How Hoarding Works

You might have a messy house, a room that's got too much junk in it or maybe an attic you haven't organized in years. Does that mean you're a hoarder? No. Compulsive hoarding is a mental health problem that makes it difficult for people to make decisions about material possessions. There are four main symptoms that signify compulsive hoarding.

Hoarders have actually died from being crushed by their stuff. Hoarding also affects the hoarder's social life. They realize they can't bring friends into their homes, and they may be reluctant to leave their homes because of anxiety that someone will rearrange or throw away their possessions while they're gone. Hoarding can also impact finances in a variety of ways (for instance, the hoarder can only eat expensive takeout food because they can no longer use the kitchen to cook meals). Other personal relationships, including the hoarder's marriage, can also be strongly affected by the disorder [source: Arkowitz and Lilienfeld].

You might think you already know a lot about hoarding, but our thinking about compulsive hoarding has changed a lot in the last few years. Let's look at some of the myths about hoarding.

As we learn more about compulsive hoarding, we're finding out some of what we thought we knew isn't true. Here are some common myths about hoarding.

There's still a lot we don't know about compulsive hoarding, including what causes it. Hoarding's classification as its own disease is a relatively recent event — it was first labeled a separate disease in 2013 in the 5th edition of the "Diagnostic and Statistical Manual of Mental Disorders," the guide used by medical and psychiatric professionals (and insurance companies) to diagnose mental health problems. This classification could attract research funding and also help compulsive hoarders get treatment covered by their health insurance.

"As research developed we found many characteristics of hoarding behaviors that suggested it was really a separate condition, both in the presentation of symptoms and poor response to treatments known to work well for OCD," Hale says. "The current line of thinking from the research is that hoarding is a neuropsychiatric condition linked to processing challenges — trouble with the connections and functionality of emotional, visual, and organizational areas of the brain."

Each study into hoarding gives us another clue as to the underlying cause. Hoarding probably has a genetic component, since research has found that hoarding behavior is part of other illnesses that are definitely known to be genetic, and compulsive hoarders are likely to have family members who are also compulsive hoarders [source: Gothelf]. There are even correlations between hoarding and certain chromosome defects [source: Samuels]. Another study found that a certain type of brain lesion seemed to account for the onset of compulsive hoarding in some subjects [source: Anderson].

Hoarding seems to be the result of some kind of short circuit of a normal human behavior. We all attach value and meaning to material items and derive a sense of security from them. Compulsive hoarding is this same behavior gone completely out of control. There's an evolutionary reason that we tend to acquire things and want to keep them, which can be expressed mathematically (the cost of acquiring the items weighed against the cost of not acquiring them).

The non-math version is this: Imagine that an animal can either save enough food to last through a short winter or enough to last through a long winter. Gathering the extra food for a long winter carries additional risk, so short winter animals have a greater chance of surviving. However, eventually there will be a long winter, which will kill off all the animals who only had enough food for a short winter. The "save up for a long winter" evolutionary trait, therefore, will be passed on to future generations [source: Bergstrom].

There are more complicated versions of the scenario (such as a genetic trait that causes long or short winter strategies to occur randomly in the same animal from year to year), but the bottom line is that long-term acquisition and saving strategies tend to have greater evolutionary success, and humans have received that trait from countless generations of our mammalian ancestors. In some humans, the trait goes haywire.

There isn't a simple, effective treatment for compulsive hoarding. There aren't any drugs that specifically target and reduce hoarding behaviors. However, hoarding often appears alongside other mental health disorders like depression, anxiety or OCD, and treating those illnesses with medications can be one way to help manage hoarding [source: Hale].

Effectively fighting compulsive hoarding requires a team effort that includes the hoarder and their family. Psychotherapy, or talk therapy, is a primary form of treatment for hoarding. The best course of talk therapy treatment is known as cognitive behavioral therapy (CBT). It works to modify the cycles of thought and behavior that are causing the hoarder to have problems. The CBT needs to be adapted specifically for hoarding, and the treatment course can take from six months to a year. Medications can also be added, particularly if the hoarder also has anxiety or depression.

"In order to help control the professional costs of therapy, and better promote development of the types of environmental supports that can keep up skills use after the active treatment stage, we include behavioral family therapy/coaching and also often involve a professional organizer who is familiar with hoarding," Hale says.

One element of the therapy involves the hoarder learning to identify and challenge his thoughts about buying and saving things, as well as practicing getting rid of them. This can move on to learning how to organize things, and getting help on deciding which things to get rid of before, hopefully progressing to successfully clearing out and completely decluttering large amounts of the hoard.

Focusing on the benefits clearing out the hoard will hopefully change the hoarder's thought patterns, decision-making and coping skills. For example, instead of worrying about needing a stockpile of clothing someday and what might happen if they don't have the clothing, hoarders can instead focus on using the cleared room to grow plants or invite friends over to play cards. Breaking down these barriers can reduce their isolation and increase social involvement.

Even with a full course of treatment, compulsive hoarding has a tendency to reoccur, especially without ongoing support from family members and during times of stress. It's a difficult and insidious mental health problem to treat, so maintaining ongoing treatment is critical.