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Hoarding Behavior: Anxious Response or Lazy Lifestyle?

Many broken and useless items are cluttered together, piled up along a wall.
 

If you’ve done any channel surfing at all in the last year or so, you might have come across a couple of documentary shows (Hoarders on A&E; Hoarding, Buried Alive on TLC) featuring people who are living with massive amounts of clutter and/or trash in their homes. The piles of “stuff” often reach to the ceilings, and there is barely space to stand, much less walk across a room. The programs show professional organizers and psychotherapists working with people to clean out their homes. If you’ve seen either of these shows, then you know what I mean when I say it’s something you don’t forget easily. Although the people being featured on the shows are treated with respect and compassion, the images are shocking and disturbing. How does this happen? Why do people do this? Can they be helped?

Contrary to what you might think, people experiencing compulsive hoarding are not just being lazy or careless. They are experiencing an anxiety related condition; although, there is disagreement in the medical/psychiatric community as to whether hoarding is its own issue, or that compulsive hoarding is a subtype of obsessive compulsive disorder (OCD). Although many people experiencing OCD also exhibit hoarding behavior, not all people experiencing OCD also hoard, and many people who hoard have no other symptoms of OCD.

People who compulsively hoard do experience excessive extreme anxiety, doubting, checking, and reassurance seeking before discarding items, which does suggest a close relationship to OCD. However, recent research suggests that compulsive hoarding may also be associated with a range of other psychiatric conditions, in addition to OCD. Compulsive hoarding behavior has been reported in disorders including schizophrenia, social phobia, eating disorders, depression, and dementia. In studies of the brain, researchers compared neurochemical activity and patterns of blood flow in the brain of people who compulsively hoard and people who experience OCD who did not hoard. They found that the neurochemical activity and blood flow patterns in people who hoard were different than those in people with OCD, suggesting that compulsive hoarding is a separate symptom/condition from OCD.

Many, if not most, people have a certain amount of clutter in at least one part of their homes. Where is the line between average messiness and compulsive hoarding? Hoarding behavior includes:

  • Acquiring and keeping, indefinitely, a large number of possessions which appear to be useless or of limited value
  • Living in spaces so intensely cluttered as to preclude activities for which those spaces were designed
  • Significant distress or impairment in functioning caused by the hoarding (e.g., health problems, inability to keep a job, difficult relationships or lack of relationships with other people)
  • Reluctance or inability to return borrowed items; impulsiveness and compulsion to acquire more “things” sometimes leading to stealing or shoplifting

Why/how does a person cross the line from messiness to hoarding? There are several proposed explanations for the causes of hoarding behavior. Investigators have suggested that errant cognitive processing leads to hoarding. These include information processing deficits, meaning that people who hoard have substantial problems focusing and sustaining attention, difficulty categorizing and prioritizing their possessions, and difficulty in making decisions about their possessions.

Maladaptive beliefs about, and extreme emotional attachment to, possessions may also contribute to a person’s hoarding behavior. People who hoard have an exaggerated sense of responsibility for their possessions, and desire complete control over them. They experience intense emotional distress (anxiety, grief, or guilt) about the ideas of discarding or losing an object, leading to avoidance, and escape in the form of saving and acquiring.

There are also studies showing that difference in brain activity and /or brain injury can lead to hoarding behavior. Scientists have identified the areas of the brain involved in hoarding. One study showed reduced glucose metabolism in certain areas of the brains of compulsive hoarders. Some people with traumatic brain injury, stroke, and neurodegenerative diseases have also developed hoarding behavior.

In the past, clinicians have used the same treatment methods for compulsive hoarding that they used for OCD, with poor results. While medication, cognitive behavioral therapy for OCD, exposure and response prevention therapy have all been effective treatments for OCD, they have been shown to be of little benefit for compulsive hoarding. People with hoarding behavior have high instances of poor insight, refusal of treatment, lack of cooperation, and inability to recognize hoarding as a problem, all contributing to difficulty in effective treatment.

There is hope for people who hoard, though. In a recent study, researchers designed a new cognitive-behavioral treatment especially for treating compulsive hoarding. In this treatment, motivational interviewing (getting people excited about the seriousness of the hazards of hoarding and the benefits of clearing out their homes), skills training for organizing and problem solving, and modification of beliefs about possessions are emphasized. Also, treatment includes frequent off-site sessions in which therapists helped people to sort, discard, and learn to resist acquiring more items. People typically respond more positively when the therapists are at the home with them, assisting them with sorting and discarding.

The sight of such intense messiness and disarray is certainly disturbing to see, but knowing that hoarding is a symptom of a person who is possibly experiencing severe emotional distress, hopefully, helps to engender compassion and patience in friends and family members. Information about help for hoarding can be found online at www.ocfoundation.org/hoarding/.

© Copyright 2010 by Becki Hein, MS, LPC, therapist in Mckinney, TX. All Rights Reserved.

