What is compulsive hoarding?
Compulsive hoarding is a common and potentially disabling problem, characterized by the accumulation of excessive clutter, to the point that parts of one's home can no longer be used for their intended purpose.
Compulsive hoarding, which may affect up to 2 million people in the United States, is often found in patients with other diseases, including dementia, Alzheimer's, schizophrenia and anorexia. It's most often seen in patients with obsessive-compulsive disorder (OCD). Researchers aren't certain whether compulsive hoarding is a subtype of OCD or a separate disorder.
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Questions and Answers about Compulsive Hoarding
Is hoarding a kind of obsessive-compulsive disorder?
Right now, compulsive hoarding is considered by many researchers to be a type of obsessive-compulsive disorder. However, for some people, compulsive hoarding may also be related to:
- Impulse control disorders (such as impulsive buying or stealing)
- Social anxiety
- Bipolar disorder
- Certain personality traits
How common is compulsive hoarding? What are its features?
- We don't know exactly. Some researchers have guessed that about half of one percent of the population suffers from compulsive hoarding, but the actual number may be much higher.
- People usually start hoarding during childhood or early adolescence, although the problem usually does not become severe until the person is an adult.
- Compulsive hoarding may run in families.
- Many people with compulsive hoarding do not recognize how bad the problem really is; often it is a family member who is most bothered by the clutter.
What causes compulsive hoarding?
Compulsive hoarding is thought to result from problems in one or more of these areas:
- Information processing. People with compulsive hoarding often have problems such as:
- Difficulty categorizing their possessions (for example, deciding what is valuable and what is not)
- Difficulty making decisions about what to do with possessions
- Trouble remembering where things are (and so they often want to keep everything in sight so they don't forget)
- Beliefs about possessions. People with compulsive hoarding often:
- Feel a strong sense of emotional attachment toward their possessions (for example, an object might be felt to be very special, or a part of them)
- Feel a need to stay in control of their possessions (and so they don't want anyone touching or moving their possessions)
- Worry about forgetting things (and use their possessions as visual reminders)
- Emotional distress about discarding. People with compulsive hoarding often:
- Feel very anxious or upset when they have to make a decision about discarding things
- Feel distressed when they see something they want and think they can't feel better until they acquire that object
- Control their uncomfortable feelings by avoiding making the decision or putting it off until later
Treatment for Compulsive Hoarding
There is no "cure" for compulsive hoarding, meaning there is no treatment that will make the problem go away completely and never come back at all. However, some treatments may help people to manage the symptoms more effectively.
Research studies using antidepressant medications (that increase the level of serotonin activity in the brain) show that some people with compulsive hoarding respond well to these medications, however, many do not. People with compulsive hoarding do not appear to respond as well to medications as do people with other kinds of obsessive-compulsive symptoms.
Cognitive-behavioral therapy is a form of counseling that goes beyond "just talking". In this form of treatment, the therapist often visits the person's home and helps them learn how to make decisions and think clearly about their possessions. There have not been as many studies of this kind of treatment, therefore it's hard to say with certainty how effective it is for hoarding. However, the available evidence suggests that cognitive-behavioral therapy is effective for many people with compulsive hoarding, perhaps more so than medications.
When a Loved One Hoards
In our hoarding clinic and research program, one of the most common inquiries we get is: "My [mother, father, sibling, friend, spouse, etc.] has a terrible hoarding problem. But he/she doesn't seem to recognize that it's a problem and isn't interested in doing anything about it. How can I make him/her see that this is a problem and get the help he/she so badly needs?"
The short answer: In most cases, you can't. That is, assuming that your loved one is an adult who is legally competent to manage his/her own affairs (meaning he/she has not been declared incompetent by a judge and appointed a legal guardian), and the clutter is not immediately life-threatening, he/she has the right to hoard, even though the hoarding might have terrible consequences for his/her quality of life.
The long answer: Even though in most cases you can't make the person do anything, you can alter your approach to minimize the likelihood of getting a defensive or "stubborn" reaction. Often, it's tempting to start arguing with the person, trying to persuade them to see things the way you do. This kind of direct confrontation rarely works.
We find that the best way to help people increase their motivation to work on the problem is to start with three key assumptions:
- Ambivalence is normal.
- People have a right to make their own choices.
- Nothing will happen until the person is ready to change.
Here are some general principles to guide your conversations:
Show empathy. Showing empathy doesn't necessarily mean that you agree with everything the person says. But it does mean you are willing to listen and to try to see things from the other person's perspective.
Don't Argue. There is simply no point in arguing about hoarding. The harder you argue, the more the person is likely to argue back. The only solution is to get out of the argument.
Respect Autonomy. Remember, most of you are dealing with an adult who has freedom of choice about his or her own possessions. Try to engage your loved one in a discussion (rather than an argument) about the home and his or her behavior. Ask your loved one what he or she wants to do, rather than just telling him or her what you want: "What do you think you would like to do about the clutter in the home?"; "How do you suggest we proceed?"
Help the person recognize that his/her actions are inconsistent with his/her greater goals or values. Ask the person about his or her goals and values: "What's really important to you in life?"; "How would you like your life to be five years from now?"; "What are your hopes and goals in life?" Discuss whether or not the person's acquiring, or difficulty organizing, or getting rid of things fit with those goals and values. This is most effective if you ask, rather than tell: "How does the condition of your home fit with your desire to be a good grandmother?"; " You've told me that friendships are very important to you, how well can you pursue that goal, given the way things are right now?"
If you have been accustomed to arguing, threatening, and blaming, your new approaches will surprise your loved one and it may take a little time before the person begins to trust you. Try these methods in several conversations and notice whether the balance seems to be tilting in the right direction. If so, be patient and keep up the good work.