“Julia,” a retired nurse from Alabama, has saved every single pamphlet her church has ever given her for the last 30 years. She also has an inordinate amount of food squirreled away in every corner of her home. “It’s no one’s business but my own,” she states matter-of-factly. “It’s my stuff, I don’t know why everyone is so concerned. I keep food in case something happens, and a little mold never hurt anyone,” she says, amused. “It’s just like penicillin.” Julia is like most hoarders — blind to the conditions they live in. “If I wanted to throw anything away, I would.”
More than six million people in the United States are consumed with the compulsive need to save, acquire, and collect an overwhelming amount of stuff. Things that they possess now own them. Old newspapers, garbage, expired food, clothing, and sometimes animals are stockpiled, stacked, and saved in so many homes that some states have implemented hoarding task forces to handle the situations.
Hoarding has been thrust into the spotlight by a number of reality shows on television, including A&E’s “Hoarders” and TLC’s “Hoarding: Buried Alive,” which looks at people who are so unable to part with their belongings they are on the verge of a personal crisis. Although hoarding is not yet seen as a mental disorder, there is a proposal before the American Psychiatric Association to classify it as one.
A key to understanding compulsive hoarding can be found in the frontal cortical region of the brain, specifically the anterior cingulate cortex (ACC). This region of the brain is associated with many cognitive functions that make everyday life possible. When there is an abnormality or a lesion, many patients have trouble processing or regulating even the simplest of tasks. The ACC is in motion when you decide to take an action or make a decision; it is also responsible for planning, regulating emotions, executive function, organization, and long-term memory. Having your ACC damaged can create a strong emotional deficit.
A study done by Dr. Sanjaya Saxena, director of the Obsessive-Compulsive Disorders Program at the University of California, San Diego, used positron emission tomography (PET) to compare the glucose metabolism in the ACC in the brains of hoarders with that of nonhoarders. If the neural activity in a region of the brain lowers, so does the metabolic activity. The brain relies on glucose to function. It is the brain’s energy source, its food. When levels of metabolic glucose are low, it will result in psychological impairment that will affect “effortful decision-making.” Hoarders showed lower levels of activity in the ACC than their nonhoarding counterparts.
“When we talk to people with hoarding problems they will tell us that they have great difficulty with making decisions — decisions of any kind,” says Dr. Randy Frost, a psychology professor at Smith College in Northampton, Massachusetts. He and Dr. Gail Steketee, a professor and acting dean at Boston University School of Social Work, have been jointly researching compulsive hoarding for more than 15 years. They have also co-written the book “Stuff: Compulsive Hoarding and the Meaning of Things.”
According to Frost, compulsive hoarders frequently report problems with deciding what to do about most things they are faced with. “It’s not just with possessions. There is some kind of convergence of the phenomenological experience of hoarding that is being seen in fMRI studies related to hoarding.”
What makes hoarding so complicated to understand is the conflicting emotions and rationalization that is brought on by mere objects. Hoarders will assign value to items that most people would see as dispensable. A broken appliances or hanger can bring on immense joy, and the thought of discarding or throwing it away will fill them with anxiety and fear. “There is a much wider arrange of emotional states,” says Steketee. “In hoarding, you see both very positive strong emotional responses and strong negative ones. We see delight, surprise, and enjoyment in objects.”