■ “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 non-hoarders. 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 non-hoarding 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 Dr. 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 Dr. Steketee. “In hoarding, you see both very positive strong emotional responses and strong negative ones. We see delight, surprise and enjoyment in objects.”
__Researchers have also found a link between heredity and hoarding. “It’s been shown in a half a dozen or more studies that people who hoard are more likely to have a family history of hoarding,” says Dr. Frost. “There are also some studies about genetic links and even a twin study looking at hoarding behavior, suggesting that hoarding may indeed be partly heritable.”
__Reality TV presents us with hoarding for our entertainment—wrapping up each episode with some progress. In real life, however, solutions to problems brewing for decades—even generations, if there is a hereditary factor—is not so simple. Drs. Frost and Steketee both agree that although the house needs to be cleaned you first have to look at the behavior that is causing it to be cluttered.
__Television’s solution only works in the short-term, says Dr. Steketee. “When there is a lot of clutter, if you just pick it all up and throw it all out then there is much less clutter. But that doesn’t mean that over the next few weeks and months people won’t re-accumulate exactly the same sort of level of clutter to fill their homes,” Dr. Steketee says, noting that there are some situations when people are in danger, and the clutter must be cleaned.
In the long run, though, it’s more important to teach these people skills to deal with their stuff than just dealing with the stuff itself. “Every time the mail arrives, instead of just piling it in a corner, they actually go through it and throw some of it out, and only keep the things that are critical for them to pay their bills. You help them set rules,” Dr. Steketee says.
__Cognitive behavioral therapy (CBT) is a treatment being offered to help sufferers of compulsive hoarding disorders. The long-term therapy and monitoring teaches hoarders how to make practical, rational decisions and offers organization tactics for day-to-day living.
__“We help with avoidance conditioning and some approach-conditioning behaviors that are associated with hoarding,” Dr. Frost says. “We can’t tell people what to think about their possessions, or how to feel about their possessions. But what we can do is to get them to take a step back and look at their beliefs about possessions and try to evaluate their validity.” They try to make the hoarders into more objective “scientists,” so they can see their beliefs are conditional. “One of the most frequent beliefs people have is that they can’t stand it if they threw something away—that is a conditional belief. If we can get them to start testing that as a hypothesis, rather then have them simply believe that they can’t stand it, then we may be able to change their beliefs in attachments to things.”
__Hoarding is a problem that is difficult to understand if you are an outsider. A “clean sweep” will not fix the deep-seated emotions that go into manic clutter. Family members of a hoarder should seek help if faced with the issue, as it is not easily solved with a mop and tough love. Understanding and compassion are needed even if you are exasperated by your loved one’s surroundings.
Julia’s family has tried on three occasions to stage an intervention to help her with her situation. She says they humiliated her, and now she will not allow them to come over. Julia does not understand why her family is so upset with her and is distraught about not seeing her children. When asked if she would consider treatment, she responded, “Why should I change? I want to be left in peace. I miss my children, but I have lived this way for over 30 years—how could I live any other way?” [bw]
To inquire about treatment or help, log on to ocfoundation.org/hoarding.