The images can be overwhelming and shocking. Mounds of clothes, toys, books, papers, newspapers, artworks, and boxes strewn all over rooms in a house. The spaces contain so much clutter that it can block entrances to rooms, and in some cases, prevent the residents from performing everyday activities.
Our society sometimes refers to individuals with hoarding disorder as pack rats. These are people who collect so much stuff that at times it can be dangerous to their safety or that of others. Television shows like “Hoarders” and “Hoarders Buried Alive” have brought those images into our homes. But psychologists warn that those shows can be sensationalistic, focusing on extreme cases, instead of capturing the reality of less severe, but still problematic, cases.
Kiara Timpano, associate professor of psychology at the University of Miami and director of the Program for Anxiety, Stress, and OCD (PASO), has been studying the condition since 2002. She said that the underlying causes and consequences of hoarding are complex. Hoarding disorder is a psychiatric condition that was recognized as a syndrome in 2013. In addition to having significant levels of clutter, people who hoard have strong attachments to their belongings and have a difficult time getting rid of them.
“What we might see as non-important or non-valuable stuff is a treasure to them,” said Timpano. “How can you ask someone to give up their treasures?”
In a study published in the Journal of Obsessive Compulsive and Related Disorders in April, Timpano and several other colleagues compared 217 individuals with hoarding disorder with 130 people who did not hoard. Using a technique called network analysis, they sought to better understand how the core symptoms of hoarding, associated clinical features, and saving motives interact with one another.
One of the key findings was that those with hoarding disorder save material things for much the same reason as those who don’t hoard. They are “saving things for sentimental reasons, not wanting to be wasteful, collecting things because they aesthetically like them and keeping things because they serve as reminders for important information,” said Timpano. The difference between the two groups is in the intensity for collecting or saving belongings, and how the symptoms relate to one another.
Timpano’s study revealed that symptoms to acquire should be considered as important as behaviors that lead to saving and clutter in how we define hoarding disorder, particularly because these tendencies help explain the link between hoarding and higher levels of anxiety.
A second important finding was that clutter was the main contributor to both general impairment and interpersonal difficulties for hoarding patients, which partially explains high levels of depression reported by those who hoard. Clutter can likewise be very serious in hoarding and can be a fire hazard in some apartments and may cause older patients to fall, according to Timpano.
Although it is not fully understood how hoarding may impact social relationships, it is known that the symptoms can put significant strains on relationships. From the patient’s view, objects provide comfort and may at times feel safer than people.
However, for family members who must deal with the clutter or who worry about their elderly parent living in these conditions, “this can cause strain in their relationships,” Timpano said. The PASO lab treats patients with the condition, and Timpano often receives calls from adult children of patients who desperately want to help their parents because they accumulate too much clutter.
But in order to benefit from treatment, someone with hoarding disorder must seek it.
Treatment for the condition is difficult. “Those with hoarding [disorder] don’t always recognize how serious their condition is,” said Timpano. If they do, often they keep their condition private because of fear of the stigma associated with it.
Once in therapy, however, the patient can make progress through cognitive behavioral therapy, where they are shown how to organize, sort, and discard their possessions. And in many cases, they are taught to lead a healthier life. The therapy uses a step approach to tackle the problem.
“Ultimately, we may do a full clean up of the house,” said Timpano. “But we certainly do not start with that.”
Some adult children have taken the drastic measure of throwing away much of the clutter from a parent’s home while the parent was away and have suffered the consequences.
“They call me to say, ‘we thought she would be happy,’ and instead it caused major issues,” said Timpano. Many of those cases where the possessions were discarded without the hoarder’s consent or knowledge resulted in relapses, she added.
Timpano and colleagues are currently continuing their research, funded by the National Institute of Mental Health, about hoarding by studying decision-making difficulties that may be contributing to the saving, collecting, and clutter behaviors.
