Compulsive Hoarding

As little as 15 years ago, people with extremely cluttered homes were known as pack rats or collectors. There has been a growing problem where homes become so extremely full of possessions that it makes it impossible to use the rooms in the house for the purpose in which they were originally intended. No cooking in the kitchen, no family meals in the dining room, and no entertaining friends and family in the living room because all of these spaces are occupied by the treasures of a hoarder, practically floor to ceiling. “Compulsive Hoarding is a mental disorder marked by an obsessive need to acquire and keep things, even if the items are worthless, hazardous, or unsanitary. More than 3 million people are compulsive hoarders.” (Flynn, Chan, & Severson, 2010)

Hoarding can sometimes appear in early adolescence. If not addressed, it will usually get progressively worse. Some of the symptoms may include:
-Cluttered living space;
-Inability to discard items;
-Keeping stacks of newspapers, magazines, or junk mail;
-Moving items from one pile to another, without discarding anything;
-Acquiring un-needed or useless items sometimes even trash;
-Difficulty managing daily activities including procrastinating and trouble making decisions;
-Difficulty organizing;
-Excessive attachments to possessions and difficulty letting anyone touch or borrow them;
-Limited or no social interactions.
Hoarding can range from a harmless mess, to a life threatening condition. (Scheff, 2010)

Triggers and Causes
Family and Genetics
Hoarding seems to run in families. Obviously, if one was raised by a hoarder, one is much more likely to be a hoarder, as many people often emulate the environment in which they were brought up. However, some research also points to a genetic link. “People with this problem tend to have a first degree relative who also does, so it might be genetic, or it might be a modeling effect.” Says Randy O. Frost, Ph.D., a psychologist at Smith College, North Hampton, Massachusetts. “Genetic research suggests that a region on chromosome 14 may be linked to compulsive hoarding in families with OCD. The study, carried out by a team from John Hopkins University School of Medicine in March 2007, analyzed samples from 999 OCD patients from 219 families. Families with 2 or more hoarding relatives showed a unique pattern on chromosome 14 where as other families’ OCD was linked to chromosome 3.” (Collingwood, 2009)
Some people classified as hoarders may just be harmless pack rats until some kind of trauma occurs in their life. Often hoarding spirals out of control after the death of a loved one such as a parent, spouse, or child. Divorce can also trigger hoarding to manifest a previously underlying problem into a disaster.
Compulsive Shopping
Hoarding also highly correlates with compulsive shopping. Compulsive shopping also correlates with other characteristics of hoarding such as indecisiveness and perfectionism, which also correlates

with OCD. Hoarding is not only characterized by the inability to discard items, but also by the obsessive way in which they are acquired. “It may be the case that compulsive shopping is one manifestation of an underlying pattern of mental activity that is part of a more general tendency towards compulsive acquisition.”(Murray, Close, & Frost, 2010)
Related Disorders
Hoarding has long been considered a symptom of OCD, or Obsessive Compulsive Disorder. However, in the last 10 years, psychologists have begun to notice a difference. Sometimes there is a person with OCD who has a tendency toward hoarding, and sometimes there are compulsive hoarders without OCD. It is estimated that at least 18 to 30 percent of people with OCD have hoarding tendencies. (Frost, & Steketee, 2010)
Although hoarding is not considered to be a disease in itself right now, this may all change soon. Experts have been debating if it is a symptom of OCD at all, and it may be recatagorized in the next edition of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM). Some of the distinctions between Compulsive Hoarding and OCD may include the following:
-Different from most patients suffering from OCD, most hoarders do not want help. This makes then also much more difficult to treat.
-Medication seems to work far better for patients with other forms of OCD.
-Hoarders have specific cognitive deficits not shared by people with other forms of OCD, such as the inability to categorize and make decisions.

