What is hoarding?

Origins and Symptoms

The precise cause of hoarding remains elusive. Research has sought to establish a relationship between the disorder and biological and environmental factors. In the fifth edition of the American Psychiatric Association’s
Diagnostic and Statistical Manual of Mental Disorders
(DSM-5), hoarding disorder is categorized along with obsessive-compulsive disorder (OCD)—an anxiety disorder in which obsessions and fears promote compulsive or repetitive behaviors the person feels driven to accommodate. In the past, it was believed that hoarding might be a subset of OCD. However, not every case includes obsession or compulsivity, and anxiety is another prominent characteristic of other hoarding cases.

For a diagnosis of hoarding disorder, the behavior must either cause distress to the individual or impairment in the person's functioning. About 60 percent of hoarders also buy compulsively. Hoarding may be comorbid with OCD, clinical depression, attention-deficit disorder, psychosis, or other disorders; however, these other conditions cannot better explain the behavior for a hoarding disorder diagnosis to be made.

Common denominators among hoarders, though difficult to identify, do exist. Stressful life events and social isolation both appear to be risk factors. Most have problems with decision-making, perfectionism, categorical organization, and risk assessment. Hoarding shows no real response to early life deprivation, and thoughts tend to focus upon loss when the hoarder is forced to discard items, regardless of the item’s objective worth or value. Hoarders may anticipate a need for the item at some unknown point or keep items as memory triggers. Still others acquire items they find exceptional.

Assorted items such as newspapers, magazines, and articles of clothing may line walls in stacks that reach the ceiling, allowing limited access to areas of the house and threatening to collapse upon persons needing access. Hoarded material covers floors, tables, chairs, and beds, obstructing movement in the residence. Also, many hoarders collect items that were purchased years earlier and still remain in the original wrapping.

Effects of Hoarding

Of the millions of persons in the United States who are thought to be hoarders, many began to exhibit signs of the disorder during adolescence. Some come from homes in which a family member engaged in hoarding. However, most family members of hoarders seem to be embarrassed by the conditions produced by hoarding and may even end all communication with the hoarder. Spouses may seek divorces or become hoarders themselves. A hoarder left alone will often continue to hoard until friends, family, neighbors, or local authorities intervene.

Animal hoarding involves keeping more pets than can be properly cared for. Animal waste, decayed food and vermin, nonexistent sanitation procedures, and a deteriorating house lead to long-lasting health problems for animals and human residents. The effects on overcrowded, underfed, medically neglected animals legally constitute animal cruelty. Animals that survive such conditions often require extensive rehabilitation; some animals never recover. Humans face high ammonia levels, insect and rodent infestations, parasitic diseases, and food-related illnesses. More than a third of object hoarders also hoard animals, according to the Anxiety and Depression Association of America.

Treatment

The main goal of treating people who hoard is to change behaviors, including the compulsion to hoard. Oftentimes, this involves changing the relationship a person has with his or her possessions, which is a long, slow process that can involve discarding one item at a time.

Hoarders may benefit from therapists or professional organizers. Also, therapists could, with the hoarder’s help, formulate guidelines for throwing items away. For example, the “two-year rule” suggests that if something has not been used in the past two years, chances are it will never be used and should probably be discarded. Another strategy is to work together to formulate and implement a list of practical questions that the hoarder can ask him- or herself when confronted with the decision of whether to acquire an item.

Cognitive-behavioral therapy (CBT) can also help hoarders become aware of the mental, emotional, and behavioral patterns that encourage hoarding. Hoarders might be urged, for example, to remove magazines and newspapers from the home after a certain period, to sort mail sorted daily (eliminating all junk mail), and to employ filing cabinets items such as bills, tax statements, and other important papers. In cases of comorbid anxiety or clinical depression, medication may reduce the negative feelings associated with discarding. Although hoarding cannot be cured, it can, with behavior modification, medication, and determination, be kept under control.

In cases of animal hoarding, the causes tend to be more serious and, therefore, require more deliberate treatment. Animal hoarders often suffer from dementia, emotional attachment difficulties, and an inability to interpret clearly. Difficult to treat successfully, animal hoarding requires extended psychological care long after the animals have been removed from the home. Also, psychologists recommend the involvement of animal welfare, police, health agencies, friends and family members, and the community in continued follow-up measures to prevent relapses.

Bibliography

Adee, Sally. “Possessed by Possessions.” New Scientist 221.2962 (2014): 44. Academic Search Complete. Web. 28 Oct. 2015.

Arluke, Arnold, and Celeste Killeen. Inside Animal Hoarding: The Case of Barbara Erickson and Her 552 Dogs. Lafayette: Purdue UP, 2009. Print.

Bratiotis, Christiana, Cristina Sorrentino Schmalisch, and Gail Steketee. The Hoarding Handbook: A Guide for Human Service Professionals. New York: Oxford UP, 2011. Print.

Frost, R. O., G. Patronek, and E. Rosenfield. “Comparison of Object and Animal Hoarding.” Depression and Anxiety 28.10 (2011): 885–91. Print.

Jabr, Ferris. “Step Inside the Real World of Compulsive Hoarders.” Scientific American. Nature America, 25 Feb. 2013. Web. 29 Oct. 2015.

Neziroglu, Fugen, Jerome Bubrick, and Jose A. Yaryara-Tobias. Overcoming Compulsive Hoarding: Why You Save and How You Can Stop. Oakland: New Harbinger, 2004. Print.

Steketee, Gail, and Randy Frost. Stuff: Compulsive Hoarding and the Meaning of Things. New York: Mariner, 2011. Print.

Tompkins, Michael A., and Tamara L. Hartl. Digging Out: Helping a Loved One Manage Clutter, Hoarding, and Compulsive Acquisitions. Oakland: New Harbinger, 2009. Print.