Hoarding – When Keeping Possessions Spins Out of Control

Have you heard about the reality show, Hoarders?  

Perhaps you have casually called someone you know a hoarder or thought of yourself as one. People do speak that way. 

“Today, we use the term ‘hoarder’ loosely, in a joking manner. You might say, ‘I’m a hoarder,’ or ‘My cousin is a hoarder.’ But with a true hoarding disorder, the situation has gone beyond being messy,” says Maria Echenique-Lopez, Psy.D., a clinical psychologist at the University of Miami Health System. 

Hoarders save all sorts of things of no apparent worth, and the problem has become extreme. 

Random stuff—clothing, tools, new products that were never opened or used, packaging from used-up products, books, magazines, mail, items purchased as gifts that were never given to anyone, even bags of garbage and soiled cat litter, can all pile-up. 

A hoarder isn’t untidy. 

“For someone with the disorder, the issue reaches a level where it is damaging to them, and they have lost control of many aspects of their daily life,” Dr. Echenique says. Hoarding can threaten health and safety and damage relationships.

This can lead a hoarder to wind up with a lonely, isolated life. 

To a hoarder, a gold watch and an old shoebox may have the same value. “They lose the ability to distinguish because of their persistent, maladaptive need to save things,” Dr. Echenique says. 

The disorder is fairly common, and cases run the gamut from mild to severe. 

Nearly 3% of Americans have a hoarding disorder.

There are higher rates among older people and those with anxiety or depression. 

Often, people with a hoarding disorder don’t recognize that they have a problem, and when they do see a therapist or psychiatrist, it’s a family member who sends or brings them.

Problems pile up alongside your stuff.

Hoarding can entail myriad problems for both the hoarder and the people with whom they are close. 

“Housework may become impossible, and the home can be overrun with vermin,” Dr. Echenique says. 

Papers and other flammable materials can create a fire hazard. Random things on floors lead to falls.

“I’ve had patients who have unintentionally had fires start in their homes because of the excessive accumulation,” Dr. Echenique says. 

For some hoarders, cooking becomes impossible when objects block the stove. Hygiene can suffer when mounds of belongings fill the shower. 

But not all hoarders exhibit the same disarray as their surroundings. Some hoarders appear neat, hold responsible jobs, and function effectively at work. 

Another hallmark of a serious hoarding issue is that the person has intense feelings of anxiety about giving up their things. 

A third sign of hoarding is that the buildup of stuff has reached massive levels. 

In severe cases, the pile-up of objects can reach the point where the person can only navigate through their mountains of things by following narrow tracks or “goat paths” through the rooms.

Meet the infamous Collyer brothers.

In Manhattan, in the 1940s, the Collyer brothers became famous as hoarders who died in their Harlem brownstone, buried under tons of stuff they’d saved for decades. 

They were highly educated. As young men, Homer practiced law, and Langley bought and sold pianos. 

Eventually, Homer had a stroke. Langley became his caregiver. Soon afterward, they both withdrew from the outside world, living as recluses. They amassed tons of jumbled belongings. 

The extent of their hoarding became known when a neighbor contacted the police to report a putrid smell coming from the house. 

It took six police officers to figure out a way through the debris into the living areas. 

Inside, they soon found Homer’s body, dead of heart disease, in a tunnel amidst the trash. After three more weeks spent removing junk mountains, they also found Langley’s corpse. 

Hoarding is most common among older people.

“Hoarding disorder is often seen among people over age 60, researchers has shown,” Dr. Echenique says. 

Part of the reason may be that older people have had more years to acquire material things. 

Also, older folks may feel nostalgic about particular objects. Clothes, books, toys, sporting equipment, and kitchen gadgets may all remind them of people they loved who have died or of children who live far away. 

Loneliness is a big risk factor in hoarding.

Dr. Echenique

According to the American Psychiatric Association, the disorder arises with equal frequency among women and men. It also appears at about the same frequency in different countries and cultures. 

“Hoarding symptoms often arise first in the teenage years. It gets worse with time if left untreated,” Dr. Echenique explained.  

For decades, the field of mental viewed hoarding as one type of obsessive-compulsive disorder, rather than a distinct syndrome.  

Obsessive-compulsive disorder is a common, chronic, long-lasting disorder. 

A person living with it has uncontrollable, reoccurring, obsessive thoughts and/or carries out certain behaviors that they repeat repeatedly. The thoughts are obsessions, and the behaviors are compulsions.

“Today, we approach hoarding as a specific type of illness. The thinking changed because, in recent years, consistent research has shown the impact that hoarding has on people and society,” says Dr. Echenique. Also, research has revealed key differences between OCD and hoarding. 

Hoarding often goes along with types of anxiety disorders or depression. 

A person with a hoarding disorder often has social anxiety disorder, separation anxiety disorders or other mental health problems. The other problem or problems are called “co-occurring disorders.”

“We see a high incidence of anxiety and depression among people who hoard things,” says Dr. Echenique. “People often come to see us because they’re sad or anxious, not because of the hoarding.” 

Hoarding often only emerges as an issue gradually.

