You might only know about compulsive hoarding from a distance: a newspaper article about a family living in squalor with dozens of animals, or a TV show about people whose homes are crammed with junk. Or your experience with hoarding might be all too close: the family member who keeps stacks of old magazines around, or your own difficulty getting rid of the stuff that is slowly taking over your home.
Hoarding is a serious mental illness that can drastically affect the quality of life for the hoarder and their family members. Surprisingly, we don't understand hoarding as much as we thought we did. There are no easy treatments, and psychiatrists only recently recognized hoarding as a separate disease, not a symptom of another problem. It's difficult to say exactly how prevalent hoarding is, but estimates range from 0.4 percent to as high as 4 or 5 percent [source: Samuels].
To sort out the myths and misconceptions about hoarding from the facts being uncovered by new research, we'll take a close look at hoarding, how to deal with it, what might be causing it and how to recognize it.
Symptoms of Hoarding
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.
- An inability to stop acquiring things or get rid of things. Hoarders often stockpile or buy items that have no immediate use or value, like clothing when it's on sale even though they don't need any and the clothes they buy aren't even the right size for them. Hoarders' homes often are filled with clothes or other items that are still wrapped in plastic or have the store tags on them, having never been used. Hoarders will also hold on to things that don't have any value at all, like stacks of old newspapers, advertisements and junk mail. They can't stop themselves from getting more junk, and they can't force themselves to get rid of the junk they already have. Even thinking about throwing something away causes them severe anxiety.
- The junk is utterly disorganized. A person who stockpiles items but keeps them sorted and stacked on shelves is perhaps a little odd, but doesn't fit the description of a compulsive hoarder. A hoarder's inability to make decisions about what to keep and what to get rid of extends to making choices about sorting and organizing. As a result, the junk forms in piles and stacks that sprawls out of control. The hoarder might remember where certain items are, but there's no organization to the mess.
- The hoarder feels ashamed. This is an important symptom of mental illness. Hoarders compulsively gather junk, then feel guilty and ashamed of their hoarding, which can lead to more hoarding to try and ease the mental anguish they're feeling. It's not unlike an alcoholic whose drinking causes problems in their life, which in turn triggers them to drink more to avoid the pain they've created. This symptom also differentiates hoarders from collectors, even those with enormous collections of seemingly strange items (yes, even your uncle's beer can collection). Collectors are proud of what they've accumulated, and they organize and display their things. Hoarders are never proud of the junk in their homes [source: Hale].
- The junk significantly impacts the hoarder's quality of life. This can take several forms. The junk fills in areas of the house until they're no longer usable for their original functions. Examples include bathtubs filled with stacks of paper, kitchen stoves piled high with broken appliances or entire rooms completely blocked off. Hoarders will carve small paths through rooms out of necessity, but the piles of junk prevent much of the house from being used. It can even become a serious health and safety problem.
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.
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.
- Hoarding only affects older people. Studies have found that hoarding symptoms begin showing up as early as adolescence [source: Ayers]. It's a progressive disease that grows worse over the years, and only the most severe cases tend to get publicized, so the hoarders we most often encounter are older. Recognizing the signs earlier in life could prevent them from getting out of control.
- Hoarders are just lazy. Hoarding is a serious mental illness that drives people to illogical extremes of acquisition and keeping items. It isn't a simple matter of being too lazy to clean up.
- Hoarding is a recent phenomenon. Although TV shows have brought hoarding into the public eye and given it a much higher profile in the last 10 years or so, there are historic reports of hoarding going back centuries. "Dante's Inferno" describes a circle of hell just for hoarders, while the protagonist of the George Eliot novel "Silas Marner," published in 1861, is in many ways a hoarder, along with the character Plyushkin in the 1842 novel "Dead Souls" by Nikolai Gogol. Sigmund Freud and other early 20th century psychologists discussed hoarding behaviors (although they were way off the mark when they tried to explain it) [sources: Arkowitz and Lilienfeld, Herring].
