Compulsive Hoarding

What Is Hoarding?

Hoarding is typically a subtype of obsessive compulsive disorder, in which those affected accumulate an enormous quantity of seemingly useless belongings – houses literally fill to the brim with what most people would consider junk, and with what hoarders consider to be irreplaceable belongings.

Estimates put the number of hoarders in America at between 700 000 and 1.4 million people.

To meet a diagnosis of hoarding, a person must:

1. Continually acquire but rarely dispose of possessions that most people would consider to be without real worth (old newspapers, plastic bags, old food containers, magazines, etc.)
2. Live in an environment so filled with possessions that living spaces are no longer usable as they were intended for (for example, a kitchen so filled with belongings as to be unusable for food preparation)
3. The act or consequences of hoarding cause the person real distress or cause an inability to participate normally in life (they feel so ashamed by the state of their house that they can never invite a friend over, for example)

Other symptoms of hoarding can include:

• Feeling great anxiety when trying to discard items
• Having a great deal of trouble deciding which items need throwing out and which items deserve retention
• Having intrusive thoughts about possessions
• Not liking it when others handle possessions
• Cannot organize or categorize possessions effectively

Why Do People Hoard?

Hoarding is a relatively newly recognized disorder. Many scientists consider hoarding to be a type of obsessive compulsive disorder, but still others disagree. Research into the causes, nature and treatment of the condition continues.

Researchers suspect that some people may be at greater risk of hoarding including:

• People who have close family members that also hoard
• People who struggle with perfectionism
• People who cope with very stressful situations

Hoarding behaviors most typically begin in early adolescence and it gains in severity as people get older (and as they accumulate more belongings) most people get noticed for their extreme hoarding by middle age, but by this point entrenched hoarding is difficult to treat. Many people with hoarding disorder do not acknowledge that they have a problem that requires treatment, although concerned family members often disagree.

People who hoard keep things for reasons similar to anyone else but have more difficulty in differentiating between something worth keeping and something that needs tossing – and so never decide to part with anything. Some common reasons for saving an item include:

• Saving things that might come in handy, be needed or be useful down the road
• Saving items for sentimental reasons
• Saving items that are considered valuable, or too good to toss
• Saving items that may be needed for their information or as reminders for the future

Hoarders may have great difficulty with decision making and be fearful of making mistakes. It becomes easier to keep everything instead of making a decision about an item’s worthiness for retention and when everything is kept, there is no perceived possibility of making a mistake. Perfectionism is thought to be a characteristic of hoarding disorder.

Behaviors Associated with Hoarding

• A failure or inability to organize clutter into a coherent system
• When attempts are made to “organize” the hoarder instead simply moves items from one pile to another
• Isolation behaviors frequently occur, as hoarders become unwilling to expose their living environment to the judgmental eyes of outsiders

Life Consequences of Hoarding

• A reduction in living space and an accompanying reduction in quality of life; in some cases, the house gets so filled with belongings as to make everyday activities, like bathing or cooking, impossible.
• Hoarding often causes family conflict. People who live with someone who hoards suffer greatly from the clutter and this can cause significant tension in the family. Well meaning family members who do not live with the hoarder often try to influence change (often without success) – and this can also result in discord.
• The accumulation of enormous quantities of certain items can lead to mold or dust that can cause health deficits like asthma
  
• Belongings that fill entire rooms are a fire safety hazard and in some cases escape routes from a house are blocked off by possessions
• Hoarding can result in legal or tenancy problems
• Hoarding can lead to extreme financial problems

Treatment for Hoarding

Hoarders often deny the need for treatment and treatment does not yet exist that is proven to help hoarders, in part due to the newness of the diagnostic category.

Treatments that are commonly recommended however, for hoarding, include medications and psychotherapy.

Medications that work well for OCD, such as the SSRI class of antidepressants, have shown some efficacy in improving the symptoms of hoarding. Medications are most commonly recommended as an adjunct to cognitive behavioral therapy (CBT); a form of psychotherapy that teaches practical ways to change thoughts in order to change actions.

“I recognize that although I want to keep this food container, I do not need to keep it.”

CBT therapists that work with hoarders often visit the home environment to help hoarders develop practical techniques for reducing the clutter and making gradual but positive progress.

Helping a Family Member That Hoards

Hoarders don’t often consider that they have a problem and typically resist intervention attempts by family members or concerned friends.

Although hoarding can detrimentally affect quality of life – except for in very extreme cases, there is little a family member can do to compel treatment. A person generally has the right to do what he or she pleases with personal belongings in the home. Although hoarding can cause an emotional reaction in the family, it is important to avoid blaming or shaming and to recognize that hoarding is a difficult to overcome disorder that can’t be “forced” away. Compassion, empathy and respect are vital.

In some cases, family style interventions (similar to substance abuse interventions) can help get a reluctant hoarder to at least agree to talk to a therapist familiar with the disorder.

Typically, family involvement in the continuing therapeutic process is very helpful.

Is It Hoarding or Clutter or Collecting?

Collectors acquire specific items and take pride and enjoyment from them – showcasing them to visitors, for example. Hoarders acquire a range of items, and typically feel embarrassed by the evidence of their condition.

People dealing with excessive clutter may live amongst a lot of junk, but these people could easily “clean house” if they were motivated or compelled to do so – or would likely have little problem with someone else coming in to help clean up. Someone with compulsive hoarding could not “clean house” without feeling substantial anxiety and would very much not want someone else to come in and get rid of their clutter for them.

Do you or a loved one have a problem with compulsive hoarding? Take this hoarding quiz to find out.