Hoarding: A Compulsive Mental Disorder

Hoarding: A Compulsive Mental DisorderMany of us hang on to treasures and memorabilia from the past, but our homes are not so overwhelmed with clutter that it becomes detrimental to our health and safety, let alone our sanity. Others are not so lucky. For some individuals, hoarding, or the obsessive compulsion to collect anything and everything – has become a danger to themselves and others. Often hoarding co-occurs with substance abuse, including alcohol, nicotine, prescription and illegal street drugs.

What is it?

Hoarding, or, more specifically, compulsive hoarding, is characterized by two parts. The first is the accumulation of things that have little or no value. The second is the inability to part with things that the hoarder has accumulated. Typically, hoarders pile up old newspapers, food cartons, cans, mail, lists, notes, clothes, garbage and other debris. There are also instances of animal hoarding, where an individual collects and houses dozens to hundreds of animals. Hoarding usually begins slowly, but builds over time. As the mountain of items increases, making passage through hallways, bedrooms, bathrooms, garages and other living areas more treacherous, the disorder progresses to a point of nearly no return.

Hoarders cannot, and will not, freely give up their possessions, however inconsequential they are, or how unsafe and unsanitary their environment has become. Without professional help, even if a cleanup crew comes in and removes the debris, clutter and detritus, the hoarder will just start to accumulate again until the problem reaches the same level of impending disaster.

Type of Disorder

Although not officially recognized as a distinct psychological disorder according to DSM-IV classifications, compulsive hoarding disorder is believed to be related to or interconnected with other disorders. These include bipolar disorder, social anxiety, and depression. Some patients who have anorexia nervosa, dementia, schizophrenia or other psychotic disorders may also exhibit signs of compulsive hoarding disorder. When compulsive hoarding disorder is seen in patients, it is most often in conjunction with obsessive-compulsive disorder (OCD) and, to a smaller extent, with attention-deficit-disorder (ADD). Compulsive hoarding disorder also may run in families.

Prevalence of the Disorder

But just how widespread is the disorder and what can be done about it? Hoarding is a serious problem for the individuals involved as well as their family members. It doesn’t discriminate according to age, gender, race, socioeconomic status, religion or any other differentiator. The fact that the elderly have more in the way of accumulation of possessions may only be due to the fact that they’ve had longer to squirrel things away. Some say that compulsive hoarders are mostly single, and that divorce often occurs when one spouse refuses to change. But this may only be speculation, as there are many instances of entire families exhibiting compulsive hoarding disorder, as well as many spouses who both exhibit the compulsion to collect things.

The cable station A&E has been airing a series Hoarders, which shows two case studies per program, each involving hoarders and their spouses/families. The series documents instances of hoarding, chronicling the conditions and the efforts of the hoarders and their families who have agreed to permit the filming in order to have the conditions cleaned up. Indeed, the producers of the show published a casting request on the Internet, looking for individuals willing to tell their stories, who were motivated to change by a crisis that caused by hoarding that required immediate attention, and were non-stereotypical cases. These individuals would need to sign a release, agree to appear on camera for 3 to 5 days, along with family members (who would also need to agree to appear on camera and sign appropriate releases). In return, the individuals would receive free services, such as mental health support, professional organizers, professional cleanup and/or junk removal services. According to the posting, the professionals are all experienced in treating the disorder and possess the training and credentials to do so.

Statistically, there are no good numbers as to the extent of compulsive hoarding. Some experts estimate the number at 1 percent of the population, while others say the disorder, or some variant of it, affects up to 2 million people in the United States. Certainly, when you tally up the affected family members of compulsive hoarders, the numbers increase exponentially.

What Causes Hoarding?

Doctors point to a number of potential causes for hoarding. These include difficulty processing information, beliefs about possessions, and the emotional distress associated with discarding items or possessions.

To the compulsive hoarder, each and every item is of value – often an exaggerated value. They believe, with almost religious fervor, that the old newspaper or tin of long-expired sardines, for example, is very valuable and must be hung onto. Even a pile of scribbled notes or rusted paperclips might come in handy, and these are an integral part of the hoarder’s personality – they have become extensions of the hoarder, and cannot be discarded.

