And The Meaning of Things
In May 26, 2010 Fire crews investigating a mysterious smell uncovered a severe case of hoarding when they found an elderly couple buried alive under mounds of garbage in their Chicago home.
Seems unbelievable, but about 2 million Americans suffer from a disorder called compulsive hoarding. This can be a part of obsessive compulsive disorder and other anxiety disorders.
So how can a professional help clients know when collecting or being a harmless pack rat becomes hoarding and is interfering with their life, career and relationships? This course will explore the definition, types of hoarding, symptoms, complications, and treatment options.
Everyone collects paperwork they are worried about throwing out, not that they could find it if they needed it, but hoarding goes much farther than a magazine that has some good recipes in it or an article that lists tax tips. Saving stuff, in moderation, is usually considered normal. But this otherwise healthy impulse can go too far and develop into what some experts consider a clinical obsessive-compulsive disorder. Compulsive hoarding can’t be chalked up to eccentricity or a character flaw. It’s more serious and harder to control than that. “This is not laziness, criminal negligence or failure to attend to the responsibilities of life,” explains Sanjaya Saxena, MD, director of the Obsessive-Compulsive Disorders Program at the University of California, San Diego. “It is, in fact, a neuropsychiatric disorder that will not get better unless the person is treated.”
And it can lead to tragic consequences. One of the most famous cases involved the wealthy and reclusive Collyer brothers. In 1947, their bodies were discovered in a crumbling New York City mansion packed with more than 100 tons of junk. In 2009, a resident of Shelton, Washington, was smothered when a massive pile of clothes toppled on her. And a few fatal fires have even made headlines. Hoarders tend to fill their homes with flammable material and often block hallways and exits in the process, which can make escaping a fire impossible.
Hoarding can affect people of all ages and backgrounds. As many as three million to six million Americans may be afflicted at some level, and hoarding often requires extensive treatment. But many deny that they have too much stuff or that the clutter is a problem. And even those who seek treatment can’t always find or afford the currently recommended approach: cognitive-behavioral therapy (sometimes paired with medication) from a specialist.
And it’s a myth that hoarders keep only junk. Like the rest of us, they may save things that are beautiful, useful or have sentimental value, say national experts Gail Steketee, PhD, professor and acting dean at the School of Social Work at Boston University, and Randy O. Frost, PhD, a psychologist at Smith College. The difference is that hoarders often find beauty, utility and meaning where others don’t, and some find it in everything.
Most people, for example, can recycle an old newspaper without a second thought. But a hoarder who saves old newspapers may see an archive of valuable, potentially life-changing information. From that perspective, discarding a newspaper is wasteful, foolish, perhaps even a personal failure. And so this clinical disorder transforms the everyday act of throwing away an object into a deeply wrenching, personal violation. Organization is also a nightmare. Steketee and Frost say that compulsive hoarders usually have trouble categorizing items, find it difficult to make decisions, and worry that objects not in sight will be forgotten. They might leave clothes on top of a bureau, for example, instead of putting them in drawers. Over time, a few items piled here and there grow into mountains of dangerous clutter.
How dangerous? The dust, mildew, mold and rodent droppings commonly found in extreme clutter can irritate allergies or lead to headaches or respiratory problems like asthma for hoarders and their families. In some cases, home maintenance suffers, so individuals may endure freezing winters without heat and sweltering summers with no air conditioning. Clutter also places hoarders and their families, especially the elderly, at high risk of injuring themselves in a fall.
Extreme hoarding endangers not only the residents but also neighbors and firefighters, who face greater risk of injury and death when battling clutter-fed flames. It can become a financial threat to communities as well. Making a hoarder’s home safe and habitable can be staggeringly expensive, and hoarders can’t always pick up that tab. One year, the health department of a small town spent approximately 75 percent of the community’s entire budget on cleaning out a hoarder’s home, according to Frost. A mere 18 months later, “the home was back the way it was before.”
