Alexandra Matthews, Ph.D. (Psy16219)

What is Hoarding?

According to Frost and Hartl (1996) Compulsive Hoarding Syndrome consists of:

1. The acquisition of, and failure to discard a large number of possessions that appear to be useless or of limited value
2. Living spaces are sufficiently cluttered so as to preclude activities for which those spaces were designed.
3. Significant distress or impairment in functioning caused by the hoarding

Three Basic Components of Hoarding:

Acquisition:     Compulsive buying, acquiring free things.
Saving:            Inability to discard anything.
Clutter:            Clutter is the end result of acquisition and saving.  It is a symptom of                         the disorder.  Clutter is not the problem, so simply cleaning out the                             clutter/hoard will not solve the problem.

Hoarding can pose a health risk to the hoarder.  It can also pose a public health risk due to infestation (rats, roaches), and a risk to public employees who sometimes must enter the home to help the resident.

Any item can be hoarded.  Some of the most commonly hoarded items are animals, reading materials (books, newspapers, magazines), clothing, containers (bags, boxes, milk cartons, bottles, cans, etc.), mail, notes and lists, personal papers (old school papers, writing samples, etc.)

Hoarding is a brain disorder.   Hoarding is genetic.  It is not simply a bad habit that can be easily overcome.

Compulsive hoarding is most commonly associated with Obsessive-Compulsive Disorder (OCD).  18-42% of all OCD patients have hoarding and saving compulsions.  However,  33% or hoarders do not have OCD.

Other mental disorders often co-occur with Compulsive Hoarding. Some of the most common are: Social Anxiety;  Anxiety; Depression; Attention Deficit Hyperactivity Disorder (ADHD); Impulse Control Disorders (compulsive shopping, gambling, etc.) stroke, neurodegenerative disorders (Alzheimer’s, etc.); eating disorders; Autistic Spectrum Disorders; mental retardation; schizophrenia; Tourette’s; compulsive hair pulling.

The estimated prevalence of hoarding ranges from 1-5% of the population.

Age of onset can be as early as 10 years of age.

The course of Compulsive Hoarding Syndrome is chronic, unremitting.  Severity of the disorder increases with age

It is important to understand that there are powerful, anxiety-driven motivations behind hoarding.  Some of the most common "reasons" for hoarding are: 

Fears of losing important items that might be needed later.
Distorted beliefs about the importance of possessions.
Excessive emotional attachments to possessions.
Fear of making “wrong decisions”.
Wanting to “take care of” hoarded items.
Wanting to make sure hoarded items have “a good home”.
Worry about wasting
An excessive sense of responsibility; Imperative not to waste items; imperative to dispose of items properly, to make sure they “go to good use”.
Hoarders typically have difficulty with : indecisiveness, perfectionism, procrastination, organization,  avoidance, attention.
Making decisions is extremely difficult and anxiety-provoking.
Hoarders experience grief-like feelings of loss in response to getting rid of anything

Hoarders have unusual brain activity that can cause problems with:

Avoidance
Attention and concentration
Decision making
Indecisiveness
Perfectionism
Procrastination


What is the Treatment for Compulsive Hoarding?

Treating hoarding is difficult because hoarders do not usually see their hoarding as a problem.  Hoarders generally have very poor motivation to clean up their hoard.

Hoarding is notoriously resistant to treatment.

Medications do not work—although they might help in conjunction with proper therapy.

Standard talk therapy does not work.

Cognitve-Behavioral Therapy (CBT) which is specifically tailored to target the cognitive and behavioaral symptoms of hoarding has been found to be effective.

CBT works with the connections between thoughts, feelings, and behaviors. There is a strong emphasis on changing behavior. Changing behavior is an effective way to increase functioning, increase rational thinking, and decrease negative feelings.

Group treatment can be more effective than individual treatment.

Effective treatment for hoarding involves education, interventions that target specific aspects of hoarding (decision making, not acquiring items, organization, difficulty with discarding, etc.)

The hoarder must be in charge of getting rid of the hoard themselves.  It is counter-productive to successful treatment of hoarding for others to get rid of the hoard.  It can be helpful for other people to help with getting rid of the hoard, but the hoarder must be in charge of the process.

TLC has an excellent series on hoarding. Hoarding: Buried Alive takes a good look at the impact of hoarding on family members.  This program is not an "extreme makeover" series, but instead takes a realistic approach to working on the hoarding problem:

Watch Hoarding: Buried Alive on TLC/Discovery Health

For more information, please contact me. 

I am available for public speaking engagements on the topic of hoarding.