“I may ask them, ‘You say you worry too much. What about you?’ As the questions continue, the hoarding may come to light,” she said. 

The person may often report arguing with a spouse. Dr. Echenique may learn that the fights are usually about excess accumulations.

Another common scenario is that the family members either encourage the person who hoards to seek help or come with the person for counseling.  

In the U.S., the mental health field relies upon a book called the Diagnostic and Statistical Manual (DSM). 

Another manual is used more widely in other countries. Professionals use the DSM to figure out what specific illness a person has so that they can then use the most helpful treatments.  

The DSM-V, published in 1994, lists these five criteria for hoarding disorder diagnosis:

• The person has trouble parting with possessions, regardless of their actual value.
• This difficulty stems from the person feeling that they must save the items and that it would be highly distressing for them to discard them.
• The hoarding causes real trouble for the person, perhaps by affecting their relationships or their ability to work. It may make it difficult or impossible for them to maintain a safe home.
• The hoarding isn’t caused by another medical condition, such as a brain injury.
• The symptoms of another mental disorder do not better explain the hoarding. For instance, it’s not a result of low energy due to major depression.

Mental illnesses often occur together, so a person may have one primary diagnosis along with other diagnoses. 

A rating scale helps to assess severity.

“We can assess the presence and the severity of a hoarding disorder by using a survey called the Hoarding Rating Scale,” says Dr. Echenique. “The questions ask about various difficulties the person has, related to their belongings and how they feel about them.” 

The person rates themselves on each of the five dimensions using a scale of zero to eight. Zero means an issue creates no difficulties. Four means it poses a moderate problem. Eight means the case creates severe difficulty. 

Here are the questions:

Because of the clutter or number of possessions, how difficult is it for you to use the rooms in your home? 

1. To what extent do you have difficulty discarding (or recycling, selling, giving away) ordinary things? 
2. To what extent do you currently have a problem with collecting free things or buying more than you need, can use, or can afford? 
3. To what extent do you experience emotional distress because of clutter, difficulty discarding, or problems with buying or acquiring things? 
4.  To what extent do you experience impairment in your life (daily routine, job/school, social activities, family activities, financial difficulties) because of clutter, difficulty discarding, or problems with buying or acquiring things? 

Another tool for diagnosis is called the Clutter Image Rating Scale. 

It consists of three series of visual images. One series shows bedrooms: the other two show kitchens and living rooms. 

The rooms range from orderly to being chockfull of piles reaching the ceiling and hiding all the furniture. 

“People with a hoarding disorder often don’t realize that they have the problem. But when they see the pictures, they can pretty accurately choose the ones that look their own rooms,” Dr. Echenique says,

If you worry that a person’s situation has grown unmanageable, seek help. 

“In some cases, such as the elderly, the person may be considered vulnerable, and your local health department or the department of children and families can help. It is important to speak out to learn what resources are available,” Dr. Echenique says. 

In some cases of extreme hoarding, a person may need to live in a facility with nursing care for their own safety. 

“Try to maintain a positive, supportive relationship with someone who hoards. Remember, they may not see the severity of the issue, and at the time, they may feel as if they have little control over their behavior,” Dr. Echenique says.

Treatment can often help a person who hoards.

“We have effective treatments for hoarding disorder. Cognitive behavioral therapy is one approach that can be very helpful. It changes the person’s perspective about the items,” says Dr. Echenique.

 Cognitive behavioral therapy centers on the idea that mental health problems stem partly from faulty ways of thinking. Therefore, treatment usually involves helping the person to replace those faulty thought patterns with more realistic ones.  

Treatment for hoarding disorder sometimes includes medications too. “The medicines we use are much like the ones used to treat anxiety and depression,” Dr. Echenique says.  

With treatment, a hoarder can learn and practice better ways of coping. They may have fewer symptoms and troubling behaviors and become more secure and effective in their own life.

Too much stuff is an issue for many people.  

Do you wonder how your closets and drawers wound up so packed with stuff you don’t really want or need anymore? Do you wish you could streamline your possessions so that the rooms in your home looked like those spare, airy rooms in decorating magazines and websites? If you do, you have much company. 

Apparently, 84% of American worry about their home not being as tidy or as clean as they would like, and 55 percent of those worriers report that disorder and clutter cause them major stress. Those are the findings of a survey done by the Huffington Post. 

Clutter can interfere with your life in practical ways, causing you to waste hours searching for things you need. It can make it difficult to be calm and present and enjoy your life to the fullest, so it may cause unnecessary stress and frustration.

Learn more about hoarding.

If you want to help a loved one who hoards, the book Digging Out, written by two psychologists, Michael Tompkins and Tamara Hartl, may be useful. 

Perhaps you don’t have a severe hoarding problem but hope to feel more organized and streamlined. If so, you may want to read Reclaim Your Life from Hoarding by Eileen Dacey, a licensed clinical social worker. 

Milly Dawson is a contributing writer for UHealth’s news service.

Tags: Dr. Marisa Echenique-Lopez, hoarding, intense fear, social isolation and loneliness, social phobia, too much stuff