-Treatments for hoarding are more tedious and take longer than typical OCD treatments
-Hoarding OCD is much more likely to suffer relapse than other types of OCD. (Elliot, 2009)
Besides OCD, compulsive hoarding is also linked to other disorders and is even a diagnostic criteria for OCPD, or Obsessive Compulsive Personality Disorder. One study suggests that almost twice as many hoarders meet the criteria for OCPD rather than OCD. Similarities between OCPD and hoarding include preoccupation with details, organizing and orderliness. Patients suffering from both disorders have very little insight into the severity of their disorder and most often do not recognize the negative impact of their behaviors on their lives. Hoarding may also correlate with disorders such as ADD and ADHD where people also have a great deal of difficulty focusing, making decisions, and organizing. (Wiegartz & Carmin, 2010)
Effects on Family and Home
Living in the home of a hoarder is very stressful. Unlike people with other obsessive compulsive disorders, hoarding compulsions directly affect all other persons living in the house. Although the emotional effects of other OC related disorders can affect the family, it is generally indirect and can be avoided. Often it is just an inconvenience. Hoarding, however, profoundly affects all persons living under one roof. For example, the hoard more often than not, spills out from one room to another until all rooms, including the bathroom, and kitchen become un-useable. This is very unsanitary and unhealthy. Also, very often if something goes wrong with the plumbing or electricity, a hoarder may not hire professionals to come in and fix the problems due to embarrassment or inability to access the area. (Fugen, Slavin,& Donelly, 2010)

For the family of one who hoards, it is impossible to live in the same house and not experience emotional, or even physical trauma. Not only through the mess, but also because hoarders’ extreme need to control all aspects of the house cause extreme friction and tension. A primary cause of contention is the loss of usable living space in the shared areas of the home including the living room, dining room, bathrooms, hallways, kitchen, entry ways, yard, and even the bedrooms of other family members. The emotional effects of hoarding are very difficult on a marriage, and often end in divorce. (Fugen et al., 2010)
Family members are forced to live in utter chaos. The hoarder assumes control of the entire house and does not allow their family members to make and decision about the home in which they live. This results in feelings of bitterness and resentment. Often, family members get so frustrated with the mess that they will attempt to organize, discard, and clean up without the knowledge or permission of the hoarder, resulting in big, blow out fights. The hoarder will become even worse due to this “deception” because they feel violated and disrespected. This causes them to become even more protective of their possessions. (Fugen et al., 2010)
The hoarding behaviors of the parent of a child can severely affect the child’s life. Children are either not allowed or too embarrassed to have friends over which adversely effects their social development, leaving them feeling isolated. Children become withdrawn and depressed and tend to do poorly in school or even drop out. Children of hoarders are prone to become abusers of drugs and alcohol. (Fugen et al., 2010)
Hoarding also affects the quality of life in the home from a health aspect. Individuals living in a hoarded house often suffer from headaches and respiratory problems. As clutter develops, it becomes impossible

to dust or vacuum for years at a time. In addition, spilled liquids are often not cleaned up causing all manors of mold, fungus, and insect infestation. Also, the home is likely to become infested with rats and other vermin who will deposit feces and urine within the clutter causing a whole range of other health issues. (Fugen et al., 2010)
Another safety hazard is the clutter itself which makes it difficult to move about the house. Pathways become blocked by fallen or new clutter and one could trip and fall and be seriously injured. Extreme clutter also puts the home at a significant risk of having a fire. Also because of the clutter, it would be extremely difficult for emergency personnel to rescue individuals trapped inside the house.
The home of a hoarder could literally cave in. People often underestimate the weight of their possessions, and the floors and walls could be destroyed under the pressure of an extreme hoard. It is even more dangerous if the home has pets. Cats often not find their litter box, if there even is one, and dogs cannot hold it long enough for their masters to navigate through the mess, leaving the animals to urinate and defecate throughout the house. The result is absolutely toxic. The hoarder becomes accustomed to the smells, and hardly notices a problem. The levels of ammonia make the air in the home unsafe to breathe, both for the animals and humans. Animal feces, mold, and fungus make it very dangerous to inhabit the house, and it may be reported and condemned by the city. (Fugen et al., 2010)
Levels of Hoarding
An official organizational assessment tool has been developed by a group known as the NSGD, or National Study Group on Chronic Disorganization. This clutter/hoarding scale was developed to give professional organizers and clinical psychologists specializing in chronic disorganization and hoarding