Hoarding is the excessive collection of items, along with the inability to discard them. Hoarding often creates such cramped living conditions that homes may be filled to capacity, with only narrow pathways winding through stacks of clutter. Some people also collect animals, keeping dozens or hundreds of pets in unsanitary conditions.
Hoarding, also called compulsive hoarding and compulsive hoarding syndrome, can be a symptom of obsessive-compulsive disorder (OCD). But many people who hoard don’t have other OCD-related symptoms, and researchers are working to better understand hoarding as a distinct mental health problem.
People who hoard often don’t see it as a problem, making treatment challenging. But intensive treatment can help people who hoard understand their compulsions and live a safer, more enjoyable life.
In the homes of people who engage in compulsive hoarding, countertops, sinks, stoves, desks, stairways and virtually all other surfaces are usually stacked with stuff. And when there’s no more room inside, the clutter may spread to the garage, vehicles and yard.
Hoarding affects emotions, thoughts and behavior. Signs and symptoms of hoarding may include:
- Cluttered living spaces
- Inability to discard items
- Keeping stacks of newspapers, magazines or junk mail
- Moving items from one pile to another, without discarding anything
- Acquiring unneeded or seemingly useless items, including trash
- Difficulty managing daily activities, including procrastination and trouble making decisions
- Difficulty organizing items
- Excessive attachment to possessions, and discomfort letting others touch or borrow possessions
- Limited or no social interactions
People who engage in hoarding typically collect items because they believe these items will be needed or have value in the future. A person also may hoard items that he or she feels have important emotional significance serving as a reminder of happier times, for example, or representing beloved people or pets. People who hoard may report feeling safer when surrounded by the things they collect.
People who hoard animals may collect dozens or even hundreds of pets. They usually hoard animals that can be confined inside and concealed more easily. Because of their sheer numbers, these animals often aren’t cared for properly. Veterinarians may be the first to notice signs of animal hoarding when owners seek help for a steady stream of sick or injured pets.
Hoarding ranges from mild to severe. In some cases, hoarding may not have much effect on your life, while in other cases it affects you on a daily basis.
Clutter and difficulty discarding things are usually the first symptoms of hoarding. These early indications of a problem usually surface during the teenage years. As an affected person grows older, he or she typically starts acquiring things for which there is no need or space. By middle age when the condition is usually diagnosed symptoms are often severe and difficult to treat.
If you or a loved one has symptoms of hoarding, talk with a doctor or mental health provider as soon as possible. Some communities have agencies that help with hoarding problems. Check with your local or county government for resources in your area.
As hard as it might be, you may also need to contact local authorities, such as police, fire, public health or animal welfare agencies, especially when health or safety is at stake.
It’s not clear what causes hoarding. Some researchers believe that hoarding occurs on a continuum some people may simply be considered harmless pack rats, while others have a much more severe form of collecting that is life-threatening. The condition is more likely to affect those with a family history of hoarding, so genetics and upbringing are likely among the triggering factors.
Hoarding is currently considered a subtype of obsessive-compulsive disorder (OCD), but this classification is under debate. Many mental health researchers argue that, while some people with OCD have hoarding behavior, hoarding is not specific to OCD. In fact, one study found that hoarding was no more likely to be associated with OCD than with other anxiety disorders.
Ongoing research is aimed at understanding the biological and environmental factors that seem to play a role in hoarding. The findings from these studies may lead to the classification of hoarding as a new and separate mental health disorder.
Hoarding can affect anyone, regardless of age, sex or economic status. It’s not clear how common hoarding is, though. That’s partly because researchers have only recently begun to study it and partly because some people never seek treatment.
Here are some risk factors and features about hoarding that researchers have come to understand:
- Age. Hoarding usually starts in early adolescence, around age 12, and it tends to get worse with age.
- Family history. People are more likely to hoard if they have close family members who engage in compulsive hoarding.
