Hoarding: the science behind
compulsive collecting
(July 2008 Issue)

Randy O. Frost, Ph.D., Israel professor of psychology at Smith College has conducted 30 hoarding-related studies and co-founded The New England Hoarding Consortium. (photo by Tom Croke)

By Phyllis Hanlon

Most people can probably plead guilty to having a messy office, cluttered car or a bed piled high with laundry on occasion. But for those who can't even find their desk or dining room table, the problem might be much more serious than simple disorganization.

David F. Tolin, Ph.D., founder and director of the Anxiety Disorders Center at Hartford Hospital's Institute of Living, says that hoarding, by definition, is the acquiring/saving of clutter sufficiently severe to preclude living spaces for their intended purposes. He makes a distinction between being messy and hoarding. "For example, your desk might be messy, but it still functions as a desk," he says.

While hoarding is sometimes associated with obsessive-compulsive disorder (OCD), Randy O. Frost, Ph.D., Israel professor of psychology at Smith College, explains that the two problems differ significantly. "In OCD there is the presence of obsessive, intrusive, unwanted thoughts and a compulsion to prevent them from occurring. They are always experienced as unpleasant and distressing," he says.

Hoarding, however, falls into a different category, Frost says. "With hoarding, getting rid of things is distressing, but there is a part that gives pleasure."

Tolin reports that those who hoard tend to keep possessions that most other people would discard, including junk mail; old catalogues and newspapers; craft supplies, although they never get used for that purpose; clothing; broken things and/or freebies.

The consequences of hoarding range from isolation and bug infestation to dangerous conditions and an unhealthful physical environment, which impacts the individual as well as others in the household. Tolin reports that in some cases, youth and elder services have removed children and seniors, respectively, from the household when clutter has reached an unmanageable state. He adds that an excess of possessions creates highly risky conditions, such as the potential for falling. An overabundance of items can also block exits in case of an emergency. "Some people have died as a direct result of the clutter," says Tolin.

While researchers have yet to create a "typical" profile of a person who hoards, Frost indicates there are some commonalities, but also a great deal of variability. "A person who hoards is usually indecisive, unrelated to their possessions," he says. They'll have trouble deciding what to wear or what dish to order from the menu. "The way in which they process information is different. It's hard for them to grasp all the details, sort through them and come to a conclusion," he says.

Some fairly new research demonstrates a powerful need to control possessions in those who hoard. "If someone else touches, moves or borrows something, they get upset," says Frost. "The role the possession plays is part of their identity. They think if they throw something away, they'll lose part of themselves."

Frost cites recent studies, which indicate that childhood memories of a cool relationship with parents may contribute to the problem of hoarding. He also finds a pattern of social phobia that includes generalized anxiety disorder and a great deal of depression in those who hoard.

In spite of these common personality traits, people who hoard demonstrate a great deal of variability regarding gender and age group, Frost says.

Tolin notes that there are "clear biological correlates" in hoarding. "We see parts of the brain that are less active than in non-hoarders," he says. "Some parts of the brain are in overdrive when decision-making."

According to Gail S. Steketee, Ph.D., professor and dean of the school of social work at Boston University, treatment usually begins with motivational interviewing. "During the initial assessment, goals and needs have to be established so we can understand the nature of the hoarder," she says.

Frost, who has conducted approximately 30 hoarding-related studies, recently joined forces with Tolin and Steketee to form The New England Hoarding Consortium. Together they have developed a cognitive behavioral therapy program that has met with relative success. Much like a physical conditioning program, this therapy "builds tolerance for the urge to acquire" and addresses the resistance to discard, according to Frost.

Steketee and Frost, together with community volunteers, developed a Compulsive Hoarding Rating Scale of 23 questions that measures clutter, difficulty in discarding and saving, and acquisition. "It covers the main features and we are getting at them from different angles. It is based on clinical experience," Steketee says.

Pharmaceutical agents have also shown some benefit in treating those who hoard, according to Steketee. She notes that two studies indicate that paroxetine, a selective serotonin reuptake inhibitor, proved more effective than placebo. She adds that venlafaxine, a serotonin/norepinephrine reuptake inhibitor, also provided a good outcome, emphasizing that these are prospective studies.

While many people hoard inanimate objects, some take the practice to a different level. Gary J. Patronek, VMD (doctor of veterinary medicine), Ph.D., director of the Tufts Center for Animals and Public Policy, says, "Animal hoarding is, like other addictive behaviors, an attempt to fill an unmet human need, likely related to a lack of satisfying human relationships, among other things."

Patronek reports that cats are the most commonly hoarded animal, but that other animals have also been hoarded. "We have seen cases of exotic birds, reptiles, big cats (tigers), rodents, rabbits and of course the whole spectrum of farm animals," he says.

For individuals who hoard animals, finding viable treatment is challenging, says Patronek. "Extreme denial [and] lack of insight certainly make any intervention difficult," he says. "Hoarding is a heterogeneous condition that requires a palette of solutions, ranging from purely therapeutic to aggressive prosecution."

Hoarding has existed below the radar for years, says Steketee. Now that the issue has become more publicized, requests for information and help have increased. "We talk to people in agencies who have known about hoarding, but didn't know they could do anything about it," she says.

Steketee purports that today's society may play a role in the rising incidence of hoarding. "From a generation ago to today, we're now more of a throwaway society. Is culture driving this? Do we not respect things? Do we have a need to accumulate more to prove you have the things you need?" See Additional resources offer advice.

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