Most of us have box or two tucked away where we keep things of sentimental value or that we think will have practical use down the road. After all, discarding perfectly good things we no longer use or need seems wasteful. Some people, however, can take this stockpiling to the extreme in a way that not only impacts their own health and wellbeing, but also the people around them.
One of the most infamous cases of accumulators was the Collyer brothers; in the 1920s, they were found dead in their Harlem brownstone buried in a heap of books, newspapers, furniture, musical instruments and rotting garbage. Newspapers of that time referred to them as eccentric hermits. Today they would likely be diagnosed with a debilitating mental health condition called compulsive hoarding, the uncontrollable impulse to collect, save or resist discarding objects.
A Disordered Mess
When hoarding escalates to the point where it has serious personal, relational and health consequences, it becomes disabling and dangerous. People who live in a hoarded household are at risk for injury due to cluttered pathways, disease from overgrowth of bacteria and mold, breathing problems from massive amounts of dust, not to mention contact with insects and vermin.
The behavior usually begins or worsens after a traumatic event such as a death, divorce, fire or other stressful incident. But hints of hoarding can appear in childhood and extend into adulthood. And the behavior runs in families, suggesting an inheritable genetic component. Hoarders often live a lonely life, socially isolated from friends and family.
It can start slowly with what seems like harmless piles, but eventually these piles extend beyond their usual place, taking over living areas. The bed is no long conducive for sleeping, the kitchen is no longer a place to cook, and the whole living situation spirals out of control.
Commonly hoarded items can include clothes, mechanical parts, newspapers, magazines, medications, toiletries, CDs, DVDs, videos and more rarely - animals, waste matter, hair, dirty diapers and decaying food.
Characterizing the Compulsions
It is not totally clear if a hoarding compulsion is a symptom of an existing diagnosis or a syndrome in itself. The Diagnostic and Statistical Manual of Mental Disorders, the guidebook mental health professionals use to see if patients fit certain criteria for psychiatric diagnoses, doesn't have a separate entry for hoarding. Instead, compulsive hoarding is considered a major or minor symptom of a number of mental conditions.
Mental health conditions frequently associated with hoarding include:
- Obsessive-compulsive disorder (OCD) - hoarding is closely associated with OCD, a condition that includes obsessions - recurrent and persistent thoughts, impulses or images, and compulsions - repetitive behaviors such as hand washing or mental acts such as counting. Hoarding and saving compulsions are relatively common in people with OCD. Nearly 5% have a form that is so disabling they can hardly perform ordinary activities of daily life.
- Obsessive-compulsive personality disorder (OCPD) - an overlapping, but distinctly different diagnosis from OCD, where people have a rigid preoccupation with perfectionism, details and control.
- Depressive, anxiety and impulse control disorders
- Posttraumatic stress disorder
- Alcoholism and drug abuse
- Diogenes syndrome - a condition in the elderly marked by self-neglect
Sizing Up the Situation
You or your loved one may not yet be a candidate for a reality TV show on hoarding, but you could be dangerously close. The important thing is to recognize the problem and get help.
Ask yourself these questions:
- Do you avoid getting rid of things?
- Do you experience anxiety or distress when you attempt to throw something out?
- Do you fear that you will need what you discarded sometime in the future?
- Do you collect things you may never use or that have no value?
- Do you feel compelled to buy (or get free) things even when you don't need them?
- Do you have little control over your urges?
- Has your collecting compromised any living space?
- Is it difficult to cook, clean or move about your house?
- Do you have unusual emotional attachments to belongings?
- Have you been diagnosed with OCD or other mental health disorder?
- Has your compulsion to hoard affected your work or personal relationships?
- Are things that should be discarded just getting moved from one place to another (churning)?
- Do you have additional storage space outside of the home?
- Are you or your family embarrassed about the clutter?
If you answered "yes" to most of these questions, then it might be time to seek professional help.
Calming the Fears and Clearing the Clutter
Since hoarding behavior is sometimes a symptom of another mental health condition, treatment usually involves measures that work for that specific condition. Treatment regimes for OCD, depression or other mental health conditions, for example, might keep compulsions in check if the behavior is a symptom of that condition. But not all hoarders can be categorized that way and successful treatment of hoarding is notoriously difficult.
Some people will gain better control however, when they combine anti-depressant or anti-anxiety medications with cognitive behavioral therapy (CBT), a method that slowly and systematically retrains the brain to react more appropriately to stressful situations. Over time the sufferer eventually learns that no harm will come to them if they throw something away.
Hoarders can also work with a professional organizer who can offer ways to categorize, store, sort, donate and discard belongings.