- Stressful life events. Some people develop hoarding after experiencing a stressful life event that they had difficulty coping with, such as the death of a loved one, divorce, eviction or losing possessions in a fire.
- Social isolation. People who hoard are typically socially withdrawn and isolated. In many cases, the hoarding leads to social isolation. But, on the other hand, some people may turn to the comfort of hoarding because they’re lonely.
- Perfectionism. People who compulsively hoard are often perfectionists. They worry about making the right decision about what to do with each possession should they keep it or discard it? Trying to decide causes distress, so they avoid making a decision and simply keep everything.
Hoarding can cause a variety of complications, including:
- Unsanitary conditions that pose a risk to health
- An inability to perform daily tasks, such as bathing or cooking
- Poor work performance
- Loneliness and social isolation
- A fire hazard
Family members often feel angry and resentful about a hoarder’s seemingly inexplicable behavior. They also feel trapped. Forcible cleanups are risky, but so is honoring a hoarder’s wishes to be left alone.
“The constant refrain we hear from professionals is ‘If they aren’t a danger to others, then they have a right to live how they want,’ ” says Donna Austin, who founded the Children of Hoarders online support group (childrenofhoarders.com). “When an aging parent runs the daily risk of slipping on glossy magazines on the floor and breaking a hip, or lives in an extreme fire hazard, it’s not so easy to stand by and do nothing.”
Hoarders and their families pay a toll for interventions. “Whichever family members carry the stick are going to pay for that in terms of the relationship,” she says.
Clearing a clutter-ridden home is so stressful that family members are often tempted to simply trash everything, which adds to the hoarder’s distress. Experienced organizers, while they can’t treat the problem, can help preserve family relationships and do more than fill dumpsters.
Tests and Diagnosis
Hoarding isn’t yet considered an official, distinct disorder. However, it can be diagnosed as a subtype or symptom of obsessive-compulsive disorder or obsessive-compulsive personality disorder.
To help diagnose obsessive-compulsive disorder, mental health providers perform a thorough psychological evaluation. They ask many questions about obsessions, compulsions and emotional well-being and may also ask permission to talk with relatives and friends of the individual.
A professional may ask a client:
1. Do you like the feeling of acquiring things
– no matter if they are expensive or free — and do you have difficulty discarding objects no longer of use to you, objects that others may throw away easily?
Acquisition of a large number of possessions that others would consider useless, along with an inability to discard them
2. Are your living or working spaces so cluttered that it’s difficult to find things or to use the spaces for their intended purposes?
-Having an overly cluttered home or living spaces so cluttered that living spaces can’t be used as intended, such as not being able to sleep in your bed, take a bath in your tub, or prepare food in your kitchen
3. Is your “collecting” of objects interfering with everyday functioning or your relationships, causing your loved ones distress?
-Having significant distress over your hoarding or an impaired ability to accomplish your daily activities.
Treatment of hoarding is often a challenge that meets with mixed success. For one thing, many people who hoard don’t recognize the negative impact of hoarding on their lives or don’t believe they need treatment. This is especially true if their possessions or animals offer comfort. And people whose animals are taken away will often quickly collect more to help fulfill emotional needs.
Treatment of hoarding is also difficult because researchers aren’t yet sure which treatment is best. Try to find a therapist or other mental health provider who has experience in treating hoarding. While therapy can be intense and time-consuming, perhaps taking many months or even years, it can pay off in the long run.
There are two main types of treatment for hoarding psychotherapy and medications.
Cognitive behavior therapy is the most common form of psychotherapy used to treat hoarding. As part of cognitive behavior therapy the client may:
- Explore why they feel compelled to hoard
- Learn to organize and categorize possessions to help them decide which ones to discard
- Improve their decision-making skills
- Declutter their home during in-home visits by a therapist or professional organizer
- Learn and practice relaxation skills
- Attend family or group therapy
- Be encouraged to consider psychiatric hospitalization if their hoarding is severe
- Have periodic visits or ongoing treatment to help them keep up healthy habits
Research continues on the most effective ways to use medications in the treatment of hoarding. The medications most commonly used for hoarding are selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant.