When faced with the prospect or need (as recommended or directed by a counselor working in conjunction with a cleanup crew) to get rid of these treasured and valued possessions, the compulsive hoarder may experience great anxiety or worry. Compulsive hoarders may be embarrassed by the stigma of their disorder, refusing to allow others to view their accumulated clutter. They often lack the ability to or have difficulty with socializing. Eventually, compulsive hoarding may lead to isolation from family, friends, and society.

Personality Traits Associated with Hoarding

Compulsive hoarders may have negative personality traits that include avoidance, anxiety, indecisiveness, perfectionism and poor socialization skills. Researchers have found that the activity levels in the brains of compulsive hoarders differ from that of non-hoarders. Specifically, these activity levels include those involved with attention, decision-making, selection, self-control, self-motivation, and visual processing. For this reason, some experts believe that obsessive-compulsive hoarding may be a distinct variant of obsessive-compulsive disorder.

How to Recognize Obsessive Compulsive Hoarding

Not every obsessive compulsive hoarder will display all the following symptoms or signs that affect emotions, thoughts and/or behavior. A hoarder who shows several of them should be cause for concern.

  • Excessive attachment to possessions
  • Extreme clutter throughout the home’s living spaces
  • Inability to discard items
  • Stacking – of magazines, newspapers, junk
  • Moving items or trash from one pile to another, without ever discarding anything
  • Acquisition of seemingly useless items, including trash
  • Organizational difficulty
  • Perfectionism
  • Difficulty permitting others to touch or move accumulated items
  • Procrastination
  • Trouble making decisions
  • Difficulty managing daily tasks
  • Limited or poor socialization skills

Treatment for Obsessive Compulsive Hoarding

Treatment may be difficult for the obsessive compulsive hoarder. Rooted in their personality traits is an ingrained stubbornness to part with items that they’ve come to see as extensions of themselves. They are often resistant to change, procrastinate or agonize over decisions, and leave items that may have previously been of value to decay or deteriorate to the point where they are, indeed, worthless.

There is no “cure” for obsessive compulsive hoarding, but there are ways to assist the hoarder and help him or her transition effectively to more healthy behaviors.

  • Medications – Antidepressant medications (that increase the levels of serotonin in the brain) have been shown in research studies to effect improvement in some compulsive hoarders. According to the Mayo Clinic, selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant, is most commonly used to treat hording. Research involving paroxetine (Paxil), an SSRI, has shown it may improve hoarding symptoms as well as other OCD symptoms. Other hoarders, however, do not respond well to such medications – or, at least not as well as individuals with other kinds of obsessive-compulsive symptoms.
  • Cognitive-Behavioral Therapy – Medication alone cannot hope to get at the underlying behavior. For this, cognitive-behavioral therapy (CBT) may be more effective. CBT is more than just talk therapy. It goes beyond talk with the therapist often visiting the hoarder’s home and helping them to think more clearly about their possessions and learn to make decisions about them. This is the case with the Hoarders program on A&E.

CBT helps patients to:

  • Gradually confront things they fear in order to feel less afraid
  • Learn healthier ways to cope with stressful situations
  • Become aware of and subsequently change how they think in critical situations

Individual and group therapy sessions are available. In addition, intensive daily outpatient therapy may be recommended for certain individuals. Free treatment may be available for persons who participate in clinical research projects. The Institute of Living at The Hartford Hospital in Connecticut is currently conducting three clinical research studies on compulsive hoarding at the Anxiety Disorders Center. One is a comparative study of compulsive hoarding to obsessive-compulsive disorder. Another is a neuropsychology study that seeks to examine cognitive functioning in compulsive hoarders. The third study seeks to understand the functioning of the brain in compulsive hoarding, using brain scans. According to the website, all the study participants are compensated for their time and effort.

A helpful resource on the subject is the paperback book Buried in Treasures: Help for Compulsive Acquiring, Saving and Hoarding by David F. Tolin, Randy O. Frost, and Gail Steketee. The book contains a self-assessment to determine the severity of the problem; tips and tools for organizing possessions and filing paperwork; strategies for changing unhealthful beliefs about possessions, and behavioral experiments to reduce the fear of anxiety and the fear of discarding possessions. David F. Tolin, Ph.D., is the founder and director of the Anxiety Disorders Center at The Institute of Living.