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Comments
  • Geriant Jones June 21st, 2010 at 11:05 AM #1

    I am pretty sure I do not suffer from any mental disorder but I do have trouble throwing out old stuff that I no longer need…I always think that it could come to use someday and just end up putting it at some place.I find it again sometime when my mom forces me to clean my room but then I just cannot bring myself to put away things…Maybe I’m just scared to lose those things…?I do not know :(

  • s.hurley June 21st, 2010 at 2:57 PM #2

    I like to keep my room clean and tidy but my brother is just the opposite…you may even find a week’s old pizza in his bedroom!
    we do not take this very seriously because most guys are like that but after reading this blog,I feel scared…I feel like there may be something wrong with him…what should be the next step?should we take him to a doctor/therapist?

  • A.Nixon June 22nd, 2010 at 10:33 AM #3

    I am somewhat of an opposite…as soon as I feel that something is not of use,I just throw it away…my sister has a problem with it because I once happened to throw away some stuff that she actually wanted but then I am just like that…and I do not think there is anything to change…is there?

  • Becki Hein June 29th, 2010 at 6:39 AM #4

    Thanks for you comments! In response to your questions:
    Many people have trouble letting go of “things” in their homes. There is a fine line between clutter,full closets, and hoarding. When there gets to be so much stuff everywhere that the floors are covered, there is nowhere to sit, and barely enough room to walk, then the line may have been crossed. Still, many people are able to keep most rooms in their homes liveable and have one room (their bedroom or junk room) where things are really piling up. I don’t think that classifies as hoarding. When the clutter becomes so huge that it intereres with everyday living and navigating through the home, and the “stuff” is on the person’s mind nearly all the time, the line to hoarding has probably been crossed.

  • Becki Hein June 29th, 2010 at 6:48 AM #5

    to s.hurley: Is your brother’s room just really messy, or does he tend to keep stacks and stacks of things? How old is he? Again, there is a difference between “really messy” and hoarding. THere are other questions to be asked in determining if he should see a therapist: Does he have any other symptoms of severe anxiety or depression? Is he able to function in daily life? Does he clean up the mess or throw things out once in a while? How old is he? How long has it been like this? There are several things to consider, and a consultation with a counselor might help to clarify your brother’s specific needs. ( many counselors offer short, free initial consultations)

  • Becki Hein June 29th, 2010 at 6:54 AM #6

    to A.Nixon:
    It sounds like you are able to let things go when you need to and there is nothing wrong with that! The only thing I would say is that you be careful to respect other people’s property and make sure you ask them before throwing their things away. If that only happened once or twice by accident, then sure, there’s nothing to really change. If people seem to be frequently upset with you for throwing their things away, then you want to think about being more careful and respecful of other people things.

  • Becki Hein June 29th, 2010 at 6:58 AM #7

    to Geriant:
    It is hard to let go of things sometimes! One of the ways I help myself get rid of old stuff is to tell myself that if I haven’t used it in 1 year, then I will give it away to someone who can use it now. Since I have’nt used it in a year, it’s unlikely I will need it anytime soon, and if I do happen to need it, I’ll go out and get a nice fresh new one! (whatever it is!) It’s kind of a waste for things to be sitting around not being used when someone else might be needing them. Geriant, these are just the thoughts I think so I can let go of some of the stuff in my closets! You can adjust them if you want to try them out!

  • Diane W. February 15th, 2012 at 12:43 PM #8

    my question is i understand hoarding… i don’t understand the filthinest…. and my problem is with paper i have a fear of tossing it…. i’m afraid something is going to get pass me with information on it….. i mean like prescriptions that are refilled have lots of info….. the envelope the medication info page then your precription on the bottle… too much info…. to get in the wrong hands…. tyvm

  • Diane W. February 15th, 2012 at 12:45 PM #9

    yes

  • jennifer April 18th, 2012 at 12:32 PM #10

    I am a hoarder due to alot of trauma in my life and relationaships that have gone bad. I have searched the computer for advice. I get anxiety when I see the amount of things. I do know where to begin to clean up. I have given alot of thing away, but have no room to store things I am keeping. Also my social life is terrible because I will not invite anyone over. I have a focusing problem and really want to get better. There is no support group for hoarders in my area. Help…

  • jennifer April 18th, 2012 at 12:38 PM #11

    i LIVE IN BUFFALO NY and there are no support groups or therapists out here and need help. Where do I go?

  • Linda June 17th, 2012 at 1:36 PM #12

    I’ve always been pretty messy, but I can’t stand filth; so I keep things pretty clean…even my trash cans. I am a procrastinator and get distracted easily. I am 4 years behind on my business bookkeeping and have become more and more overwhelmed and unable to face it as time goes on. I sold some stuff in a garage sale last year, and my neice-in-law, without asking me, threw away all my odd socks that she could find without checking with me…now I have the matches! That made me very angry, but she is so touchy I just bit my tongue; but I am still angry about it. I need someone to help me get organized, especially with my paperwork, but haven’t had to money to hire someone yet. I am bipolar, which doesn’t help matters…although I am fairy under control on my meds.

  • Danny McKinney February 22nd, 2014 at 1:03 AM #13

    Sometimes, hoarding can be an issue not resolving the situation. It’s like someone is hiding something from home and not discussing the situation what’s going on ? Cause, there’s crime going on like stealing and borrowing other people’s personal things. People think they are wasting their time, by telling the truth. There’s too much drama going when somebody were asked not to take anything for granted. Very shameful.

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