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The question

The woman I love is a hoarder. She refuses to even talk about it - we always spend time together at my house and go out, but just bringing up the subject is too much for her. Do I have to leave this relationship?

The answer

First, understand what hoarding means, as many people use this term loosely. Someone who is a true hoarder engages in pathological or compulsive behaviours where they acquire or collect a large number of items that seem to have little or no value to others (e.g., clothes, newspapers, flyers), and have significant difficulty discarding these items.

They will often continue to acquire items despite having significant clutter in their living space, which may be both unsanitary and pose safety risks. They also experience ongoing impairment with respect to their social and/or occupational function. Most hoarders are what are called "object" hoarders (collecting inanimate objects), and a smaller portion are animal hoarders (collecting a range of animals, most commonly cats).

Individuals who engage in hoarding often meet criteria for one or more psychological/psychiatric diagnoses. The most common conditions are obsessive-compulsive disorder and depression. Hoarders are also more likely than the general population to have experienced abuse or neglect in childhood.

Individuals who hoard can be extremely resistant to acknowledging their difficulties and seeking help - due to a combination of factors, including significant anxiety when thinking of letting go of or discarding the objects of their hoarding, as well as associated shame and guilt.

Although there are effective treatments, these are often very intensive and are multimodal, requiring a combination of psychological therapy, medication therapy, and community supports/assistance. Hoarders often need the unconditional support of their family or close friends as well to be able to make and sustain changes.

To an outsider, hoarding behaviour can be highly puzzling and complex to understand. Loved ones often struggle with how to approach this. Giving an ultimatum or telling the hoarder to simply discard the objects is not effective, nor is trying to convince them about the problems the hoarding is causing.

Start by telling your girlfriend how much you care about her. Indicate that you are concerned about her and that you appreciate how difficult it may be for her to even talk about her difficulties with hoarding.

Ask her what you could do that could help facilitate the process. Indicate that her difficulties are impacting you and your relationship and that you jointly need to find an effective way to communicate about this as a starting point. Assure her that you are not going to ask her or force her to do anything that she is not comfortable with, as ultimately that is her decision.

The question about whether you stay or leave is one that you ultimately have to decide over time based on how your discussions with her go. Loving someone involves unconditionally accepting their strengths and their weaknesses, but you need to know the elements of your relationship you can accept and live with for the long term.

Send psychologist Joti Samra your questions at She will answer select questions, which could appear in The Globe and Mail and/or on The Globe and Mail web site. Your name will not be published if your question is chosen.

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The content provided in The Globe and Mail's Ask a Health Expert centre is for information purposes only and is neither intended to be relied upon nor to be a substitute for professional medical advice, diagnosis or treatment.

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