Hoarders

A&E is airing a 60 minute reality TV show on people who have trouble with hoarding– the inability to discard personal possessions even if they appear to be only of limited value.  Each episode follows two people with challenges and tells their stories.

The show illustrates the many problems that come along with hoarding: From difficulty walking around the home, to health risks, conflict with family members, threat of eviction, or fire hazards.  Many hoarders are too ashamed to invite people to enter their home, ending up socially isolated and feeling overwhelmed, demoralized, and hopeless.

Protagonists are matched up with therapists and professional organizers to help them adress the issue, get organized, and get rid of the clutter.  This poses tremendous emotional strain on the hoarder, who tends to react with intense feelings of loss, grief, anger, or anxiety.  The show acknowledges that the home visit is usually just the beginning, though.  In real life, clutter is often not the only thing a person is struggling with.  Change is difficult, and maintaining the newfound order and clutter-free state is a challenge.

It so happens that the journal Clinical Psychology Review currently has an article in press in which several international experts on hoarding, including Alberto Pertusa, Randy Frost, and Gail Steketee, review the current state of the art on this issue. Let me summarize here for you a few of the major conclusions of their paper that may even surprise some regular viewers of the A&E show:

• It’s common: Significant compulsive hoarding appears to occur in around 5% of the population.
• On its own: Hoarding has long been considered a part of Obsessive Compulsive Disorder and is also considered a symptom of Obsessive Compulsive Personality Disorder.  Some people who have OCD and hoarding behaviors (in fact, about one-fourth of them) report having obsessions and compulsions around their hoarding (for instance, checking behaviors; fear that people can become contaminated if items are discarded; or mental rituals when discarding an item). However, after a thorough review of the literature,  Pertusa and colleagues suggest that compulsive hoarding, while it commonly co-occurs with OCD and Personality Disorders, may be best classified as a concrete disorder with its own diagnostic criteria.
• Hoarders are spenders: There seems to be a relation between hoarding and impulse control problems: Hoarders like to acquire and collect things excessively, and have a hard time discarding items.  Nearly 75% percent of hoarders engage in excessive buying and about 50% excessively acquire free things.
• Cluttered, not filthy: While the A&E show may present many people whose homes look unhygienic and flithy, research on the topic of squalor (domestic neglect and lack of personal hygiene) and hoarding is still scarce. Despite this scarcity, Pertusa and colleagues conclude that the great majority of hoarders do not exhibit self-neglect and squalor.
• In the family: The review references a study by Frost and Gross (1993), which found that 78% of people with compulsive hoarding reported having a first-degree family member who was also a hoarder.
• There’s hope: Frost and Steketee have developed a treatment manual that is based on Cognitive Behavior Therapy and includes office and in-home sessions, skills training such as organizing, problem solving, and decision making, and exposure to sorting, discarding, and not acquiring. The course of treatment takes about 26 sessions over 7-12 months, and it was tested on 14 hoarders.  Ten of them completed treatment and showed significant decrease of their hoarding behavior.