From Clutter to Compulsive Hoarding
When discussing the issue of hoarding, we are not talking about hobbyists, individuals with a passion to collect baseball cards or coins or stamps. Nor are we discussing “messy,” a somewhat laid-back approach to housekeeping that causes consternation in so many marriages. Rather, we are examining a potentially dangerous pathological condition that significantly impacts not only the compulsive hoarder, but often his or her spouse and family members. Hoarding is a condition that the Obsessive Compulsive Foundation estimates affects 1 million to 2 million people in the United States.
By Thomas L. Cory, PH.D.
First a definition: Compulsive hoarding has, until recently, been defined as “the acquisition of and inability to discard worthless items, even though they appear to have no real value.” Some theorists have now dropped the word “worthless” from the definition, as it appears a small but significant number of hoarders do accumulate objects with some intrinsic value, such as car parts, shoes, junk mail and bars of soap.
In addition, the number of items accumulated must be of sufficient quantity that living spaces are sufficiently cluttered so as to preclude activities for which those spaces were designed. For example, beds may be piled high with magazines and newspapers, making them totally unusable for sleep. Navigating through the house of a compulsive hoarder is often close to impossible. So compulsive hoarding is more than just clutter, more than an inconvenience; it seriously impairs the everyday functioning of the hoarder.
There’s more. Compulsive hoarders typically form an extremely strong emotional attachment to the objects they “collect,” to the degree that they experience an extreme amount of anxiety at even the thought of throwing anything out; hence, they don’t. Unable to have visitors in their houses – most hoarders are embarrassed by their clutter – they often become socially isolated.
Dr. Fred Penzel, a psychologist and author of Obsessive-Compulsive Disorders: A Complete Guide to Getting Well and Staying Well, has compiled a checklist of symptoms typical of compulsive hoarders.
The Psychology of Hoarding
How does one become a compulsive hoarder? Dr. Penzel points out that the urge to hoard and collect may be instinctive, just as squirrels store nuts and human beings gather food for winter. For the compulsive hoarder, however, this “instinct” runs amuck.
Could there be a genetic component, a disposition to developing obsessive hoarding? “Children and other close relatives of hoarders are more likely to be hoarders themselves,” writes Elizabeth Svoboda in Psychology Today. Evidently, a pattern of genes associated with obsessive-compulsive behavior is characteristic of compulsive hoarders.
Other research suggests that hoarders have brain activity patterns associated with problems involving emotional self-control, decision-making and attention. This pattern may account for the extreme emotional discomfort hoarders feel when faced with a decision to keep or discard an item.
Although hoarding behavior appears to be related to obsessive-compulsive disorder (OCD), researchers are not sure how close this relationship really is. Certainly many individuals with OCD do not hoard. Many, but certainly not all, compulsive hoarders do, however, demonstrate obsessive thought patterns and compulsive behaviors.
How about psychological explanations for hoarding behavior? We do know that hoarders form a deep emotional relationship with the things they own. The question is, why? Most of us can relate to being sentimental about a family heirloom, memorabilia from a special event, or souvenirs from a cherished vacation; wonderful memories are often associated with these items. For the hoarder, however, their accumulated objects may define who they are. Piles of magazines, often unread, may allow the hoarder to define his or herself as intelligent and knowledgeable. While many of us see our possessions as pleasurable indicators of our success, hoarders often see possessions as totally defining who they are.
We also know that hoarders frequently come from families with rather distant, unapproachable parents – parents who may have difficulty showing love and affection. Psychologists have theorized that for the hoarder, possessions can serve as a substitute for love.
In Western society, we often hear references to “retail therapy” – shopping for unessential items – as a way of dealing with bouts of depression and anxiety. The hoarder may carry this type of self-therapy to a self-defeating extreme.
Other theorists point to the frantic pace of change in contemporary society and the insecurity it can engender. Acquiring and holding onto things, whether needed or not, may serve as a buffer against insecurity and anxiety for the compulsive hoarder.
Some psychologists believe that hoarding may be a reaction to a fundamental insecurity, a generalized anxiety about the world. Compulsive hoarders are thought to see the world as a threatening, dangerous place.
Dr. Randy Frost, a psychologist at Smith College and author of Stuff, writes in Psychology Today: “We see the objects in our home as symbols of safety and comfort. This tendency seems to be exaggerated in people who hoard.” The irony is that the hoarder’s “stuff” often constitutes a very real physical danger. Indeed, there are cases in which hoarders have been seriously injured or killed when a pile of collected items fell on them.
Another possible reason for hoarding is that the hoarder fears that if he or she throws something away it will certainly be needed someday, but will then be gone for good. Dr. Penzel believes that many hoarders simply cannot discriminate between what is truly useless and what isn’t. He points out that few hoarders actually use, or even look through, the things they save. And, it turns out, their ability to actually find something they are looking for is minimal.
