When Possessions Rule Your Life

by: Julia M. Klein

Not until my mother died last year, at 82, did I realize how much she had saved. Her attic, closets and drawers overflowed with Playbills and travel brochures; size two designer dresses from the 1960s; broken appliances; baby furniture; expense receipts and stock annual reports; scrapbooks and photo albums; magazines and newspaper clippings; and every letter, greeting card and announcement she had ever received. It was an embarrassment of riches—and of junk. My exasperation was tempered by a sudden realization: I was hoarding identical emblems of my past, from Playbills and newspaper clippings to ancient letters from almost-forgotten lovers.

So it was with both interest and trepidation that I picked up Randy O. Frost and Gail Steketee’s new book, Stuff: Compulsive Hoarding and the Meaning of Things. To my relief, I discovered that my mother and I were rank amateurs compared with the pseudonymous subjects of this book, who live among clutter so overwhelming that they scarcely have room to walk, or eat, or sleep. Before treatment, Irene mixed empty boxes, expired coupons and old newspapers with photographs of her children, important documents, even cash. Pamela tried to take care of 200 cats, filling her house with excrement. Ralph stockpiled rusty, broken objects and stacked moldy newspapers so high that they threatened to crush him.

Frost, professor of psychology at Smith College, and Steketee, professor and dean of the School of Social Work at Boston University, have been studying hoarding for nearly two decades and have developed a cognitive-behavioral approach to helping hard-case hoarders. But their book, with its insight into the magic and meaning of ordinary objects, speaks to the hoarder in all of us. I asked Frost to elaborate on some of their findings. (Read an excerpt from Stuff.)

Q. How did you first become interested in hoarding?

A. My interest began with a simple question from a student. We were discussing obsessive-compulsive disorder, and the student asked, “Why are there no studies of hoarding?” I couldn’t answer. So we placed an ad in the local newspaper looking for a “pack rat” to interview. We got more than 100 phone calls. I was hooked.

A Q&A with Randy O. Frost and Gail Steketee, Authors of Stuff: Compulsive Hoarding and the Meaning of Things

Q: What is hoarding, and how does it differ from collecting?

A: Two behaviors characterize hoarding: acquiring too many possessions and difficulty in getting rid of them when they are no longer useful or needed. When these behaviors lead to the kind of clutter and disorganization that disrupts or threatens a person's health or safety, or they lead to significant distress, then hoarding becomes a disorder. Simply collecting or owning lots of things does not qualify as hoarding.

A major feature of hoarding is the large amount of disorganized clutter that creates chaos in the home. Rooms can no longer be used as they were intended, moving around the house is difficult, exits are blocked, and life inside the home becomes dysfunctional. Collectors typically keep their possessions well organized, and each item differs from other items to form an interesting and often valuable collection. Further, an important purpose of collecting is to display the special items so that others can appreciate them. People who hoard are seldom able to accomplish such goals.

Q: What kinds of things do hoarders typically save?

A: While it may appear that people who hoard save only trash or things of no real value, in fact most people who hoard save almost everything. Often this includes things that were purchased but never removed from their original wrappers. The most frequent items saved are clothes and newspapers. Other commonly hoarded items include containers, junk mail, books, and craft items.

Q: What factors contribute to the development of hoarding?

A: People who hoard often have deficits in the way they process information. For example, they are often highly distractible and show symptoms of attention deficit hyperactivity disorder. These symptoms make is difficult for them to concentrate on a task without being diverted by other things..." More (scroll towards the bottom of the Amazon order page for the balance of this interview)

Interview with Randy Frost, Part I Compulsive Hoarding Disorder Definition and Causes

By Sere Halverson

Editor’s Note: We recently sat down with Randy Frost to discuss compulsive hoarding disorder – a fascinating and complex problem that affects from 2.5 to 5 percent of the population, many who are elderly.

Randy has a Ph.D. in clinical psychology and is a professor of psychology at Smith College. He is one of the leading authorities on compulsive hoarding disorder. He has co-authored two books, a self-help book entitled Buried in Treasures: Help for Compulsive Acquiring, Saving and Hoarding, and a therapist manual entitled Compulsive Hoarding and Acquiring: Therapist Guide and Workbook. Randy has been featured on The Dr. Oz Show, NPR and ABC News and has been interviewed for articles for numerous publications, including The Wall Street Journal, The New York Times, and Newsweek.