- Hoarders have experienced poverty or deprivation in their past. One of the ways people have tried to explain hoarding behavior is suggesting that it's a response to a period of poverty or lack of material things in their past, such as living through the Great Depression. Research has found that no such connection exists [source: Frost and Gross]. However, there is a connection between hoarding behaviors and past trauma, such as excessive discipline as a child. This suggests that compulsive hoarding may be a form of post-traumatic stress disorder [source: Samuels].
- Hoarding is just a symptom of obsessive-compulsive disorder (OCD). Although the seemingly illogical behavior of compulsive hoarding might look similar to some of the behaviors associated with people who suffer from OCD, recent studies have found that it is a distinct disease, not simply a symptom of another disease. For instance, hoarders don't experience the "intrusive thoughts" that plague OCD sufferers. However, the issue is complicated by the fact that hoarders often have OCD, as well as other mental health problems such as anxiety and depression [source: Duenwald].
- Hoarding can be cured simply by just throwing away all the junk and cleaning the house. There are times when, for health, safety or even legal reasons, an emergency cleanout of a hoarder's home might be unavoidable. A cleanout will not change the underlying mental health problem, however. We asked Lisa Hale, founding director of the Kansas City Center for Anxiety Treatment and an adjunct associate professor at the University of Missouri-Kansas City about ways to deal with a family member's hoarding. "A cleanout or move to a new environment does not resolve the behavior without treatment," she says in an email. "The statistics literally approach the 100 percent mark of hoarding reoccurring unless treatment and/or close environmental oversight is in place."
Underlying Causes of 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.
Treatments for Hoarders
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.
Author's Note: How Hoarding Works
Hoarding is a fascinating disorder to me for a few reasons. First, it's weirdly familiar to us, since it's rooted in natural behaviors we all exhibit. I think everyone at some point feels that strange attraction to material things. Plus, it's a bit unsettling to hear the echo of incredibly distant evolutionary adaptations and recognize in humans the behaviors found on far-off cladistic branches. But it's also incredible to watch our understanding of a disorder change and unfold. As frustrating as it is that we don't understand hoarding enough to cure it, research and the experience of therapists keeps bringing us closer.
- Anderson, SW. "A neural basis for collecting behaviour in humans." Brain, Jan. 2005.
- Arkowitz, Hal and Lilienfeld, Scott. " Hoarding may have evolutionary origins." Salon, Sept. 6, 2013. (Nov. 20, 2017) https://www.salon.com/2013/09/06/hoarding_may_have_evolutionary_origins_partner/
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- Bergstrom, TC. "On the evolution of hoarding, risk-taking, and wealth distribution in nonhuman and human populations." Proceedings of the National Academy of Sciences, July 2014. Nov. 20, 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4113914/
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- Gothelf, D et al. "Obsessive-compulsive disorder in patients with velocardiofacial (22q11 deletion) syndrome." American Journal of Medical Genetics, April 2004.
- Hale, Lisa. Founding Director of the Kansas City Center for Anxiety Treatment. Email interview, Nov. 15, 2017.
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- New York Daily News. "Inside the Collyer brownstone: The story of Harlem's hermits and their hoarding." (Nov. 20, 2017) http://www.nydailynews.com/new-york/collyer-brothers-brownstone-gallery-1.1187698?pmSlide=1.1187676
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- Samuels, J et al. "Significant linkage to compulsive hoarding on chromosome 14 in families with obsessive-compulsive disorder: results from the OCD Collaborative Genetics Study." American Journal of Psychiatry, March 2007. (Nov. 20, 2017) https://www.ncbi.nlm.nih.gov/pubmed/17329475
- Samuels, Jack et al. "Prevalence and Correlates of Hoarding Behavior in a Community-Based Sample." Behavioral Research and Therapy, June 2008. (Nov. 20, 2017) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2483957/