Compulsive hoarding

Collectors gather many of the same types of objects together - a box filled with seaside shells, a jar of mismatched buttons, or an album of rare coins. Many of us squirrel away treasured mementoes, while the "packrats" among us hold on to trash or useless, outdated things for longer than we need them. But for compulsive hoarders the line between treasure and trash becomes hazy. A flurry of new research is revealing new insight into this poorly understood compulsive behaviour. Ultimately, it could be the very decision of "What is treasure and what is trash?" that lies at the heart of the behaviour.

Lifting the lid on a hidden compulsion
When Oprah Winfrey aired an episode of her show focusing on the hidden life of hoarders, viewers were aghast at what they saw: people being literally buried alive by their possessions. Men and women with hoarding behaviours live in homes that are beyond cluttered. One room overflows into the next, and every nook, cranny, and crevice becomes stuffed with stuff: avalanches of newspapers, documents, and junk mail, free giveaways and objects bought at garage sales, piles of clothes never worn. More and more things are bought or brought into the home, and very little if anything is ever thrown away.

All of this stuff can create real danger. Aside from the obvious fire hazards, parts of the home crucial to daily living - the bed, the bath, the kitchen - become blocked by the flood of stuff. As a result, people living in the home can't do the things they need to do to stay healthy, like get a good night's sleep, bathe properly, or cook nutritious meals.

People living amidst the mess may isolate themselves from friends and family. Surveys of self-identified hoarders reveal that they're more likely to be overweight or obese and to have chronic or serious medical problems. Many have been threatened with eviction or had children or elder relatives removed from their homes because of the unsafe conditions of their homes. How does someone get to this point where the things they own, own them?

Is it OCD?
Hoarding is currently not considered a medical disease. Hoarding is currently classified as a symptom or sub-type of obsessive compulsive disorder (OCD). OCD is an anxiety disorder in which a person obsesses about a particular worry, such as recurring doubts or fear of contamination or loss. The person also has compulsions (or urges) to do something that will relieve the uneasiness caused by the obsession. Hoarding is thought to be rooted in a fear of loss, and can be found in people who have experienced some profound loss, like death of a loved one, divorce, or loss of home in fire or disaster.

In this theory of hoarding, then, a person obsesses over a fear of loss by acquiring more and more and more. Other risk factors that researchers believe may cause hoarding include being a perfectionist, being socially isolated, family history, and having an intense attachment to possessions. Hoarders believe the items they collect will have value or be needed in the future and they worry about not having these items on hand.

New hoarding research raises doubts about the OCD connection. This research suggests that compulsive hoarding is a separate clinical syndrome with its own distinct characteristics. People who compulsively hoard will likely:

struggle with the decision to throw away items
feel strong urges to save items
buy or acquire many more items than they'd ever need
procrastinate or avoid tasks
be indecisive, perfectionist, disorganized
Hoarding also has a strong genetic component. You're more likely to compulsively hoard if a close family member does.

Whether or not a person has OCD may impact the way that compulsive hoarding is treated. Some people may be hoarders without having other obsessive tendencies. Not everyone who is diagnosed with OCD is a hoarder. And though some people with OCD do display hoarding behaviours, their behaviour tends to be different from that of a typical hoarder. For example, they're more likely to collect bizarre items or feel the need to perform compulsions related to the items they hoard, like checking to make sure items are still there or going through certain rituals before discarding any item.

If it's not OCD, what is it?
Compulsive hoarding has only recently been recognized as a problem. Though it is not yet considered a distinct disorder from OCD, much research is being conducted to try to better understand what goes on in the brain of someone with these behaviours.

In one study, 30 hoarders and 30 non-hoarders were tested to measure the ways they processed information. Compared to the other group, hoarders were found to be less attentive and more impulsive - but slower to react.

In another study, 12 people with compulsive hoarding behaviours and 12 without were asked to make decisions about whether to keep or discard certain items. As the test subjects sifted through personal junk mail and other random items that the researchers had provided to them, MRI scans were run on their brain activity.

When the hoarders wrestled with the decisions about their personal items, their MRI showed much more activity in the areas of the brain that regulate decision-making, attention, and controlling emotions. Their choices appeared to be much more complicated than the ones made by the non-hoarders.

The lead researcher in that study, Dr. David Tolin of the Anxiety Disorder Center at Hartford Hospital's Institute of Living, has done extensive investigations into the mysteries of hoarding. He notes that hoarding often happens because of one or more of these problems dealing with personal possessions: disorganization, very strong emotional attachments to items, anxiety over discarding items, trouble deciding what to do with possessions, or worrying about forgetting things.

So for someone who hoards, the choices about what items to buy, where to put them, how much they'll be used, and other everyday decisions about "stuff" become challenging to the point of being impossible to make. Instead of making choices, they keep it all and run out of places to put it all.

Lightening the load of compulsive hoarding
If you recognize the symptoms and characteristics in yourself or someone you love, there are steps you can take. Treatment options exist that can help to alleviate symptoms and guide a person toward a more normal, healthy life. The effectiveness of treatment will depend on whether hoarding is a unique syndrome or a symptom of OCD. Search for therapists in your community, especially those who practice cognitive-behavioural therapy.

Remember that personal hygiene and nutrition are crucial. Try to keep your kitchen, bathroom, and bedroom as clutter-free as possible so that you have daily, easy access to the tools you need to stay as healthy as possible. If your kitchen is unreachable, seek out community meal support programs until you can get help clearing it out for use. Above all else, try to focus on your goal of living a healthier and more enjoyable life.