Symptomatic of compulsive hoarders is a severe impairment in decision-making. Even the simplest of decisions, such as what to have for lunch, can be extremely difficult for these individuals. Any decision means giving up something in order to get something else, and compulsive hoarders simply cannot give up anything easily.
Researchers have identified several subtypes of hoarding, based on the type of object hoarded:
• Bibliomania (book hoarding): Collecting books to the point that social relations and/or health are damaged. The books hoarded typically have no use to the collector, nor any great intrinsic value to a genuine book collector.
• Digital Hoarding: Collecting computer files that go far beyond the point of usefulness. Digital hoarders often have to buy multiple hard drives to store their collections. Digital hoarders find it extremely difficult to delete items, just as traditional hoarders have extreme difficulty throwing away useless items.
• Animal Hoarding: One of the most tragic subcategories of hoarding, animal hoarding is distinguished by keeping a larger than normal number of pets without the ability to properly house or care for them, while at the same time denying this inability. An animal hoarder simply cannot see that the animals he or she keeps are suffering from malnutrition or neglect. This type of hoarding is considered to be a delusional disorder.
Additionally, certain types of compulsive buying are almost certainly linked to compulsive hoarding. Hoarders routinely report being totally unable to pass up a sale of any of the items they collect.
Treatment Options for Hoarding
Compulsive hoarding is an extremely difficult disorder to treat. The primary impediment to treatment is the resistance of the compulsive hoarder to any treatment at all. These individuals do not recognize that they have any type of problem; as noted above, compulsive hoarders have very little insight into their disorder.
According to Karron Maidment, RN, of the UCLA OCD Intensive Treatment Program, hoarders tend to have little awareness of how much their hoarding/cluttering behavior impacts their lives. Hoarders tend to see their behavior as healthy, often seeing themselves as efficient and frugal. They often resist pressure from loved ones and outside authorities to enter treatment or declutter their living space. Any attempt to impose a “decluttering” intervention on a compulsive hoarder will typically be met by denial and resistance.
Even if a compulsive hoarder agrees to treatment, the outcome remains uncertain. Medications for obsessive-compulsive disorders have been found to be of limited help in treating chronic hoarding. Psychotherapy, usually some form of behavior therapy or cognitive-behavior therapy, is only marginally effective. The best current research suggests a positive treatment outcome only 35 percent of the time.
So what can be done? Family members are often the only ones who can convince a compulsive hoarder to seek treatment. A gentle but firm approach appears to have the best chance of success. Interestingly, some therapists have found that showing hoarders pictures of their extremely cluttered living spaces sometimes can help these individuals recognize that they do indeed have a serious problem.
Once in treatment, a therapist will most likely begin with pragmatic, small interventions aimed at helping the compulsive hoarder begin the process of decluttering. One approach is to have the hoarder bring in a bag or two of his or her collected objects and begin the sorting and discarding process, with the emotional support of the therapist. The therapist might then focus on improving decision-making skills and improving the hoarder’s organizational and sorting skills.
Interventions aimed at helping the compulsive hoarder develop insight into their condition and the anxiety that may underlie the need to hoard may also prove useful. Therapists agree that family members need to be involved in the treatment process so they can learn how to support and encourage the hoarder without enabling a continuation of the hoarding behavior.
Conquering Hoarding Tendencies
If you find yourself on the cluttering end of the compulsive-hoarding syndrome and decide it’s time to make a change before you potentially become a hoarder yourself, here is what you can do. First of all, start small and set achievable goals. For example, make a decision to clean a shelf or a drawer, not a whole room. Seek the help and support of family and friends or even a professional home organizer who can help you identify what you really need and don’t need. If you’re unsure about an item, put it in a box and put the date on the box; if you haven’t used it in six months, get rid of it. Incidentally, many hoarders find it easier to donate useful objects to a charity or take piles of newspapers to a recycling center, instead of just throwing potentially useful materials out.
Do some self-therapy. If collecting is in your blood, try collecting memories and experiences. You can do this by keeping a journal with notations of special evenings with friends, walks in the park, and particularly good meals. Examine your life and look at other changes you might make in terms of forming more friendships, taking better care of yourself physically, and developing interesting hobbies.
Give yourself plenty of positive reinforcement for even small improvements. Visualize how your life will be better without clutter. Always remember: you can change, you can declutter.
Tom Cory has lived in Chattanooga for 35 years. He is a graduate of the College of William and Mary and Miami University where he received his Ph.D. in Clinical Psychology. Today he practices clinical psychology specializing in interpersonal and marital therapy.