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Hoarding, a unique disorder

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March 14th, 2010
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ERC_0310_newspaper-horder
Is your dining room table piled with so much stuff you can t eat there? Does it stress you out to think about letting go of things? Are relationships with friends and family affected by your cluttered home? If so, you may have hoarding disorder.

What is hoarding?

People with hoarding disorder cannot part with things they acquire. Because of the possessions they have accumulated, hoarders experience mental distress or physical challenges and are unable to use living spaces for their intended purposes. Usually people with hoarding disorder struggle with decision-making, organization, procrastination, and perfectionism. It s a continuum, says Roberta Feldhausen, A.P.R.N.-M.H., director of ' mental health services atRiderwood. ' People who don t have a problem could have some of these traits, but there are others who have full-blown mental illness.

Causes of hoarding

Hoarders cling to their precious objects, in part, because they have a hard time categorizing them. Each item seems to have something so unique about it that it must be placed in its own group. As a result, organization is difficult and ends up as a multitude of piles that does not appear organized at all. The most commonly hoarded items are containers, clothing, newspapers, and other paper products. People who hoard collect virtually anything that comes into their sphere of ownership, says Randy Frost, Ph.D., coauthor ofStuff: Compulsive Hoarding and the Meaning of Things(Houghton Mifflin, April 2010). There s something about ownership that s very important. If they own it, people with hoarding problems have great difficulty keeping it organized. If they don t own it, organization is not so hard for them. This difficulty may result from brain chemistry. There are certain places in the brain where information is processed that, for people who hoard, operate differently, says Frost. Hoarders also attach emotional value to their things in ways that most people do not. If I asked you to throw away your driver s license, you d think I was crazy and you wouldn t do it, he explains. That s the kind of sense people who hoard have when someone asks them to throw something away. They think they may need it in the future. Some hoarders consider their belongings part of their identity. There s a sense that if I lose this object or throw it away, I m losing a part of myself, says Frost. Who I am will be different somehow if I don t have it. Throwing things away can also jeopardize the sense of safety their items create. Others consider their possessions human, and getting rid of them feels like they re losing a friend. Another group saves things because they believe these objects are beautiful and it s their responsibility to appreciate them, says Frost. And some attachments have to do with not being able to pass up an opportunity presented by an object. For example, people may accumulate piles of junk mail because they believe they contain a deal. Regardless of the reasons people give, according to Frost, two deviations from the norm are apparent in those who hoard: There s the processing information part and the nature of the attachments. Just one of these things is probably not going to result in a hoarding problem; but if they occur together, then it might.

Who is affected?

Older adults are the most affected, but it s not because they grew up in the Depression. Material deprivation early in life doesn t seem to be associated with the development of hoarding, says Frost. We see hoarding behavior in people who grew up in the lap of luxury. Usually the disorder which can develop in anyone starts during childhood and becomes increasingly problematic as people get older. In more than 80% of hoarding cases among older adults, the disorder poses health risks through unsanitary conditions, inability to perform daily activities (eating, bathing), fall and fire hazards, and social isolation.

Treating hoarding

When it s happening, you have to figure out why. So the person needs to be evaluated, says Danielle Anderson, M.D., assistant professor of psychiatry at the University of Chicago. Especially with older adults, other factors may be at play. It could be depression, dementia, or Diogenes syndrome. A geropsychologist or geriatric psychiatrist is the best bet for teasing apart what is really going on, says Catherine R. Ayers, Ph.D., assistant clinical professor of psychiatry at the University of California, San Diego. When you re working with older people, it s a complicated diagnostic picture, she explains. There are some things that look like hoarding but are not. If a person doesn t feel like cleaning up, that can be depression. Keeping things can be related to dementia. For those with hoarding disorder, There is no national consensus on treatment guidelines, says XinQi Dong, M.D., geriatric specialist at Rush University Medical Center in Chicago. However, Ayers is on the case. I just completed a study that looked at treatment outcomes to cognitive-behavioral therapy, she says. In younger populations, it certainly has been effective. Unfortunately, in our older population, it was not as effective. She thinks it s related to differences in brain functioning and hopes to begin a new study to find better treatment options soon. Even though we re in development, there is help out there, and as long as people seek treatment and want to change, I think there s hope. For information on treatment for hoarding disorder, visitwww.ocfoundation.org.

What to do when a loved one is hoarding

Nobody is going to throw things out if somebody just tells them to, says Ayers. It s best to approach a loved one in a kind, caring, and compassionate way.
  • Imagine yourself in the other person s shoes. How would you want others to talk to you?
  • Don t be judgmental (e.g., What kind of person lives like this? ) or try to persuade people to change.
  • Focus on creating a living space that is safe and organized with what is already there. Discussions of discarding can come later.
  • Don t touch the person s belongings without permission. People who hoard often get upset when others touch their things.
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