Many people will admit to having packed garages, cabinets and storage spaces full of un-used furniture, gadgets, tools, books, and boxes overflowing with forgotten objects. Others will admit to having their closets stuffed to capacity with many garments they have not used in a long time and will probably never wear again. Yet, none of these people may be considered compulsive hoarders.
Drs. Randy Frost and Tamara Hartl of Smith College are credited with the widely accepted definition of compulsive hoarding. It is the behavior that consists of: “accumulation of a large number of possessions that seem useless to others; creating living spaces that are difficult to use; and being prone to impairment such as indecisiveness, disorganization, perfectionism, procrastination and avoidance that isolate them from others.”
Hoarding symptoms may develop in 5% of Americans according to a 2008 survey report by Samuels, JF, et al. in “Prevalence and Correlates of Hoarding Behavior in a community –Based Sample”. The onset of hoarding behavior usually begins at age 12-13, and progressively worsens as people age. It often comes to the attention of authorities or social service agencies through the complaints of neighbors or relatives of the elderly hoarder.
In the past, compulsive hoarding has been assumed to be a subtype of obsessive -compulsive disorder (OCD). Yet, it is not listed as a sub-category in the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-IV), nor does it appear to be as receptive to psychotropic medications and cognitive behavioral treatments effectively used with many patients with OCD.
The Institute of Living-Anxiety Disorder Center at Hartford, Connecticut delineates the three areas of difficulties that result in compulsive hoarding; Information Processing, Beliefs about possessions and Emotional distress about discarding.
Hoarder’s difficulties with Information Processing experience: “ Difficulties categorizing their possessions, making decisions about what to do with possessions and trouble remembering where things are.” Hoarders’ Beliefs about their possessions involves: “A strong sense of emotional attachment toward their possession, feeling a need to stay in control of their possessions and worry about forgetting things.” People with compulsive hoarding often feel Emotional distress about discarding items. They “feel very anxious or upset when they have to make a decision about discarding things and feel distressed when they see something they want and think they can’t feel better until they acquire the object.”
Neziroglu and co-writers describe additional emotional stresses In “Overcoming Compulsive Hoarding: Why You Save and How You Can Stop” 1. Feeling overwhelmed or embarrassed by possessions. 2. Feeling suspicious of others touching items. 3. Depression. 4. Anxiety.”
The amassing of objects and the inability to navigate comfortably from room to room makes hoarders life cumbersome. They often feel trapped and hopeless as they become prisoners in their own mounds of blocking messes.
This situation worsens as the elderly hoarder encounters impaired vision, illness, or ambulation difficulties. He/she is at risk of falling, being hurt, or starting a fire as piles of flammable papers encroach into the kitchen. Yards filled with debris, or dozens of animals living in small quarters, are all health and safety hazards.
Since compulsive hoarding is so stressful to the individual and others with no optimal treatments available as of now, it may be wise to:
• Identify this habit in early adolescence and offer therapy to explore the teen’s accumulation of things as an attachment issue.
• Deal with anxiety, depression, disorganization and social isolation through currently available and effective medical and psychotherapeutic treatments.
• Understand that a compulsive hoarder is emotionally and socially in pain. Be compassionate about his/her suffering of overwhelming compulsion, fear, shame, confusion, overwhelm and helplessness.
• Abstain from negative feedback or judgments. Remember that compulsive hoarding is not volitional. The hoarder needs support and help not criticism and isolation.
• Address issues of safety and health of the elderly hoarder by recruiting social service agencies that can provide assistance to safeguard the hoarder’s well-being.