Compulsive hoarding is a serious chronic psychological condition where a person acquires more and more new “stuff” without getting rid of enough old stuff. This results in a massive overflow of things that take over the person’s living space and creates a health and safety hazard and economic and relational distress. The severity can be such that their home may become uninhabitable or even condemned by local authorities.
Some hoarders may have insight into their problem. They can recognize that their home is a disaster-area, but feel overwhelmed at the prospect of cleaning and organizing such an out-of-control environment. Other people with compulsive hoarding are in denial about the severity of the problem and feel oppressed by people who attempt to push them to change what they see as a desirable behavior.
There has been relatively little research into hoarding and, unfortunately, it is a poorly understood problem with treatments that are challenging for the hoarder to undergo and have a high failure rate. That’s the bad news.
The good news is that researchers are beginning to focus on hoarding, and treatments are being developed that are designed to lessen the problem of hoarding. Additionally, with several television shows currently in production that focus on hoarding, more public and clinical awareness is being generated. It is reasonable to expect that new and better treatments are on the horizon.
A recent study by Dr. David Tolin and colleagues indicated that hoarding starts early for most people (average age 11-15) and carries on with mild symptoms until mid-adulthood when the severity increases significantly. Most people in the study of 751 hoarders reported that over time their hoarding had continued. Only less than one-percent reported that their symptoms had improved. The study also found that the majority of people who hoard have had traumatic life events to a greater degree than most people.
Doctors Gail Steketee and Randy Frost are hoarding authorities and have come up with a model that is useful in understanding this confusing disorder. They state that there are certain factors that make one vulnerable to becoming a hoarder (aside from genetics). This includes basic information processing problems such as having a difficult time paying attention to details, making decisions, and categorizing and organizing. Add on top of this a history of either family hoarding or a parent being overly neat (perhaps throwing away cherished toys). Perhaps they grew up deprived (e.g. depression-era) or lost possessions in a fire or burglary.
These factors, they theorize, leads to specific automatic thoughts and beliefs (“need to keep things just in case…need to have this information close-by…it’s bad to be wasteful…”) that lead to strong emotions of fear or guilt at the prospect of disposing of things they believe they truly need. These strong emotions, obviously, feel bad so they respond by acquiring more things (which trigger very positive feelings) and they avoid discarding current things (which allows them to decrease the negative emotions that discarding items would bring up).
Bottom-line is that in their pursuit of avoiding negative emotions they stay trapped!
So how does treatment proceed?
Well, the rookie mistake that typically happens is that a family member or a friend, seeing the apparent absurdity of keeping things that (to them) seem worthless, goes in and begins to throw things away themselves. Once discovered by the hoarder, fury is unleashed and the relationship is damaged. To the family member or friend, they had simply thrown away an old newspaper from two years ago, but to the hoarder they have thrown away a valuable and irreplaceable treasure.
The way that professional treatment works is this:
- Assess the situation.
- Provide information to the hoarder about what hoarding is, what the consequences can be, and how hoarding is maintained and how it can improve.
- Bolstering motivation is key. If the hoarder does not have sufficient motivation to change, then treatment will fail.
- They are given a temporary moratorium on acquiring new items and at the same time are taken on “non-acquiring shopping trips” where they are exposed to their strong desire to purchase something and are helped to see that they can leave the store and their urge will eventually subside.
- Sometimes in conjunction with a professional organizer, the hoarder is guided through the process of sorting objects into KEEP, TRASH, RECYCLE, and SELL, DONATE, or GIVE AWAY boxes and are encouraged to follow-through with regular sorting sessions. The hoarder is helped to reason-through their decisions for each item so that they learn tools for sorting and coping skills for dealing with challenging feelings that arise.
- They are encouraged to plan out how each space will be utilized and to maintain their cleared spaces.
Hoarding is a challenging psychological condition to overcome, but with motivation and hard work it is possible to live a much less clutter-filled life.
Eric Goodman, Ph.D.
References:
Steketee, G. & Frost, R. Compulsive Hoarding and Acquiring: Therapist’s Guide. New York: Oxford University Press; 2007.
Tolin, D., Meunier, S., Frost, R., & Steketee, G. Course of compulsive hoarding and its relationship to life events. Depression and Anxiety 2010; 27: 829-838.