Image: Hoarding
Courtesy Seattle Police Department
After calls from concerned neighbors, Seattle police visited this house belonging to an elderly man with hoarding issues. The kitchen (seen here) and bedrooms were stuffed with heaps of trash. Mental health treatment was provided and the house was eventually cleaned out.
By
Special to MSNBC
updated 3/11/2008 8:55:55 AM ET 2008-03-11T12:55:55

For actress Delta Burke, it was antique furniture and porcelain dolls — enough to fill 27 climate-controlled storage units.

For Roger Gorman’s father-in-law, it was books, newspapers, plastic grocery bags and leisure magazines.

“There must have been over 2,000 magazines in his apartment,” says the 53-year-old graphic designer from Manhattan. “There were stacks and stacks of them, columns of them. It looked like the landscape of a city.”

What connects a doll-collecting beauty queen, a magazine-reading recluse and 3 million to 6 million others in the U.S.? An overwhelming desire to acquire, save and compulsively collect an inordinate amount of stuff, so much stuff that it literally takes over the person’s life, sometimes even destroys their life.

But thanks to new research, the cluttered, confusing world of the compulsive hoarder may finally be starting to sort itself out.

In a recent study conducted by Dr. Sanjaya Saxena, director of the Obsessive-Compulsive Disorders Program at the University of California, San Diego, 20 adults with clinically significant compulsive hoarding issues and 18 healthy non-hoarding controls were given PET scans to measure their brain metabolism. Hoarders were found to have lower activity in a specific part of the brain that’s involved in decision-making, focused attention and the regulation of emotion.

“We found that patients with compulsive hoarding had a unique pattern of brain function abnormalities,” says Saxena, whose study is currently undergoing pre-publication review. “This pattern was not seen in other OCD patients, nor in the normal controls. It looks like compulsive hoarding is truly a distinctive diagnostic category, which has big implications for both diagnosis and treatment.”

Saxena says these findings may pave the way for future studies on medication and other treatments that can increase the activity in this particular part of the brain and regulate the impulses that make hoarders save and acquire excessively.

In the meantime, therapy offers hope on another front.

In a July 2007 study in the British journal Behaviour Research and Therapy, 10 compulsive hoarders underwent cognitive behavioral therapy, which included 26 individual sessions and frequent home visits. Following seven to 12 months of treatment, 50 percent had “very much improved” when it came to classic hoarding behaviors like the clutter, excessive acquisition and the inability to discard.

These new findings hold promise not just for hoarders but for exasperated friends and family members who are both baffled and burdened by their loved ones’ compulsions to stockpile newspapers, magazines, junk mail, plastic sacks full of unworn clothing, broken appliances, animals, even rotting food.

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Like ‘Aladdin's cave’
“My father-in-law is a really intelligent guy,” says Gorman, who was completely taken aback by the “Aladdin’s cave” of possessions he found when his wife’s dad was unexpectedly hospitalized. “He’s healthy and active, he still works and is constantly reading and learning. But he can’t throw anything away.”

Maureen Brown of Pacific Grove, Calif., is similarly perplexed by her mother-in-law’s hoarding, which has prompted multiple family interventions.

“My husband and I have cleaned up her place probably eight times,” says the 27-year-old daughter-in-law. “We’ve taken multiple truck loads to the county dump and had at least five separate garage sales. There was so much mail she hadn’t opened. We found tons of foreclosure notices, shut-off notices from the electricity company. I had to stop a foreclosure on her property twice.”

What is it that makes seemingly normal, even bright, witty, and charming people accumulate so much stuff that it threatens their homes, their health, their relationships, even their safety? How could otherwise functional people clutter their life to the extent that they lose important papers, block off entire rooms to their house, or pack them so tightly they have to live in a car?

It’s complicated, says Randy Frost, co-author of the therapy studies and professor of psychology at Smith College in Northampton, Mass.

Compulsive hoarders are different from die-hard collectors or “clutter bugs” in that they can’t stop acquiring things nor can they make themselves throw anything away. In addition to eBay bargains and department store finds, they’ll keep items that are completely useless to them like old newspapers and burned-out light bulbs and collect so much of it that it interferes with their basic ability to function. They can’t cook a meal, eat off the table, sleep in their bed or — worst case scenario — walk through their house without a tremendous amount of difficulty (in extreme cases, homes will have “goat paths” through towering piles of junk).

Not that hoarders see the situation they’re living in. According to Frost, many of his patients are “blind to the clutter” and will deny it’s their mess even when shown pictures of their own homes during therapy.

