Magazine Hoarding
People who hoard have a strong emotional attachment to things many of us see as unimportant, or even junk. They perceive a beauty or value in their “junk” that others do not see, and often keep something because they feel it may “come in handy” one day. Giving or, worse yet, throwing these items away causes a deep sense of loss.
In a recent article on the treatment of hoarding, Suzanne Otte, MBA, MSW and Gail Steketee, PhD theorized that “a combination of early experiences and cognitive challenges result in mistaken beliefs about and attachments to possessions, with resulting negative emotions that lead to avoidance behaviors (saving unneeded items) and clutter. In addition, objects that evoke feelings of positive attachment and experiences of pleasure may result in excessive acquiring and clutter.”
No one is sure why, but there are more male than female hoarders. Hoarding symptoms typically arise in the teen-age years, but most hoarders don’t seek help until after they turn 40. Hoarding is differentiated from “collecting” by:
• Acquiring many items, but never disposing of any of them
• A living space that is so cluttered it can no longer be used as it was intended to be
• Significant stress or impaired functioning related to the hoarding
Until recently, hoarding was considered a form of obsessive compulsive disorder (OCD). But according to psychologist and hoarding specialist David Tolin, PhD, “As we have more studies coming in, we’re increasingly seeing that it’s not. In fact, Tolin says, “It seems like there is not a particular special or strong relationship with OCD. Much more common are problems like major depression disorder, anxiety, and attention deficit disorder.”
Hoarding is now under consideration for inclusion in DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) as a stand-alone disorder, but it often occurs alongside another disorder. A recent study of 217 hoarders found that more than 50% of them also suffered from major depression, and almost 25% experienced generalized or social phobia. Less than 20% were also diagnosed with OCD. Interestingly, 10% were also identified as kleptomaniacs.
Most hoarders have little insight into the depth and impact of their disorder, which greatly frustrates their family, friends, and community. Hoarders may not seek treatment until outside agencies take action in the form of an eviction notice, the removal of a child from the home, or an order from the health or fire department to clean up the property.
Hoarding is very resistant to treatment. “When it comes to chronic and severe problems like drug use, bipolar disorder, severe depression, or hoarding,” Tolin says, “Even with the best of treatment, a lot of people will still be struggling.” Because of that, many therapists concentrate on “harm reduction” rather than healing – such as eliminating vermin, meeting fire and health standards, and decluttering the yard to appease the neighbors.
Hoarding is usually treated with a combination of therapy and depression medication. Cognitive behavior therapy (CBT) – a structured therapy that seeks to change unwanted behaviors and emotions by identifying and replacing the underlying negative and inaccurate thoughts and beliefs – is the treatment of choice for hoarding, with a 70% to 80% clinical improvement rate for those who complete therapy.
The prescription antidepressants most commonly prescribed to treat hoarding are selective serotonin reuptake inhibitors (SSRIs), such as escitalopram oxalate (Lexapro) and paroxetine (Paxil).
Given the recently established links between hoarding, depression and anxiety, it’s not surprising that CBT and anti-depression medication are leading treatments for all three conditions.
