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How-To Handbook for Handling Hoarders

BU researcher is go-to source for those finding hoarders

Christiana Bratiotis author The Hoarding Handbook, Boston University

People who find hoarders often don’t know what to do, says Christiana Bratiotis, director of BU’s Hoarding Research Project. Photo by Cydney Scott

When a cable TV technician arrived at an elderly woman’s home, he found it so crammed with piles of paper that he could barely make his way through. At home that night, he scanned the web for information on hoarding and found Christiana Bratiotis’ name and phone number. He called the postdoctoral researcher the next day at Boston University’s School of Social Work to ask what he should do. After considering his description of the house, Bratiotis suggested that he file a report with a local social service agency.

Over the past few years, postdoctoral researcher Bratiotis (SSW’09), director of the SSW Hoarding Research Project, has become a de facto hotline for anyone, from firemen to exterminators, who comes across a hoarder. Along with two graduate students, she fields calls and emails from hoarders around the country and from people who are concerned about them. She typically gets a dozen calls a week. One recent inquiry came from a nurse at an assisted living facility in the Boston area who found that a new resident was stashing tissue and toilet paper under her bed. Another came from a housing inspector in western Massachusetts who needed to immediately find temporary housing for a hoarder. Bratiotis says most of the calls come from around New England, with California a close second.

Hoarding is a mental illness that is largely hidden, because most hoarders don’t think they have a problem. When they are discovered, it is usually by someone with no mental health training, such as a Meals on Wheels volunteer, a landlord, or an emergency medical technician. Most of those coming across a hoarder have no idea what to do.

The Hoarding Handbook, Christiana Bratiotis

Photo by Cydney Scott

“Mental illness is confusing to people who are not mental health practitioners,” says Bratiotis. “And hoarding is an overwhelming problem when you walk into it.”

That’s one reason Bratiotis and coauthors Gail Steketee, a professor and dean of the School of Social work, and Cristina Sorrentino Schmalisch (SSW’05), a psychotherapist and former director of the Hoarding Research Project, wrote The Hoarding Handbook, published this year by Oxford University Press. While there are books about hoarders and books for hoarders, The Hoarding Handbook is the first book written for people who find hoarders.

According to Steketee’s research, between 3 percent and 4 percent of the population, or six million Americans, are hoarders. And while the disorder has proved a riveting subject for reality TV shows, it is often not taken seriously as a mental illness.

The book includes practical tips on how to interact with hoarders: do not touch their stuff, do not make suggestions about how they could organize it, do not make negative remarks or use the word “hoarder.” Always use respectful language. For example, if a hoarder refers to what looks like garbage as his “collection,” you should do the same.

Bratiotis says the book grew out of her doctoral research on the effectiveness of hoarding task forces. These groups, which currently number 85 in the United States, are made up of safety inspectors, police officers, public health nurses, social workers, and animal control officers. People who find hoarders can help tremendously, Bratiotis says, or they can make it harder to help, even with innocent exclamations like, “What a mess!”


Bratiotis says when you find a hoarder, you should not make negative comments. Photo by Melody Komyerov

“One of the biggest dangers,” says Steketee, “is negative comments, which will cause the hoarder to not open the door to anyone else, especially a mental health worker.”

Another mistake is the clean-out, which has unfortunately been the solution of choice for many agencies for decades. Steketee says removing the mountains of magazines might resolve safety code violations, but it can aggravate the hoarder’s underlying problem. In nearly every case where there is a clean-out, she says, the mounds of belongings rise again, often more quickly than the first time around.

Bratiotis, who says it’s crucial that anyone who comes across a hoarder notify a mental health agency, now gets calls nearly constantly.

While at a conference in Atlanta recently, she got several questions on her BlackBerry, including one from a manager at a geriatric care facility. He was concerned that a patient was going to be released to a home jammed with belongings. Bratiotis suggested that the hoarder and her family devise a plan to clear the house just enough to make it safe for the hoarder and visiting nurses.

“These calls are a heartbreaking part of the work and a very rewarding part of the work,” she says.

Amy Sutherland, What Shamu Taught Me About Life Love and Marriage, Boston Globe, Boston University
Amy Sutherland

Amy Sutherland can be reached at alks@bu.edu.

10 Comments on How-To Handbook for Handling Hoarders

  • Dottie on 11.17.2011 at 3:39 pm

    And then what?

  • Maryann Murphy, MSW on 11.19.2011 at 1:45 pm

    I’m a BUSSW grad, and belong to the Mashpee, MA Task Force on Hoarding. Hoarding is a challenge here on Cape Cod as it is everywhere. Thank goodness for the team at BU and elsewhere working on this problem! The books, videos, and even the TV shows are helping make the problem more visible, but we need more people willing to do the work to help these clients. Thanks to the authors for another way to help us all understand the world of the hoarder and some solutions that can help!

  • Matt on 12.08.2011 at 9:52 am

    As a regulatory employee of a municipal government, I am charged with the enforcement of property maintenance regulations. These regulations focus on providing protection to the neighbors of those people that choose, by choice or as compelled by their illness, to hoard or otherwise ignore their property maintenance responsibilities. Our involvment is typically concerned with the condition of the exterior and grounds of the property. Our involvement within the structures is typically pursuant to police or fire department interaction.

