What Am I Going To Do with all This Stuff ~ Fugen Neziroglu, Ph.D

I’ve always had trouble throwing things away. Magazines, newspapers, old clothes… What if I need them one day? I don’t want to risk throwing something out that might be valuable. The large piles of stuff in our house keep growing so it’s difficult to move around and sit or eat together as a family.

My husband is upset and embarrassed, and we get into horrible fights. I’m scared when he threatens to leave me. My children won’t invite friends over, and I feel guilty that the clutter makes them cry. But I get so anxious when I try to throw anything away. I don’t know what’s wrong with me, and I don’t know what to do.

This example is typical of someone who suffers from hoarding. Read on to learn more about the symptoms, effects, and treatment options for hoarding disorder.

Magazines, newspapers, used cups, household supplies, and other trinkets scattered around the house may be commonplace. However, when individuals begin to excessively save such items that only they may see value in, and have difficulty parting with possessions, it may be a sign of hoarding disorder. Individuals with hoarding disorder often experience severe distress at the thought of getting rid of their possessions, thus leading to their homes filling with clutter that disrupts their ability to use living and working spaces. Individuals may engage in hoarding behavior because of sentimental reasons, where they feel that an item is unique, irreplaceable, or serves as a reminder of a cherished memory, or because of instrumental reasons, where they believe that one day the item will be useful. The burdens of hoarding may lead to unhealthy and dangerous living conditions as hoarders are often reluctant to allow people into their homes to fix broken heating systems and appliances. Unlivable conditions such as these can lead to divorce, eviction, or loss of child custody.

The degree of impairment in functioning and well-being in hoarding, like other psychiatric disorders, can range from mild to severe, and can have negative emotional, physical, social, and financial effects. Often individuals with the disorder and their family members experience anger, resentment, and depression.

Hoarding is not the same as collecting, as collectors tend to look for specific items and often organize and display them in well-maintained settings. Collectors also express a sense of pride about their possessions, enthusiastically talk about them, feel satisfied when adding to it, and are able to budget their time and money.

Hoarding is a disorder that may be present on its own or as a symptom of another disorder. Those most often associated with hoarding are obsessive-compulsive personality disorder (OCPD), obsessive-compulsive disorder (OCD), attention-deficit/hyperactivity disorder (ADHD), and depression. Although less often, hoarding may also be associated with an eating disorder, pica (eating non-food materials), Prader-Willi syndrome (a genetic disorder), psychosis, or dementia.

In my experience hoarders suffer tremendously and so do their families who feel the “stuff” are more important than themselves.  Because hoarding develops gradually it is hard to recognize it coming on until it is almost too late.  The person feels overwhelmed and doesn’t know what to do.  Yet there is way to work through the piles gradually, learning to change your relationship to the possessions.  It takes time, a good strategy and commitment to the job.  Once you are ready to learn the method the clutter will disappear.  Just need to gain control over the stuff rather than they over you.

My work in hoarding arouse through my interest in OCD, when a family’s father once came to see me, reporting extreme concern for his children who didn’t have a bed to sleep-on as the home’s condition was in disarray. The father was a prominent man in the community, and was therefore expected to regularly invite guests to his home, which he was however never able to do.  Meeting the children was a terribly saddening story, where I personally learned about their isolation and the conditions in which they were living.  My heart truly went out to the children in these experiences, memories that drove my future pursuits involved in treating and researching hoarding.  Upon meeting the wife who was the hoarder, it was evident that she was very socially presentable and an active member of the community.  If you had met her outside of her home without knowledge of her home’s condition and clutter, you would’ve had no indication that she was a hoarder. This is very typical of most hoarders, and sadly a leading reason which perpetuates the hoarder from receiving treatment.

Due to the hoarders’ attachments to their objects and possessions, it’s very difficult for them to part with them. Unlike many other psychiatric disorders in which there are major functioning impairments, the hoarder may not be as personally affected or functionally impaired.

Although hoarders may be unable to invites others into their home, their conditions may likely not interfere with their abilities to socialize outside their homes and to function in occupational settings.  However, the hoarding condition may cause very lasting and damaging impacts to interpersonal relationships, which inevitably may emotionally or physically harm those around the hoarder, as well as themselves.

Hoarding typically develop over the course of many years, sometimes beginning at a very young age and continuing throughout their life development. Generally, in individuals living alone, the hoarding manifestation tends to develop more quickly and intensely than those living with others.  However, a significant passage of time must generally pass before the hoarder’s condition becomes very severe and impairing.  It is the secretive and insidiously progressive exacerbation of the disorder that prevents those on the outside from recognizing the hoarder’s issues and symptoms, and from facilitating the required intervention for the hoarder.  

When clinical intervention has been facilitated, which is often coordinated by those in the life of the hoarder, cognitive-behavioral therapy (CBT) has been demonstrated with rather good efficacy.  In such cases, it may be appropriate for the therapist to first specifically focus on helping the patient achieve greater insight into their personal situation, symptom severity, and necessity for change. Successful treatment is much more likely to be achieved and continued when the patient maintains awareness into these areas, and seriously engages in their intervention work.

Commonly, many hoarders will comply to seeking therapy in order to avoid eviction or other negative consequences.  Therefore, hoarders who are not determined to develop and exercise coping skills often don’t sufficiently engage in treatment to the point where they achieve long-lasting and sustainable progress, leading them vulnerable to resume hoarding.  When CBT protocol intervention is appropriate, it focuses upon four domains: information processing, emotional attachment to possessions, beliefs about possessions, and behavioral avoidance.  The first domain addresses the patient’s ability to more effectively sort, organize, and make decisions involving their possessions. The therapist will then perform techniques such as cognitive restructuring and exposure therapy in order to challenge the patient’s beliefs over maintaining their possessions and the strong sentimental value placed upon the hoarded belongings.  Furthermore, the therapist will engage the patient into commonly avoided situations intended to provoke anxiety, while allowing for the development of more adaptive coping techniques.

If you have concerns about yourself or a loved one potentially having hoarding symptoms, please acquire resources available in your community or reach out to your primary healthcare professional.