t use it, get rid of it.”
People who hoard need help from people who acknowledge the gravity of their losses, and their attachments. While people with hoarding behaviors are characteristically reluctant to let others into their homes, many LGBTQ clients also fear maltreatment based on their LGBTQ identity. They risk being doubly stigmatized by providers—as people who hoard, and as LGBTQ. As one client shared, “I don’t want a total stranger to see my totally gay apartment; they might flip (out) on me!”
There are no wide-scale studies on LGBTQ older adults and hoarding. Fortunately, that may change. In 2015, California passed the Lesbian, Gay, Bisexual and Transgender Disparities Reduction Act. It requires government agencies to collect voluntarily provided sexual orientation and gender identity (SOGI) data when collecting demographic information. Implementing this bill continues to take time as ongoing trainings across agencies statewide teach staff on how respectfully to ask SOGI questions. I am hopeful that this data may lead to a better understanding of hoarding behavior in the LGBTQ community.
In recent years, San Francisco agencies like Adult Protective Services (APS) have rolled out short-term interagency pilot programs to serve those at risk for eviction due to hoarding. Such initiatives have proven to be effective, but they are resource-intensive and have specific eligibility criterion.
The Mental Health Association of San Francisco (MHASF) has also continued to be a key player in advocating for and serving people who hoard. Programs include trainings, treatment groups, peer-led groups and a peer-run warm line. A bi-weekly LGBTQ-focused group has been facilitated at Openhouse in San Francisco for several years. It’s drop-in and free.
The complex nature of hoarding calls for such community-based interventions. One-shot massive deep-cleans have been widely found to be ineffective. Recent research out of UCSF in collaboration with MHASF showed peer-facilitated treatment groups to be as effective as therapist-led groups. While Cognitive Behavioral Therapy (CBT) is considered standard clinical treatment, recent trials suggest that Compassion-Focused therapy may be more effective than CBT alone. Most clinicians and advocates now favor approaches wherein clinicians collaborate with clients to jointly set incremental goals and assess readiness for change.
In my practice, we work not only on behavioral change, but also on the client’s grief, loss and trauma, as well as their strengths and aspirations. We talk about the gifts that they still want to give, or the art that they still want to make. Together, we imagine what change could look like.
People who “struggle with stuff” make up a more significant part of the LGBTQ community than we might imagine. We need to stop stigmatizing and shaming them. They are our friends and neighbors and they need our collective support.
The author received permission for all quotes used herein. Identifying information has been omitted to protect client privacy. Fairley Parson, LCSW, is a psychotherapist in private practice in San Francisco. She can be reached at fairley@fairleyparsontherapy.com or on the web at https://www.fairleyparsontherapy.com/
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