‘Need’ to save it
In addition to feeling a heightened responsibility for items (if someone could use it at some point, they “need” to save it), hoarders will assign emotional or aesthetic value to objects that other people don’t, i.e., they’ll feel sentimental about a garage sale puzzle or save things simply because they’re purple. They’ll also buy presents for people then forget to give them or “file” electricity bills on a pile with clothes, computer parts and canned corn due to an inability to focus attention and properly categorize.

“Hoarders have a fundamental inability to keep things organized,” says Frost. “Not just their possessions, but other things, like finishing tasks. We see a lot of attention deficit problems in hoarding.”

To complicate matters further, hoarders seldom stop hoarding without treatment, yet many refuse to seek help or recognize that they need it and become extremely antagonistic if others try to clean out their homes.

Elise Davis, 41, of Seattle, says her grandmother is in “total denial” about her hoarding problem even though the 86-year-old’s spare bedrooms are crammed to capacity and her kitchen drawers are jammed shut with “those little free packets of jam you get from Denny’s.”

“She’s gets really feisty if you try to approach her about it,” says Davis. “You can’t even clean up a pile of paper because she’s petrified that you’re going to get rid of something that she needs, even though it’s all just packets of jam and $4 half-slips from Penneys and geology textbooks from when my mom was in high school.”

Maureen Brown, who recently moved her 65-year-old mother-in-law into a condo (the bills all go to Brown and her husband), has also encountered resistance.

“My mother-in-law is still employed and has good health insurance and could get her counseling paid for, but she won’t go,” she says. “She feels it’s her right to collect as much stuff as she wants and refuses to acknowledge that it’s a problem.”

But compulsive hoarding can be a problem — for all concerned. According to a new study on the economic and social burden of hoarding (currently under review), 8 percent to 12 percent of hoarders have been evicted or threatened with eviction and many suffer from health problems like asthma, arthritis, high blood pressure, diabetes and obesity.

Deadly consequences
Hoarding can also be dangerous, even lethal.

In January 2006, a 62-year-old woman from Shelton, Wash., suffocated under a pile of clothing in her debris-filled home. In July of that same year, 14 firefighters were injured while putting out a three-alarm apartment fire in Queens that was classified a “Collyers’ Mansion,” named for the infamous brothers who, in 1947, suffocated and/or starved in a Harlem brownstone filled with more than 120 tons of floor-to-ceiling clutter.

And it doesn’t stop there. Condos and townhouses packed to the rafters with newspapers and other heavy objects can crack floor joints, pull on adjacent walls and structurally threaten the homes of neighbors. Animal hoarders can cause untold physical and psychological damage to the trapped creatures they’re “trying to help.”

And then there’s the vermin issue.

“I went into one home where the rats were so awful, they’d eaten through this woman’s oxygen lines,” says Seattle Police Officer Suzanne Parton. “The house was declared a biohazard — it was full of dead rats, rotting food, all kinds of paper and piles of clothes. It was nasty.”

Cases like these have spurred many cities and counties to create hoarding task forces, which cobble together agencies such as health departments, fire and police, family services, mental health services, housing, and public works in order to tackle the problem.

“Ten or fifteen years ago, we didn’t really look at this phenomenon as a hoarding problem,” says Jim Armstrong, chairman of the Fairfax County (Virginia) Hoarding Task Force, the first of its kind in the country. “We looked at it as a fire code violation or a sanitation violation or an animal abuse issue. But what we’re trying to do now is work in a coordinated fashion, to get involved before it gets out of hand and tragedy occurs.”

Christiana Bratiotis, research assistant and therapist for the Compulsive Hoarding Research Project at Boston University, sees task forces that combine mental health services with local enforcement agencies as “the ticket” to helping many hoarders.

“We have someone with the big stick saying you’re in violation of public health and safety codes and then we have the carrot, a social worker or public health nurse who tells them ‘We’ll advocate on your behalf and help you stave off an eviction while you’re in mental health treatment.’ That’s where we’re seeing lasting change.”

And as for those quick fixes such as reality TV shows that encourage family members living with “pack rats” and “clutter bugs” to take care of the issue with one quick “Clean Sweep?”

“I watch some of those pop culture shows and just cringe,” says Bratiotis, “because I know what the after effect of that kind of intervention is going to be. In six months time, the stuff will just be back.”

Diane Mapes is a Seattle freelance writer and author of "How to Date in a Post-Dating World."

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