November 22, 2014

Medina
Partly cloudy
18°F

The Secret Life of a Hoarder

Dr. Ranjan

Dr. Ranjan

Many of you have been wondering why there is such an interest in media about compulsive hoarding –so much so that cable television now has two shows, ‘Hoarders’ and ‘Hoarding: Buried Alive’ depicting the lives of hoarders. I believe the primary reason is the newly found and welcome openness about mental health issues; but in addition, the stark and visible nature of the symptom related to compulsive hoarding also lends itself to intriguing viewing.

So, what exactly is compulsive hoarding (CH)?
CH is usually defined as the excessive acquisition of possessions which may be worthless, hazardous and even unsanitary; and an inability to use or discard them. The compulsive hoarders have long been described by lay people as ‘pack-rats’, a term which, in my opinion, should be abolished as it is demeaning and also distracts from the fact that CH is a neurobiological condition.

Heidi, the hoarder
Heidi, 42 and divorced, had been under my care for about two years for depression, when she got fired from her job. Shortly thereafter, when I saw her for a scheduled visit, she was in a panic. With tears flowing down her face, she said, “Doctor, how am I going to afford all the storage space I have?!” I was baffled as the topic of her renting storage space had never come up before in our sessions. When I asked her what the storage was all about, she cried harder and, in an embarrassed tone, described how she began hoarding items discarded by other people. She would go around her neighborhood on garbage collection days and pick up items from people’s garbage. The items ranged from broken furniture to used toys. She said she felt those items could still be used by others. At first, she collected everything in her house. When no more space was left inside her home, she collected items in her garage. In a few months, the garage was filled with items. She would park her car in the driveway, even during the winter months. As she could not resist collecting items, she began renting storage space — by now she had six of them!!

As she became further consumed by hoarding, and began spending more time on these activities, she would often be late for work. Eventually, this led to the loss of her job.

Ashley, the ‘animal lover’
Ashley was in treatment with me for bipolar disorder. She was in her 50’s and lived with her husband. In her monthly session with me, she would always talk about her pet cats. Almost every time we met, she would tell me how she “rescued” another cat. Over the course of a year in treatment with me, she had collected about twenty cats. She would complain that her married life was strained and her husband did not help her in caring for the cats. Nonetheless, she kept acquiring cats at an alarming rate. She suffered from asthma which was growing worse by the day. She informed me that her internist had suggested she call the Animal Protective League and ask them to find new homes for her cats, but she felt guilty and could not bring herself to do so. On the other hand, she became increasingly overwhelmed both psychologically and physically. In ensuing months, she developed pneumonia and had to be hospitalized.

How common is CH?
It affects up to two million people in the U.S.A. This is perhaps an underestimation as most hoarders do not report their symptoms or seek professional help.

What makes one likely to have CH?
Symptoms typically start in early adolescence and worsen over time. You have a higher risk of suffering from CH if one of your first-degree relatives suffers from it. Social isolation and major stressful life events (e.g.: death of a family member) could lead to hoarding behavior.

People who tend to be perfectionists and/or suffer from Obsessive Compulsive Personality Disorder (OCPD: this is not the same as Obsessive Compulsive Disorder or OCD) are at higher risk.

You are likely to have CH if you suffer from OCD. However, one also has a higher risk of CH if one suffers from dementia, schizophrenia, depression, bipolar disorder, social anxiety, anorexia, and impulse control disorder such as gambling, etc.

What items are typically hoarded?
A broad and unusual range of objects could be hoarded. Common items include printed material, mail, food, clothing, empty containers, and even animals.

Digital hoarding is a newer phenomenon where people collect files, music, movies, TV shows, computer games, and pornography on their computers.

Hoarding vs. collecting
The distinction may not be apparent to some people but collectors almost always seek items that have true value and they display their prized items in an organized manner. On the other hand, hoarders not only acquire items of minimal or no value but also keep them in boxes or disorganized piles.

When does hoarding become a problem?
CH becomes a challenging problem when it begins to interfere with one’s day-to-day functioning and/or creates social isolation. In some cases, CH becomes a safety hazard (e.g.: tripping, fire) and a health issue (e.g.: breathing problems due to animals and their body waste, etc.).

What causes CH?
You are probably wondering why Heidi and Ashley could not resist their compulsions or impulses, and what caused them to behave the way they did. Well, we do not clearly understand what causes CH. We used to believe it was a subtype of OCD, but recent research suggests it may be related to poor impulse control and difficulties in the processing of information.

How to help a loved one with CH?
Since compulsive hoarders are typically not distressed by their symptoms, the first step in helping people with CH is to motivate them to seek treatment.

Showing empathy, not arguing, and respecting the person’s autonomy are very critical to striking constructive conversations with your loved one.

If your loved one gets motivated to seek treatment, the combination of certain medication [a tricyclic antidepressant clomipramine or selective serotonin re-uptake inhibitors (SSRI) such as paroxetine, sertraline, etc.] and a form of Cognitive Behavioral Therapy known as Exposure and Response Prevention (ERP) is most helpful.

You should realize CH is very difficult to treat even when the afflicted person is motivated. But there is always hope!!

Next Week: Mirror Mirror On The Wall: Obsessing About Perfection