“You can’t hook up a U-Haul to a hearse.” ― Randy O. Frost, Stuff: Compulsive Hoarding and the Meaning of Things

According to Wikipedia hoarding, also known as compulsive hoarding, is defined as a pattern of behavior that is characterized by the excessive acquisition of and inability, or unwillingness, to discard large quantities of objects that would seemingly qualify as useless or without value.   It is this excessive collecting of needless items, and the incapacity to discard them that often produces such cramped living conditions that homes, cars, and other potential areas of storage end up being filled to capacity with only small narrow paths meandering through endless heaps of clutter.  This can, and often does, progress to such a severe level of impaired functioning that normal activities of daily living (sleeping, moving freely around the home, cooking, cleaning) are dramatically hampered.  This hoarding behavior is also often associated with increased health risks, risk of falling and fire, poor sanitation, significant negative impacts on family and friends, and marked financial problems.  Some with compulsive hoarding will also collect animals, oftentimes keeping many dozens of pets, frequently in grossly unsanitary conditions.

People who demonstrate hoarding behavior will oftentimes report a sense of safety and calm when surrounded by the items they compulsively collect.  For the most part they collect, and hold onto, stuff because they have the conviction that the needless items will one day be needed, or that they will possess some value in the future.  They may also hoard items they attribute emotional importance to…a reminder of a long lost person or pet, or of happier more fulfilling times.  They believe that their hoarding is reasonable and beneficial.

Although hoarding is considered by some mental health professionals to be a subtype of obsessive-compulsive disorder (OCD), many who hoard do not have other symptoms most commonly seen with OCD.  As such, while some individuals with OCD demonstrate hoarding behavior, this behavior is not specific to OCD.

Compulsive hoarding is typically characterized by:

• The accumulation of a vast amount of stuff that fills up and clutters the living areas of a home and/or workplace so much so that the space’s intended use is no longer possible.  In the case of a home, making it functionally uninhabitable.
• Considerable distress and/or impairment in social, occupational and other areas of functioning.

Hording can, and most often does, significantly impact a sufferer’s thoughts and emotions as well as their behaviors.  Signs and symptoms of hoarding include, but are not limited to:

• The acquisition of seemingly useless and unnecessary items.
• Appear powerless when it comes to discarding these possessions.
• The urge to hold on to items is related to feelings of anxiety and/or distress when pushed to discard them.
• Perfectionist traits.
• No, or rather limited, social connections and interactions.
• Tendency to move stuff from one pile to another without disposing of any of it.
• Trouble organizing things.
• Holding onto loads of magazine, newspapers, and even junk mail.
• Extreme attachment to the useless items, and tremendous anxiety over letting others borrow, or even touch, their stuff.
• Marked difficulty in making decisions and managing activities of daily living.

Hoarding can affect anyone, regardless of age, sex, race or socio-economic level.  It is difficult to clearly identify how common hoarding is as a large number of sufferer’s never seek treatment.  Although there is very limited statistical studies on strictly hoarding behavior alone, based on estimates from a study undertaken with college students in the United States, the prevalence of compulsive hoarding is estimated to be somewhere between 2-4%.  Although hoarding behavior is not specific to OCD, approximately 20-30% of OCD sufferers demonstrate compulsive hoarding as their chief problem.  While hoarding behavior typically begins in childhood it often will go unnoticed, and therefore unaddressed, until adulthood.  Of interest is the potential genetic component of this disorder as individuals who hoard often have relatives who have also suffered from the compulsive behavior.

Researchers have been able to identify some of the potential risk factors of hoarding.  These include:

• Age – Compulsive hoarding typically begins in early adolescence, and is likely to worsen with age.
• Isolation – Sufferers of compulsive hoarding will often be socially withdrawn and isolated.  In some cases hoarders turn to the comfort of hoarding as a result of their isolation and loneliness.  In others, it is the hoarding behavior itself that leads to the social seclusion.
• Perfectionism – Sufferers of compulsive hoarding often have very strong perfectionist tendencies.  They tend to worry and obsess over the “right” thing to do with their items, internally struggling whether to keep or get rid of each and every possession.  This decision making process can become all encompassing and cause great distress.  So, in order to avoid the anguish such decision making creates they simply decide to keep everything.
•  Family history of compulsive hoarding – People with a close family history of hoarding are more likely to demonstrate hoarding behavior as well.
• Acute stress experience – Some sufferers of compulsive hoarding develop the behavior following a particularly stressful acute life event as a way of coping with it, although not very functionally.  Some of the more common acute events are divorce, loss of a loved one (family, close friend, or pet), or loss of all possession (such as in a fire or flood).

One of the more challenging issues in treating the individual with compulsive hoarding is the person themselves really do not see their hoarding as any sort of problem.  They most often are able to accept that all of the clutter and dysfunction may well be of concern to others, but for them they see no problem, nor do they experience it as distressful.   Concentrated and focused treatment can indeed help those who hoard acquire understanding of their compulsions.

The use of Cognitive-Behavioral Therapy (CBT) has been demonstrated to be an effective intervention specifically targeting the attendant distressing thoughts.  This, along with the judicious use of psychiatric medications such as selective serotonin re-uptake inhibitors (SSRIs), anti-anxiety benzodiazepines, and/or atypical antipsychotics, can provide the compulsive hoarder the ability to limit their need for acquiring and keeping items, thereby leading to a more full and enjoyable life.