Randy had so much valuable information about the causes and characteristics of hoarding, and how best to try to help a loved one with a hoarding problem, that we’ve divided this interview into several parts that we’ll post throughout the coming weeks. Keep checking back for more.

icarevillage: Randy, will you explain to our readers what compulsive hoarding disorder is?

Randy: Compulsive hoarding is the acquisition of and the failure to discard a large number of possessions. Many of us engage in this type of behavior to some extent. We all collect things, we all have a lot more possessions than we probably need. But there are two important distinctions that point to a disorder rather than the more common behavior of collecting.

First, the accumulation is so vast that it clutters living spaces and makes them unusable. For instance, you can’t sit on the couch because it’s full of stuff, as is the kitchen sink, the kitchen table, the bathtub, and so on.

The other component is the level of distress and impairment the hoarding causes. While the person usually enjoys the act of collecting, the distress occurs when they worry about someone seeing the home, or become anxious about having to get rid of any possessions.

The hoarding causes significant impairment. It affects their ability to handle financial affairs, because when your home is filled with disorganized stuff, it’s easy to lose bills and important papers. The home is often unsafe because exits are blocked. There are fire hazards.

Appliances often stay broken. The person with a hoarding problem is afraid to have anyone into the house for repairs because the home’s condition may be reported to authorities. We’ve seen elderly people who have no working refrigerator, no working stove, sometimes no working hot water – sometimes no water at all, which means no working bathroom.

icarevillage: So we’re talking about much, much more than just a disorganized, messy house. Hoarding can become a serious problem that causes unfit living conditions and puts people in danger. Are the elderly more susceptible to compulsive hoarding?

Randy: We do see a lot of hoarding behavior in the elderly. But interestingly, when we ask older people how long they have been hoarding and how long their home has been like this, most of them tell us it’s been going on all their lives.

So we’re not sure if there is a separate kind of phenomenon of hoarding that begins in old age. Most of the research on the onset of hoarding suggests that the behavior itself starts sometime around age 12 or 13, but doesn’t become a problem for several decades after that.

One of the reasons why hoarding in the elderly may be so much more apparent to us is that while the hoarding behavior may have always been present, when people get older they lose some of their ability to cognitively process things. They lose some of their resources for handling things, they move more slowly, and so forth. So aging increases the severity of the behavior. But we suspect that the hoarding behavior probably was there most of their lives. And we’ve seen people who are as young as 19 with serious hoarding problems, so it’s definitely not limited to the elderly.

icarevillage: Do you know what causes hoarding?

Randy: We think that people who hoard process information in several unusual ways. A person with a hoarding problem pays attention to the unique detail in objects, such as the shape, the color, the texture, and so forth. For example, take a bottle cap. They might focus on these details and give it value rather than focusing on the fact that it’s a bottle cap without a bottle and therefore has no useful function.

Another feature of information processing that differs in the person that hoards has to do with the amount of information they pay attention to with respect to an object. So they will look at an object and focus on all its unusual details and those details will have meaning. When that person tries to make a decision about that object, they’re faced with many more details to consider than most of us are. Therefore, making any kind of decision requires taking a large amount of information and filtering it down and using it to come to a conclusion – and this is very difficult for them. It affects everything they do, from ordering off a menu to choosing what to wear in the morning. These are decisions they sometimes struggle with for long periods of time.

The other characteristic of people who hoard has to do with the way in which they organize their lives. Most of us organize our lives categorically. We get an electricity bill, we put it the category called bills, and when we need to find it we can go to that location. But people who hoard seem for the most part to organize visually and spatially instead. So if you ask them where their last electricity bill is, they’re likely to tell you that it is halfway down in the middle of the pile in this room, because that’s where they saw it last. Their organization occurs by remembering where objects are in space.

Now, a lot of us organize some things this way. My desk is organized like this – I have piles of things and I remember what’s there because I last saw it there. But if I were to do that for all my possessions, that system would break down quickly..." More

Hoarding Intervention Interview

In this hoarding intervention interview, you will read expert advice about hoarding disorder, when it's time to step in to help a loved one and how to perform a successful intervention. Dr. Simon Rego is a licensed clinical psychologist, and board-certified in Cognitive Behavioral Psychology, which is evidence-based treatment of choice for hoarding. As Director of Clinical Training at the American Institute for Cognitive Therapy, he has treated many hoarders.

Hoarding Intervention Interview with Dr. Simon Rego

LTK: How does a loved one know when hoarding has become a problem and an intervention needs to take place?