definitive parameters. The parameters relate to specific health and safety issues. Five different levels have been established to measure the degree of squalor and severity that professionals may be dealing with. Within each different level, there are four specific categories which define the severity of clutter and hoarding potential.
-Structure and zoning;
-Pets and rodents;
-Household functions:
-Sanitation and cleanliness. (Delson, Govinsky, Prince,& Shultz, 2003)
Level I hoarder
Household is considered standard. No special knowledge in working with the chronically disorganized is necessary.
Level II hoarder
Household requires professional organizers or related professionals to have additional knowledge and understanding of chronic disorganization.
Level III hoarder
Household may require services in addition to those a professional organizer and related professional can provide. Professional organizers and related professionals working with Level III households should have significant training in chronic disorganization and have developed a helpful community network of resources, especially mental health providers.

Level IV hoarder
Household needs the help of a professional organizer and a coordinated team of service providers. Psychological, medical issues or financial hardships are generally involved. Resources will be necessary to bring a household to a functioning level. These services may include pest control services, “crime scene cleaners”, financial counseling and licensed contractors and handy persons.
Level V hoarder
Professional organizers should not venture directly into working solo with this type of household. The Level V household may be under the care of a conservator or be an inherited estate of a mentally ill individual. Assistance is needed through the use of a multi-tasked team. These members may include social services and psychological/mental health representatives (not applicable if an inherited estate), conservator/trustee, building and zoning, fire and safety, landlord, legal aid and/or legal representatives. A written strategy needs to be outlined and contractual agreements made before proceeding. (Delson et al., 2003)
Subtypes of Hoarding
Animal Hoarding
Animal Hoarding is a complex community health issue. It involves mental health, animal welfare and public safety concerns. In most cases, animal hoarders appear to believe they are helping their animals. They believe that any home is better than letting the animals die in a shelter. They are in denial and are able to convince other people that they are in control of the situation. Usually, animal hoarders

are completely blind to the fact that they are not helping the animals, and they do not see the degree of suffering that they cause. Indications for an animal hoarder may be:
-Owning many animals without knowing an exact number of how many;
-Home is deteriorated and may have dirty windows, broken furniture, and holes in the floors and walls;
-Extreme Clutter;
-Strong smells of ammonia and the presence of urine, feces and vomit;
-Animals are unsocialized, emaciated, and lethargic;
-The presence of fleas and vermin;
-Individual isolated themselves from the community and appears to also be in neglect themselves;
-Individual insists all animals are loved and cared for, even in the presence of extreme distress and illness. (ASPCA 2010)
Dr. Stephanie LaFarge, ASPCA Senior Director of Counseling Services says; “I have worked with many animal hoarders in their homes. Their mental illness allows them to maintain an absolute denial of the filth and suffering of the animals. They simply cannot see, smell, or react to the situation as a normal person would.” (ASPCA, 2010)

Garbage Hoarding
Some people suffering from compulsive hoarding are obsessed with collecting garbage. The term for this is syllogomania. These people will go as far as climbing into dumpster and removing trash to bring home with little to no insight as to how unsanitary their actions are. Often they believe that they are doing good for the world by saving what they consider to be useful items from going to the dump. In their minds, they plan to find use for these items at a later time, but instead just manage to turn their own home into a dump.
Some compulsive hoarders do not just simply collect junk, but focus their attention on one or more type of useful items in copious amounts. Often these homes are not as unsanitary as the homes of garbage or animal hoarders. However, what starts out as a harmless collection may soon turn into an obsession. Collector/Hoarders are known to collect some of the following items; clothing, newspapers, magazines, books, toy trains, cameras, and personal items, just to name a few. These types of hoarders most likely also have a problem with compulsive shopping and may spend many hours and lots of money frequenting flea markets, thrift stores, and garage sales, and may also be hooked on home shopping channels and eBay.
Case Studies
Animal Hoarder
“On Tuesday, November 9, 40 cats were seized from a mobile home in Tampa, Florida, that authorities called a “liter box without litter,” according to the St. Petersburg Times. After an anonymous