    I can certainly understand that hoarders need compassion and assistance. However, I can also understand that the neighbors need protection for their quality of life and support for their property values. At some point, interaction with the hoarder must include the impact that their actions and inaction have on the community.

    • Veterans Liaison Project of Silicon Valley on 05.28.2013 at 6:58 pm

      It is exactly this kind of ignorance and intolerance of those different than ourselves that we wish to stamp out.

      Fortunately or not, the general public are not members of Federally Protected Classes of Citizens, so they would have no more protection from the effects of a neighborhood resident who is nuerologically-atypical any more than a Caucasian-exclusive enclave would have protection against minorities moving in, or persons with disabiliites, senior citizens, military veterans or any other protected group.

      The response from Dr. Schmalisch was equally forceful:

      Members of Protected Classes may or may not
      cooperate with efforts to maintain their domiciles.

      But as such, part of their Federal protections is
      they are permitted to create, allow, have created
      for them or allowances made for them to live in
      a disability-conducive stress-free environment.

      Failure to provide this, or allow the nuerologically atypical person to create his own environment where he feels safest is a violation of Federal law.

      As such, there are a lot more disability-rights
      activists with a lot deeper pockets than there is
      conventional people who wish to be able to live
      conventional lives.

      In the case of the exterior or curb appeal of a house containing one or more members of a Federally Protected Class, sources need to be identified and/or created which can alleviate the problem.

      The nuerologically-atypical person will usually not be interested in paying anybody to perform a
      service due to the facts that A) he doesn’t see a
      problem and B) if he did, the issues of past violations of basic human trust would play a direct role.

      As most schools now require a certain amount of
      civics duties to be performed before a student can graduate. one possible solution may be for a
      neighbor-student to get his required hours by
      beautifying the exterior of a house containing the Member of a Protected Class.

      In addition, other programs and services may be
      able to be located or created in order to reach a
      compromise between the nuerologically-atypical
      and those around him.

      However, the usual response of “not in my backyard” is not only counterproductive, but also backward- thinking as well. It’s imperative that a disability-conducive environment be allowed and/or created as well as maintained for the nuerologically-atypical individual.

      Meaning if the resources used to battle the Protected Class Member were instead used to create and/or allow a disability conducive environment, not only would the problem become abated, but the general public would become educated about the condition.

      • Joy on 06.16.2014 at 10:56 am

        While hoarders may be a part of the Protected Class of Citizens, Matt is entirely correct. A hoarder’s actions do impact his/her community. It affects the health and safety of not only the individual, but also his/her neighbors. Most hoarder homes are condemned by the health department because they are such a hazard. While people who interact with hoarders should always treat them with respect, the impact that person is having on the community has to be addressed. A person has a right to live how they wish, until it becomes a hazard to himself or others regardless of whether they are a member the protected-class of citizens. Secondly, many communities now have HOAs. Which is a legally binding agreement to keep your property a certain way. Since hoarders generally aren’t mentally incompetent, then they are legally bound to abide by the terms of the HOA contract. Lastly, if I own a house in a particular neighborhood and my neighbor develops this terrible illness or it progresses to the point that junk has accumulated outside of the home, then there should be some legal recourse to have them clean it up. To be equitable, the neighbors shouldn’t have to suffer because this individual is ill. After all, when a property isn’t taken care of it not only devalues that home and property, but also those surrounding it. It prevents people from being able to sell their home and move. It also invites people who engage in illegal activities, such as drug dealers to a neighborhood. I, as well as everyone else, have a right to keep their community looking nice and free from crime and such. A person wanting to protect his family’s health and safety as well as his financial investments isn’t ignorance nor does it show a lack of compassion or respect. It shows a concern for his community and the people who live in it.

        • Danielle on 12.24.2016 at 12:20 am

          Wow, you really have a big heart. Haha! Let’s hope you never suffer through something catastrophic in your life and need to inconvenience other people. “By the grace of God go I…”

  • Valencia Hooper, LMSW on 03.10.2012 at 11:12 pm

    Your book is a great practical resource for a variety of people. I am the chair of the Hoarding Task in Dallas, TX. And we are too fortunate to have Dr. Bratiotis speak at our up-coming conference! People who hoard need understanding. Thank you for your research and book!

  • Jessica on 01.21.2015 at 6:54 am

    This was helpful. How can I get a copy of this book? Can I order it from Barnes and Noble?

    • RubbishBeGone on 06.24.2015 at 2:45 pm

      Jessica, yes you can. Great book, sad thing is not many are going to read it, not if any of their relatives have the symptoms. As a professional who have made many house clearances in the UK, I have met many hoarders, they are not bad, they just have issues which reflect on the hoarding.

  • Marco Velez on 09.19.2016 at 1:50 am

    My father is a severely ill person with advanced and grave hoarding disorder, he is 80 now and i’m concerned about his safety, his disorder made all my family to stay away from him, his home is fill with garbage and filth, and produces pests, and is a source for infections; i’m from Mexico city and I want to know if there is any help centre or professional that could guide me through this horrible illness.

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