Dr. Simon Rego (SR): While we all have the tendency to acquire and save things at times, hoarding is typically only considered to be a clinical problem after it becomes “compulsive”. By compulsive, we mean that the acquiring and then failing to discard possessions turns into a repetitive behavior that the person feels driven to perform, despite the fact that the items may be of limited value. The compulsive behavior also causes extremely negative consequences (e.g., rooms so cluttered that they cannot be used as intended), and/or significant distress or impairment in the person’s ability to function. A quick way to determine whether the hoarding has reached clinical levels is to check to see if rooms/objects cannot be used as intended. If the person can no longer function at home, work, school or socially due to his/her hoarding, or if any interference in their compulsion to hoard (e.g., family members throwing out items) causes him/her to get very upset.

LTK: What is the first step when trying to help someone with a hoarding disorder?

SR: If you are a concerned friend or family member and can find a treatment provider trained to treat compulsive hoarding, you may actually have some success in getting the person in the door to get some help. Compulsive hoarders may lose motivation quickly once they realize the treatment will focus on having them “debulk” or eliminate a large percentage of the items that they have acquired. They may also be initially hesitant if they previously have had unsuccessful treatment or if family members have tried to eliminate their items without consent in the past. They may also defend their behavior as not that much different as anyone else’s collecting of things or come up with reasons why they find it important to keep their materials.

LTK: How does an intervention for hoarding work?

SR: The treatment of choice for compulsive hoarding is something called Cognitive Behavioral Therapy (CBT). CBT is an evidence-based treatment that has patients examine and challenge their problematic beliefs and also identify and change any problematic behavioral patterns. In the case of compulsive hoarding, the treatment targets the thoughts that lead to the excessive acquisition of materials of limited value (e.g., “This soap is on sale! It is such a good deal that I should buy a crate!”), the saving of these materials (e.g., “I bet Aunt Joan will be able to use this!”), and the way the person tries to organize these materials (e.g., “I’m not sure where it should go.”). The treatment then targets the avoidance behaviors that compulsive hoarders usually engage in, usually in response to the distress caused by their dysfunctional beliefs. For example, compulsive hoarders may avoid storing an object out of sight because they believe they will lose the memory the item generates.

Treatment has patients gradually and intentionally confront these beliefs using something called exposure and response prevention. For example, this may involve sorting items into categories and ranking them in terms of how anxiety provoking it would be to discard them, and then selecting an item that provokes less anxiety (at first) and then discarding it. In the process, negative thoughts become challenged and corrected, and a tolerance to anxiety can be built. Over time, if this is done in a structured, prolonged, and repetitive manner, it gets increasingly easier for compulsive hoarders to debulk materials from their home (i.e., momentum builds).

LTK: Do you always need a professional, such as a counselor, involved in an intervention?

SR: Some people on the less severe end of the spectrum may be quite successful doing the work on their own. Other people may do well using a good self-help book. Still others correct the issue with the help of family members or friends, or by hiring a de-cluttering service. It is when the hoarding has reached clinical levels (e.g., rooms cannot be used as intended or the person cannot function in other areas of his or her life or becomes very distressed when unable to/prevented from hoarding) that professional assistance becomes essential. One other thing to consider, however, is how long the issue has been a problem, and if it seems to be growing worse (i.e., rooms can still be used, but are getting very cluttered). In this case, it may be wise to act in advance of the problem getting bigger and reach out for professional assistance from someone with expertise in treating this problem.

LTK: What are some common mistakes loved ones make when trying to help a loved one with hoarding disorder?

SR: The first mistake that loved ones make with compulsive hoarders is to assume that it is not a psychological disorder. It can be easy to fall into the trap of thinking that the person with the problem simply has to “push” him or herself in order to change. As with any other psychological condition, this attitude is very unhelpful and can often make the compulsive hoarder feel alienated and more resistant to change!

Another common mistake loved ones make is trying to “help” by throwing out materials themselves – either with or without the consent of the compulsive hoarder. They may even hire a cleaning service to remove all of the materials if their patience runs thin! This is unhelpful, as it often causes the compulsive hoarder to experience great distress (which can impact relationships), and ultimately, unless the person is successfully treated, he or she will likely start to acquire and save again over time.

And yet another mistake loved ones make is to not address the problem at all! Either by ignoring it, limiting it to certain areas that they are willing to “live” with, or writing it off as part of the person’s “quirkiness” – in order to not upset him/her. Although this may “help” the person in the short-term, it only allows the problematic behaviors and thoughts to grow over time..." More