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Determining Needs Versus Wants In Hoarding Disorder

Determining Needs Versus Wants In Hoarding Disorder


If you've ever dealt with someone who has hoarding disorder you know they have extreme difficulty in making decisions, especially when it comes to dealing with their possessions. Given that hoarding is an actual diagnosis and a true mental health disorder research has shown that there are certain regions of their brains that show excessive activation when it comes to decision-making. This means that people with hoarding disorder are wired to be overly anxious and attached to their possessions making it challenging for them to decide what to do with their items. Too often what we see is people with hoarding opting to keep their items rather than having to make a decision on getting rid of it. 


There was a study done by Dr. David Tolin and his team at the Anxiety Disorders Center at Hartford Hospital, CT in which they recruited 43 adults with hoarding disorder and 33 healthy adults as controls. Each adult was asked to bring in a stack of miscellaneous paper from their homes. Fifty items from the experimenter and fifty items from the participant were then selected and shown to the study participants who had to make a decision whether to keep it or get rid of it. In the end, the healthy control adults chose to discard about 40 out of the 50 pieces of paper whereas those with hoarding discarded only about 29 out of the 50 pieces. 


This leads me to talk about how important it is to be able to talk about needs versus wants with a person with hoarding disorder. Too often they think they need something, when in fact it's a wish or something of little significance. 


Here are some questions* to help a person with hoarding disorder to evaluate their true need for an item:

  • Would you die without it?
  • Would your safety be impaired without it?
  • Would your health be jeopardized without it?
  • Is this critical to your work or employment?
  • Is it essential for your financial records (e.g., tax or insurance records?)

Here are some questions* to help a person with hoarding disorder to determine their want or wish for an item:

  • Do you keep this because you like it? How much do you actually look at it?
  • Are you keeping it for sentimental reasons? Is this the best way to remember?
  • How much do you actually use it now? If you plan to use it, would you bet money on this?
  • Do you keep this for emotional comfort or vulnerability? Does it really protect you?
  • Does it offer information or opportunity? How real and important is that? 

*Questions from the Compulsive Hoarding and Acquiring Workbook by Gail Steketee & Randy O. Frost (Oxford Press, 2007).


You can begin to use these questions during sorting at home to identify needs and wants. Deciding the real value of an item based on your own goals and values requires you to distinguish what you truly need to survive and function versus what you would want or desire to have. 


Do you have any questions you use to determine when you need an item or just want it? 


Categories: Mental Health / Hoarding


  • I guess the biggest challenge for me is to get to a point of rational thought. I have a few clients I work with who can clearly articulate that they don't need it or won't use it, and then they say they still want to keep it. I find I'm on a fine line between encouraging them to shed and stepping back so we can stay engaged in the process. The progress is very slow, but I'm happy to say we are making progress!
    5/25/2018 4:13:01 PM Reply
    • @Seana Turner: I know what you mean. It may seem like clients don't have insight into their situation, but they do! It's just a matter of forming that relationship and being patient. I have another post coming out soon about people's attachments to their possessions which might be helpful for some of your challenges. It is slow progress, but is so rewarding!
      6/1/2018 2:21:26 PM Reply

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