Newswise — udging from the proliferation of home shows and magazines devoted to organizing our lives, Americans have a problem with clutter.
But the problems of people who compulsively hoard clutter go beyond a disorganized home and can't be solved neatly in a half-hour home organization show or magazine article. Hoarders have a brain disorder resulting in an all-consuming compulsion to collect that often cuts them off from society and damages their relationships. In severe cases, clutter can get so out of control it can endanger lives—as in the case of a Houston woman who died in a 2006 fire because her clutter-filled home hindered firefighters' efforts to rescue her.
"Hoarding is different from being disorganized or not prioritizing," says John Hart, LCPC, a behavior therapist with the Menninger Obsessive-Compulsive Disorders Treatment Program who treats patients who hoard. "If there is a pathological accumulation of stuff in their home, then something has gone pretty desperately wrong."
A sub-type of obsessive-compulsive disorder, hoarding is the compulsion to collect and store items considered by most people to be worthless or useless. Little is known about what causes hoarding, but like many mental disorders, it is believed in part to have a genetic cause. In some cases, a loss or other significant life event can trigger hoarding behavior. Hoarding behavior may also be present in persons with dementia.
The motivation driving the compulsion to hoard varies among persons with the behavior. Some persons who hoard receive pleasure out of collecting items they want, for example a person who loves to shop sales. Even when their purchases begin to overtake their house, they may not think they have a problem.
"Friends and family may see the hoarding as a bigger problem than the person who hoards," Hart says. "They come to visit and there is no place to sit down because of all the clutter."
Other persons who hoard may feel they have no control over their behavior, for example, they feel they must hold on to every piece of mail with their names on it, in case they need it some day, or out of fear of someone using that information against them. Some persons, out of love for animals, may keep too many pets in their home—another form of hoarding. Persons who hoard often have extreme problems with making decisions. Instead of facing the decision to throw something away, they just avoid it.
"They have a hard time seeing the big picture," Hart says. "They don't see how a little decision, like keeping an old magazine because they haven't yet read it, can turn into a whole big mess. They have a hard time moving from the particular to the general."
Well-meaning family and friends may try to help by clearing all the clutter away from the hoarder's home—a temporary solution at best. Without mental health counseling, hoarders usually will go back to hoarding again.
For severe cases of hoarding, inpatient treatment may help by removing the person from their hoarding environment and evaluating whether they may also have a co-occurring psychological problem, such as depression or anxiety, Hart says. Patients in the Menninger OCD Treatment program who hoard participate in cognitive behavioral therapy and learn decision making skills. They also work on their beliefs about hoarding, and learn to understand their emotional reaction when they throw items away. For treatment to be successful, it must also happen where the patients hoard.
"It is important that they receive some sort of therapeutic help in the home," Hart says. "It is usually the best strategy for the therapist to train family or friends or volunteers how to help."
The Menninger Clinic is an international specialty psychiatric center, providing treatment, research and education. Founded in 1925 in Kansas, Menninger relocated to Houston in 2003 and is affiliated with Baylor College of Medicine and The Methodist Hospital. For 16 consecutive years, Menninger has been named among the leading psychiatric hospitals in U.S. News & World Report's annual ranking of America's Best Hospitals.
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