The moment the elevator doors opened, the stench was overpowering. Eyes watered, nostrils burned, fight or flight impulses activated.

We hadn’t even gotten into the apartment yet — the trash was crammed so tightly floor to ceiling it was nearly impossible to open the door.

Inside: Narrow paths from room to room. Boxes filled with junk mail, old newspapers, invitations to exhibitions that happened years ago.

This is just one example of an apartment of a hoarder, far different from mere clutter. A hoarded home and a home with excessive clutter have one thing in common — excessive clutter — but that’s where the similarities end.

Keeping a house clean and well-lighted requires time, energy, a level of physical health and, sometimes, other financial resources with which to hire help, rent a truck to take trash to the dump, and pay the dump fees.

It can get away from us. Though it may take a while for it to get to the point where we can’t deal with it by ourselves, it happens.

A psychological issue

A person who lives with excessive clutter is happy to be rid of it, and frequently will take steps to deal with it.

In contrast, a true hoarder finds it almost impossible to act. The process is too painful.

Throw the broken chair, the moldy box spring, the 100 margarine tubs away? To hoarders, that’s like throwing away parts of themselves.

Despite appearances, Compulsive Hoarding Syndrome actually isn’t about things — it’s about trying to fill a psychological need through acquiring and keeping things.

As Sandy S., a compulsive hoarder put it: “You’re pulling everything in around you, building the hamster’s nest, building the wall. Part of it is for the high. It’s an addiction, sort of. But it’s also to fill a void. It fills a lot of void.”

The difference, then, between the excessively cluttered and the hoarded home is — almost always — the person living there.

It’s important to note: Hoarding is not a moral failing. It is a distinct mental illness recognized by the American Psychiatric Association, and it can indicate many additional problems.

Some 60 percent of people who hoard are affected by depression, 30 percent by social anxiety disorder, 20 to 23 percent are in varying stages of dementia, as shown by Dr. David Tolin.

An equal-opportunity disorder, hoarding syndrome affects those of all ages, races, genders, educational levels, nationalities and socio-economic statuses.

Signs of hoarding

Might someone you know have a hoarding problem? Here are some tell-tale traits:

Hoarders don’t tend to let people into their homes. This doesn’t mean they’re anti-social. Often they are happy to meet you somewhere for coffee, take in a movie together, or visit you in your home.

The shades are always down, the curtains are always drawn. The person who hoards won’t invite you in, and they don’t want you to see in, either.

Things are outside that should be inside, such as appliances, upholstered furniture and knick-knacks spilling onto the porch or into the yard. Frequently, even the car is packed with stuff.

They’re using an off-site storage facility (or two or three) to house belongings. Meanwhile, their home is so full that you’re not sure if the couch is even there anymore.

Living spaces are so cluttered they cannot be used. Often, hoarders cannot cook in the kitchen, sleep in their beds, bathe in their bathrooms — they’re buried in clutter. Plumbing, electricity, heating, air conditioning may not function well, if at all. Insect and animal infestations are common.

How to help

If you’re seeing these signs, it’s time to initiate the remediation process. The alternative is to wait until an eviction notice is served and state agencies get involved.

Bringing the home to a level that can be easily maintained is crucial but, good intentions notwithstanding, the “slash and burn” method is more likely to produce trauma than promote gratitude.

During the project, the tasks will include everything from donating, recycling and trashing, to mold removal, heavy cleaning and construction. And sometimes more.

Afterwards, ongoing support will be needed, as the underlying causes of hoarding do not go away. (Without regular support, the behavior reappears quickly after remediation.)

But before the declutterers, exterminators, cleaners and appraisers can even begin, your job is to communicate with your loved one — to help them see that they have a problem and that it needs to be dealt with immediately.

Here are 10 ways to make the process go as smoothly as possible:

1. Set boundaries. Communicate what you can and cannot, will and will not do — respectfully, but firmly.

2. Respect the person who hoards. You can judge the living situation; not the individual.

3. Listen to the individual’s ideas and plans for their belongings.

4. Find a positive space to begin. Even if it’s just a one-square-foot space that’s not cluttered. It builds on hope, faith and ability, which is often lacking.

5. Encourage them to voice their hopes — realistic or not.

6. Then, help them be realistic. “You’re in violation of health and fire codes, and you’re being evicted. You won’t be able to go home until we change that.”

7. Be firm in identifying the problem, even when you’re screamed at. One roach means hundreds. One mouse seen equals scores not seen. All carry disease. This is dangerous to health and safety — everyone’s.

8. Professional help is needed. Family and friends, landlords and boards, need help in order to be able to help people who hoard. Legally, physically, psychologically, the remediation is a complex project — a collaboration, not a confrontation. 

9. Pace the work. Account for the time it takes to go through years of memories, stories and fears. Steady progress in decluttering is most important.

10. How much is good enough? The space needs to be clean and safe, not perfect.

No one wants to disrespect a parent, the sweet neighbor next door, the colleague. But is hoarding a threat to health and safety? Yes.

The most respectful and caring thing one can do is take action. The sooner action is taken, the sooner that person is safe.

Joan Van De Moortel is executive director of Care for You, a homecare services company.