These medications often work well for obsessive-compulsive disorder. However, studies of SSRIs as a treatment for hoarding symptoms have produced varied results. Although some research suggests that people with hoarding symptoms are less likely to respond to SSRIs, other research has found that the SSRI drug paroxetine (Paxil) may improve hoarding symptoms, as well as other symptoms associated with OCD.
Because little is understood about what causes hoarding, there’s no known way to prevent it. However, as with many mental conditions, getting treatment at the first sign of a problem may help prevent hoarding from becoming severe and impairing your life.
Hoarding can cause many difficulties in treatment and self-care, especially for people who don’t feel that hoarding is a problem in their lives. Whether or not they believe they need treatment for hoarding, here are some steps they can take to try to care for themselves:
- Stick to your treatment plan if you’re receiving treatment. It’s hard work, and it’s normal to have some setbacks over time. But treatment can help you feel better about yourself and understand what’s driving your hoarding.
- Try to keep up personal hygiene and bathing. If you have possessions piled in your tub or shower, resolve to move them so that you can bathe.
- Make sure you’re getting proper nutrition. If you can’t use your stove or reach your refrigerator, you may not be eating properly. Try to clear those areas so that you can prepare nutritious meals.
- Reach out to others. Hoarding can lead to isolation and loneliness, which in turn can lead to more hoarding. If you don’t want visitors in your house, try to get out to see friends and family.
- Look out for yourself. Remind yourself that you don’t have to live in squalor and chaos that you deserve better.
- Take small steps. If you feel overwhelmed by the volume of your possessions and the decluttering task that lies ahead, remember that you can take small steps. With a professional’s help, you can tackle one area at a time. Small wins like this can lead to big wins.
- Focus on your goals. To keep motivated to declutter, focus on your goals living a healthier and more enjoyable life.
- Do what’s best for your pets. If the number of pets you have has grown beyond your ability to care for them properly, remind yourself that you aren’t doing them any favors. They also deserve to live healthy and happy lives, and that’s not possible if you can’t provide them with proper nutrition, sanitation and veterinary care.
Profile of a Hoarder
Hoarders may be viewed as unkempt, uncaring slobs. Not the case. Some of the traits may be surprising:
An urge to acquire– Some hoarders may be shoppers; others masters of finding freebies or near-freebies, from coupons to garage-sale bargains. For some, the “stuff” gives them comfort. Others may form emotional attachments to the items.
Perfectionism–“It doesn’t seem to fit at first,” Frost says. But consider the thinking pattern of a typical hoarder: When faced with a pile of stuff, the first thought in deciding to clear it out, Frost says, is often this: “If I throw this away, I might be making a mistake.” Saxena agrees, saying that hoarders often tell him: “I can’t do any task unless I do it perfectly.” Faced with towering stacks of newspapers, for instance, they think there is no way they can do an outstanding job — so they don’t even start.
Indecision and avoidance– Hoarders also tend to have trouble making decisions — to throw it out or not? — and so the clutter accumulates. Suppose an empty shoe box is found in the midst of closet cleaning. A non-hoarder may dump it without thinking twice, reasoning that the shoes, if they even still have them, are on a shoe rack or on the closet floor. But Frost finds a hoarder’s thinking process often is different. A hoarder might think: “But it could hold something else. Maybe I should save it for bills.” Then indecision may creep in. “Maybe my bills won’t fit,” the hoarder may think. More indecision. “My cousin does a lot of eBay business and he needs boxes, so I better save it.” Saxena says, “Saving stuff is an avoidance behavior. You don’t need to decide whether to throw it away.”
A sense of responsibility– Some hoarders loathe to waste anything and feel guilty about throwing things away. They feel like a bad person, they often tell Frost, if they are wasteful. For others, a sense of responsibility can keep them in cluttered surroundings.
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