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Compulsive Hoarding

          One of the current popular reality TV programs concerns compulsive hoarders and their attempts to get out from under their possessions. We find it fascinating to see the items with which these people surround themselves. In many cases, the quality of their lives is reduced to such an extent that they live in unsafe conditions, lose their families and/or spouses and even become recluses. They may even end up in jail for hoarding animals or creating conditions so unsanitary that they invite rats and other vermin into the neighborhood. 

            But, why do they do it? Why would someone accumulate so much stuff that he or she wouldn’t be able to live a normal life? Do they know they have a problem? Are they out of control or is it just a lifestyle choice?  And when does collecting become hoarding?

            Not too long ago, the hoarder would have been considered an “eccentric.” We all heard stories about the “cat lady” whose house was overrun by cats. Or perhaps we know someone who had decades worth of old magazines or newspapers piled in the attic or the man who had so much stuff piled up in his garage or shed that he had to build a new one.

            Truth is, almost all of us have more than we need. The hoarder, however, collects so much stuff that his or her life is negatively impacted. He or she may have multiples of the same item or items which are of new use or value. He or she may be unable get rid of duplicates or multiples, be unable to return borrowed items or even resort to stealing to acquire more. 

            Some hoarders come to believe the items they have collected have a high value when they really don’t. Others may recognize that they have accumulated too much stuff, but are so overwhelmed by the task of cleaning it up that they don’t know where to start. Still others may think of their items as collections and will have multiple collections throughout their homes. In any case, they collect so much stuff, it becomes impossible for them to use or enjoy their possessions.

            Some recent studies may indicate that some instances of hoarding are associated with abnormal brain patterns. A study published in the American Journal of Psychiatry suggests that there may be a decrease in activity in the portion of the brain which controls focus and attention. Other studies have shown that lesions in certain parts of the brain caused by injury have in some cases resulted in hoarding behavior. 

            Although hoarding is obviously not normal, the jury is still out as to what causes it. It is a compulsion in that the sufferer cannot control his or her actions, but it lacks the ritualistic character of most obsessive-compulsive behavior. In some cases, hoarding may be associated with compulsive shopping, but not always. In some cases, elderly people who are suffering from dementia may begin hoarding as their mental faculties decrease or change. In other cases, hoarding may be a subconscious expression of fear. The hoarder may reason that he or she must save everything in case of some sort of emergency. Animal hoarders may begin collecting animals out of loneliness, only to have the collecting get out of hand when the animals don’t meet their underlying need for companionship.

            Cognitive Behavioral Therapy (CBT) has shown to be successful in treating hoarding behavior. The therapist works with the hoarder to find the underlying cause of the behavior and any corresponding problems such as obsessive/compulsive disorder, depression, anxiety disorder, dementia or other issues. Getting to the root cause of the problem gives the hoarder a foot-hold for the journey out of it. From there, he or she can begin to learn coping techniques for the underlying problem. 

            Depending on what the underlying cause of the hoarding is, drug therapy can also be helpful.  It is important for the hoarder to work as a team with his or her therapist and a prescribing physician throughout the treatment process. Several types of medications may need to be tried before the appropriate drug is found. The therapist and prescribing physician can help monitor side-effects and effectiveness to assure the best and most timely outcome.

            However, hoarders may need more than regular office visits with a therapist and medication. In many cases, they are so buried in their possessions that they need help getting out from under them. It may be necessary to bring family members into the counseling process, with the patient’s permission, to finally resolve the problem. Even after the hoarder gets over the hurdle of deciding to rid himself of his excess stuff, he will need the help of loving friends or family who understand the problem and can help in a non-judgmental and positive manner.