tip led them to the property, officials entered the residence wearing protective gear to shield them from the smells of the unsanitary home. All of the cats were kept on one side of the mobile home where the windows were sealed and there was no ventilation. Many of the animals had conditions such as respiratory infections, open wounds and urine burns. The news source reports that ammonia levels begin to become unsafe at 25, and this home reached 38. Kevin Lamar Addison, who lived with the animals, was charged with five felony counts of animal cruelty and 40 counts of unlawful containment of an animal. (ASPCA, 2010)
Garbage Hoarder
Lloyd is an elderly man from California. He was told by his mother, during the Great Depression, “Don’t put anything on your plate that you can’t eat, and don’t waste anything.” Lloyd collects garbage from dumpsters and has a giant outdoor hoard of miscellaneous debris. Five years ago, it was so bad that the county came in and cleaned it up. They also fined him 50,000 dollars. This made him feel violated, and he began hoarding worse than ever. He ignored the huge fine, on continued to hoard his property. Now he is facing another fine of the same magnitude. Lloyd hoards everything including, but not limited to broken fans, construction garbage and debris, pieces of worthless broken furniture, paper, and empty boxes.
Lloyd was originally a successful insurance salesman, but buckled under the pressure and began drinking. His family fell apart as he became controlling, violent, and abusive. Even after being sober for 35 years, his abusive and obsessive behaviors persist, and his family finds him difficult to love. Even when he is out with his grown daughter, he cannot resist removing items from garbage cans.

Facing 100,000 dollars in fines, he agrees to get help. He could possibly lose everything. Lloyd’s situation is desperate. He sleeps in a trailer on his property that is also hoarded. He climbs in through a window to sleep, because all entry ways are blocked. He has no electricity, no running water, and no ventilation. He has not been inside his house for over a year. After seeing the grotesque situation in which Lloyd lives, Dr. Liz Moore, the clinical psychologist working on his case, has no choice but to get Adult protective services involved.
During the clean up, Lloyd has problems parting with any garbage. He is hostile and agitated and is lamenting over every piece of trash. He has very little insight into his situation and is erratic, and could possibly be suffering from dementia. Lloyd is removed from the property for the last part of the cleanup to get as much done as possible.
There is very little hope for Lloyd because of his negative mind set, age, and possibly his dementia. He will most likely be removed from his home by Adult Protective Services. It is not humane to continue to let him live alone. Sixty dumpsters were filled on his property, and only 25 percent of the hoard was removed. His property will most likely be surrendered to the county. (Flynn et al., 2010)
Theresa is a retired state worker, and a mother of six grown children. She raised her family in California and kept a clean home. All of the children had chores. Ten years after her kids were grown and gone; Theresa moved to Alabama and bought a house to be closer to her side of the family. Her husband stayed behind in California to continue to work. Three years ago, tragedy struck, and Theresa lost three family members in a short period of time. Alone and devastated, Theresa turned to shopping to ease her pain.

