Call to Collect As Understanding of Hoarding Grows, So Does the Scope of the Issue

Occasionally, we see reports of overloaded homes on the evening news.As footage rolls of law enforcement and public health officials prying open doors to reveal ceiling-high stacks of books, magazines, appliances, and knickknacks, many people will shake their heads in disgust and disbelief.

However, what many fail to realize is that hoarding – the uncontrollable urge to acquire and keep things for years on end – is a very real behavioral problem that is only now beginning to receive greater attention.

Dr. Randy Frost, a psychology professor at Smith College, said there was a time when he, too, knew little about the disorder. But today, he’s one of the leading researchers on hoarding in the country, having published the first comprehensive study of compulsive hoarding in 1993, and speaking on the subject in various forums, including the national Hoarding and Cluttering Conference and several news outlets including Dateline, 20/20, and NPR. And he said that the more he learns, the larger the problem seems to grow.

In the Stacks

Frost explained that he was teaching a seminar on Obsessive Compulsive Disorder (OCD) several years ago when a student pointed out that the classs had yet to cover hoarding in any depth.

“I realized there wasn’t much about hoarding included in the class,” he said, adding that he began researching the topic to boost his own knowledge, and soon developed a keen interest as he compiled bits and pieces of documented hoarding cases.

The search for more information soon led Frost to place an ad in the Daily Hampshire Gazette in search of potential research subjects. He put a call out for ‘chronic savers’ and ‘pack rats,’ and about 100 calls came in. Not all cases fell within the parameters of a hoarding diagnosis, but the number of responses to one ad in a community newspaper did call attention to the fact that hoarding may be more widespread than previously thought.

It also led Frost and his research partner, Dr. Gail Steketee, to delve even deeper into the issue and now the two are among the leading experts on hoarding in the country. They’ve led a number of seminars on the subject nationally after coordinating the New England Hoarding Consortium, published a therapist’s guide to treating the disorder as well as a workbook for patients, and have recently published a third book with the Oxford University Press, Buried in Treasures:

elp for Compulsive Acquiring, Saving, and Hoarding, which will be available early next year.

But in addition, Frost and Steketee have also mobilized efforts to combat the problem locally through the Hoarding Task Force, which serves Hampden, Hampshire, and Franklin counties through the combined efforts of a number of organizations such as the Tenancy Preservation Program, Western Mass. Legal Services, and Clutterer’s Anonymous. The task force also works closely with local health departments.

“Health departments run into this all the time,” said Frost. “Often, they get stuck in the middle. They want to help the person, but it’s also their duty to maintain safe, healthy, environments, and that can mean condemning a house and clearing out everything inside. That addresses the immediate health and safety problem, but not the behavioral problem – and it won’t be long before the situation is out of control again.

“It’s also a real trauma to the person involved,” Frost continued, “and in the future, they’ll be less likely to ask for help.”

Working with various health departments to address the larger issue, he said, continues to call greater attention to the disorder and the ways it can be identified and treated before the point at which laws must be enforced.

Clutter, Clutter Everywhere

The three features of the disorder, Frost explained, are a tendency to acquire, an inability to get rid of things, and an inability to remain organized. People acquire things in a number of ways – compulsive buying, Dumpster diving, picking up free things from the side of the road, tag and estate sales, or in rare cases, by stealing.

What’s more, hoarding can be far more disruptive than an out-of-control collection or two. Frost said several people amass so many things that they must create pathways through their homes in order to walk; some people have so many possessions they must ‘swim’ through their houses.

Obsession with acquiring and keeping things could be a lifelong problem, or triggered later in life, sometimes due to a traumatic event. The items acquired also vary; while some people will hoard anything and everything, other people show a tendency toward specific objects, such as containers, newspapers, clothes, or even animals.

“Some peculiar things we see in hoarding are an attentional bias for unusual details,” he said. “They see something that no one else does in an object, as though it has potential. We think these are signals of safety … people find comfort and calm among their things. But if it interferes with someone’s ability to function in any way, then it’s an issue.”

Further, new findings suggest that hoarding might be a broader disorder than previously thought. While often diagnosed as a form of OCD, now some research suggests that it is seen in conjunction with other issues, which could also mean that more people suffer from hoarding than is generally believed.

“We began working with the Center for Anxiety and Related Disorders in Boston and the Institute of Living in Hartford, and once we started looking, we began finding a lot of people with hoarding problems,” said Frost. “It steamrolled a bit – there were a number of studies across the country that connected hoarding with social phobia, depression, attention deficit disorder … there’s a lot of overlap, and it’s not entirely clear that it’s a symptom of a larger issue.”

Because of that widening gamut of related behavioral health issues, treatment of hoarding is being closely examined. Frost said that, in the past, some therapies for OCD have proven effective, however medication to treat hoarding is still difficult to identify in many patients.

Tailored, cognitive-behavioral therapy seems to hold the most promise, as it teaches patients to recognize errors in thinking and often includes home visits by a clinician, consultations with professional organizers, and the development of sorting, organizing, and filing plans. Several aspects of that approach were gleaned from the research Frost and Steketee have completed over the past decade.

Clearing the Way

Regardless of its root causes, however, hoarding can lead to many serious problems, including eviction from a home or apartment due to health code violations, loss of the support of friends and family, and safety-in-the-home issues, especially among the elderly.

“We see hoarding more in the elderly, but that’s not necessarily because the disorder began late in life, but because the community pays more attention to that population,” Frost said.

By paying attention to the disorder itself, various mental and public health officials can better identify hoarding among people of all ages and walks of life, and Frost said hoarders don’t favor any one age bracket or social stratum.

“We’ve seen hoarders with a high school education and hoarders with Ph.D.s,” he said, adding that most people possess the same emotions or attachments to things as hoarders, but without the incessant urge to collect.

“What we’re seeing is that this isn’t so unusual,” said Frost. “And slowly, people are gaining a better understanding of hoarding and accepting that it is a health-related issue.”