What to Do About Your Loved One’s Hoarding

Experts say that as long as your loved one is competent mentally, capable of making his or her decisions, there isn’t much you can do other than recommend counseling. Your loved one has the right to hoard, despite the fact that there may be long-term negative consequences as a result.

Show empathy for the individual and respect their right to make their own decisions. Recognize that your loved one may show ambivalence toward making any changes. This is normal. Also recognize that there cannot be any change until the individual is ready to make the change.

Here are some other tips:

  • Do not argue. – There’s no point in raising your voice, arguing over how self-destructive the hoarding behavior is. Your arguments will likely fall on deaf ears. Likewise, do not engage in any back and forth bickering over hoarding. The best recommendation is to get out of the argument.
  • Respect freedom of choice. – You need to respect the individual’s autonomy, their freedom of choice to do as they will in their own home. A better strategy is to engage the person in a discussion about what they would like to see done in their home, what kind of changes they would be willing to or like to make. Ask for their suggestions in how best to proceed. This technique is likely to produce better results than demands or ultimatums to clean up the mess.
  • Helping with gentle recognition of inconsistencies. – This is a little more difficult to manage. The idea is to help your loved one (or friend) recognize the inconsistency of their action with their stated desire to change. If they say they want to clean up the clutter, but refuse to do so, this is an obvious inconsistency. But you can’t reprimand the person for failure to address the situation. That will only cause them to entrench deeper. Inquire about long-term goals and values versus today’s situation. In other words, ask but don’t tell. If your loved one says he or she wants to be a loved and respected grandparent 5 to 10 years from now, ask whether his or her current habits of accumulating or difficulty in discarding items will be an effective way of achieving that goal? Or, is there something else that can be done?
  • Strive for gradual change. – Obsessive compulsive hoarding proceeds slowly over time. It may take quite some time for change to occur as well. First, the individual has to want to change, and professional counseling may be the most effective way to get at that desire. But ongoing counseling will be required in order to sustain the motivation to change and get at the roots of the cause for the hoarding. In dealing with the obsessive compulsive hoarder, then, it will be more beneficial to all concerned if you strive for gradual change. If you’ve been used to arguing, threatening, and blaming your loved one for the situation, backing off and changing your attitude toward one of empathy, respect, and helping in whatever way possible may reap unexpected rewards. At first, your loved one may be suspicious, since this is something new in your relationship. Gradually, they may soften their resistance a bit. Certainly, discussions will become easier and possibly more productive. Trust is what you’re looking for, and striking a balance between give and take.

If You Are a Hoarder

Hoarders are not all mental incompetents. A hoarder can just as easily be you or me. We may have grown accustomed to stashing things away over the years to the point where even we can’t stand the mess. The point is not to beat yourself up over your hoarding, but to get help to learn more effective ways of managing your situation.

Research the subject. Inquire about counseling that may be available, at low cost or free (if you participate in clinical research studies). Talk with your doctor or mental health provider. Some communities have agencies that help with hoarding problems. Local or county government may also have resources for hoarding.

Read up on hoarding. Sign up for a newsletter from the Anxiety Disorder Center. Experts recommend the No Matter What Rule. This is the practice that you do something every day for at least 10 minutes to help clean up your clutter – regardless of how you feel. You can gradually increase that time to a half hour or more. Eventually, you’ll be able to see that you are making progress.

Above all, don’t give up. Seek the help you need, both to de-clutter your home and help gain the skills you need to live a healthier lifestyle. Even if you have years of accumulated stuff, it’s never too late to start the process to change your life.

Hoarding Cleanup Companies

Mountains of clutter may require more effort than one person (the hoarder) and his or her family can muster. Just looking at the immense mess is enough to depress most people. There is help in the form of hoarding cleanup companies. Look for a hoarding cleanup company that carries all the right types of insurance, including general liability insurance, workers compensation, automobile insurance, and make sure that the company is bonded.

One company, Hoarding Cleanup, has a nationwide network of providers.

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