Theresa frequented the thrift store two times per day. Her husband sent her $5,000 at a time. Her shopping got so out of control that she went through their entire life savings totaling $112,000 in one and a half years. Theresa believes the 3,000 designed purses that she owns will bring in a small fortune. She is counting on the sale of these items to save her from bankruptcy.
Her husband worked two jobs his entire life to support the family. He retired two months ago, and moved to Alabama to be with Theresa. He was shocked by what he found. The house is hoarded floor to ceiling with clothes, purses, and shoes. Nobody is allowed to touch her possessions, she is controlling and possessive.
Extremely in debt, and facing financial ruin, Theresa agrees to get help. Dr. Susan Chabaud, licensed clinical psychologist, specializing in OCD and hoarding comes on to help Theresa. She breaks down soon into the session, realizing what she has done. In addition to the pressure of her financial burden, Theresa is afraid her husband will leave her. She has tested his loyalty to the limit.
Professional organizers arrive with dumpsters. The team begins removing items from the house. At first, things are going smoothly, but Theresa unravels when she notices things being thrown out. She breaks down, and the cleanup comes to a halt. Her family is afraid of her temper. When the crew leaves for the day, Theresa climbs into the dumpster and removes items.
The next day, consignment experts arrive to assess the value of Theresa’s 3,000 purses. It is disappointing when they discover that most of her bags are designer imitations, and 95% are worthless. She is upset that she cannot get top dollar for her bags, and only walks away with $300. This will not prevent her from bankruptcy.

Theresa is humbled by her situation, and the rest of the cleanup goes smoothly. Her husband is pleased with the progress and sticks by her side. Theresa is provided with after care funds, and uses them to get counseling. Her daughter steps in and intervenes financially to save them from ruin. (Flynn et al., 2010)
Initial Assessment
The first step in helping one who hoards overcome their affliction must be through a thorough psychiatric evaluation to rule out primary psychotic disorders such as, dementia, and major depression as a cause to the problem, since apathy, fatigue, or hopelessness could lead to failure to discard, clean, or organize possessions. The initial session should include an assessment of the amount of clutter, types of items acquired, usability of the space, health and safety hazards, beliefs about possessions, information processing deficits, avoidance behaviors, insight, motivation for treatment, social and occupational functioning, and activities of daily living. (Saxena 2008)
Hoarding symptoms may be treated with Serotonin Reuptake Inhibitors, or SRIs. A few studies of OCD patients have found that hoarding symptoms were not easily treated with these drugs, and responded poorly to them. Another study, however, found that compulsive hoarders responded equally well to SRIs as non-hoarding OCD patients, with signifigant improvements in shared symptoms such as anxiety, depression, and overall functioning. Similar proportions of hoarding and non-hoarding OCD patients responder strongly and partially. The proportions of people dropping out of the study were also

similar. Compulsive hoarders who completed treatment showed a mean 31% decline in symptom severity. Hoarding symptoms improved as much as other OCD symptoms. (Saxena 2008)

Cognitive Behavioral Therapy
Hartl, Frost, Steketee, and colleagues developed a Cognitive Behavioral Therapy or, CBT treatment strategy based on their Cognitive/Behavioral model of compulsive hoarding. They are the leading researchers on the subject. They conceptualize hoarding as involving four main problem areas;
-Information processing deficits;
-Problems in forming emotional attachments;
-Behavioral avoidance;
-Erroneous beliefs about the nature of possessions.
Treatment involves cognitive restructuring, decision making training and exposure and response prevention involving the discarding of clutter.
After 20 weeks of treatment, five in seven patients had noticeable improvement in acquiring of new possessions, awareness of irrational reasons for saving possessions and organizational skill. The ability to discard possessions also improved, but more slowly. This study also demonstrated the need to address patient motivation and involve family members in treatment. (Saxena 2010)

A growing awareness has shed some light on the deeply rooted problems of compulsive hoarding. Hoarding is a serious condition that not only affects the individual with the problem, but also has a serious impact on the lives of all persons living in the home, as well as loved ones living outside the home who want to help, but do not know how.
The issues of a hoarder are deeply seeded and not easily treated. In order to provide adequate treatment, several different levels of therapy are recommended, including; therapy with a clinical psychologist specializing in hoarding, professional organizers, and perhaps even drug therapy to reduce anxiety. Strong family support is also very important, as relapse is almost inevitable.
Hoarding has long classified as a symptom of OCD, but research has shown strong evidence that it is its own entity with a unique profile of core symptoms, genetic markers, and neurobiology abnormalities that differ from those of OCD. Perhaps in the near future, compulsive hoarding will be classified as a separate disorder entirely. More research is recommended.

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