When cluttered living turns into hoarding

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Valerie Lambros

There are probably many of us who have homes or offices that are less neat than we’d like them to be. Maybe there are piles of papers, files or books that we put off sorting because we’ve grown accustomed to them, and they don’t interfere with our daily routines.

This tendency is common and rarely cause for concern. Unfortunately, for some people the accumulation of stuff can develop into a more advanced state of clutter, turning a few piles into roomfuls of belongings that get in the way of living life. These people suffer from hoarding.

Hoarding is defined as the acquisition of, and failure to discard, a large number of possessions that invade living spaces in such a way that people can no longer live normally in them

Hoarding is estimated to affect between 2 and 5 percent of the population and is more prevalent in seniors. Scientists have found that the onset of hoarding typically occurs between 11 and 15 years of age, but does not reach significant levels until later in life.

Can be life-threatening

“Hoarders can collect all measure of things, and many times doorways will be blocked, windows will be blocked. This condition can be life-threatening, particularly if someone had to get out of the house quickly,” said Randy Frost, a Smith College professor and expert on hoarding. “Piles of papers near a stove, for instance, are a fire hazard,” he added.

A frequent feature of these cluttered homes, he said, is the presence of what some call “goat paths” — narrow aisles that navigate through the mountains of stuff.

An inability to clean, dust and vacuum can lead family members to suffer acutely from dust and mold allergies.

Most people might think the easy fix to hoarding is to have someone come in and throw everything out, but anyone who’s watched one of the popular television programs dedicated to this topic, such as “Hoarding: Buried Alive,” knows it’s not that simple. The people who hoard don’t often see the problem. 

There is resistance, denial and bargaining. The process frequently becomes emotional, with tears and anger a typical outcome.

“When others clean up after them, they feel as though they are losing things of value, even parts of themselves,” Frost said. “One person said, ‘If I throw away too much, there will be nothing left of me.’”

While hoarding does share some traits with obsessive-compulsive disorder (OCD), the overlap isn’t exact and many people who hoard display characteristics that differ from OCD.

For example, researchers have reported that while there are few differences in memory or problem-solving between hoarders and control subjects, hoarders often performed much worse on matters relating to attention span and decision-making

Because hoarding is mostly hidden behind closed doors, few are aware of the condition’s prevalence. Little attention has been given to the disorder until recently.

Hoarding is not currently included in the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association, but there is talk of adding it to the latest edition of the book. The inclusion of hoarding might open more doors to study the disorder, scientists say.

Treatments exist

Treatments for the condition are lengthy and difficult.

“We face a great deal of treatment refusal and dropout, low insight into the problem, and limited cooperation during treatment,” said Dr. Gail Steketee, dean and professor at Boston University’s School of Social Work.

A National Institutes of Mental Health study found there is hope in using cognitive behavioral therapy (CBT), particularly when it includes specialized components designed for hoarding, such as motivational interviewing, organizing and decision skills training, and practice discarding and not acquiring.

“While standard therapy doesn’t work, specialized CBT makes a dent,” Steketee said. “And group treatments provide [patients] with an instant, built-in support system. The therapy turns into something they look forward to.”

For more information on hoarding, see Frost and Steketee’s book Stuff: Compulsive Hoarding and the Meaning of Things, published earlier this year. Also visit the International OCD Foundation’s Hoarding Center at www.ocfoundation.org/hoarding.

This article is excerpted from the newsletter “NIH Record,” published by the National Institutes of Health.