When you can’t let go: What to do about hoarding

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Many of us have trouble parting with our possessions—even when we no longer need them. I have a collection of greeting cards I’ve been storing since childhood and will probably never look at again. My husband owns a few pieces of clothing older than our 17-year marriage.

Yet some people take their keepsakes to the extreme, holding onto decades’ worth of receipts, newspapers, and other seemingly useless items. They have hoarding disorder—a mental health condition characterized by a compulsive need to acquire and keep possessions, even when they’re not needed. It’s the subject of a review article in today’s New England Journal of Medicine.

Exactly when a “pack rat” crosses the line into true hoarding has to do with “the intensity with which they’re saving, and the difficulty getting rid of things,” says Dr. Jessica Rasmussen, an instructor in psychology at Harvard Medical School and Assistant in Psychology at Harvard-affiliated Massachusetts General Hospital.

A wave of recent TV shows like Hoarders and Hoarding: Buried Alive has publicized the rarest and most extreme form of hoarding—homes filled floor-to-ceiling with piles of boxes, books, knick-knacks, and rat- and bug-infested garbage. Severe hoarders can accumulate so much that they render their living spaces unusable—and dangerous.

Why do people hoard?

Anywhere from 2% to 6% of adults have hoarding disorder. The condition tends to run in families, although a specific “hoarding gene” hasn’t yet been found. Women seem to hoard more than men, but that gender distinction still needs to be proven.

People hoard for many reasons, says Dr. Gail Steketee, a leading hoarding researcher who is dean and professor at the Boston University School of Social Work. One reason is sentimental attachment. “There is some specific association to an object, or an object is seen to represent a person’s identity in some important way.” For example, a woman who views herself as a cook might hold on to every conceivable kitchen implement, to the point where her kitchen becomes too cluttered to use.

In other cases, people feel a sentimental attachment to certain possessions—like a shell they found on their first trip to the beach. They fear that if they throw away the object, they’ll lose the memory or experience. And there are people who see the usefulness in everything, even in items many of us would regard as junk, like an old nail or a ripped shoelace.

The dangers of hoarding

As piles of hoarded items grow, dust can collect on them, leading to COPD and other respiratory issues. Those piles can also block hallways and stairways, hampering mobility—especially in older adults who already struggle to get around. “If the person has arthritis and is having trouble navigating the house, they can be at greater risk for falling,” Dr. Rasmussen says. Clutter can contribute to other health hazards as well, including bug and rodent infestations and fire hazards.

Hoarding also takes an emotional toll on families and friends. “Sometimes people are frustrated by the notion of, ‘Why can’t my loved one just throw this away?'” Dr. Rasmussen says.

Often it’s a family member who finally makes the call for help, either because the person who is hoarding doesn’t recognize the problem or isn’t comfortable talking about it. “There is a lot of shame people have, a lot of embarrassment,” says Dr. Rasmussen. “There’s still a lot of stigma around it.”

Help for Hoarders

Though families fed up with hoarding might be tempted to get a dumpster and start cleaning house like they do in the hoarding TV shows, a full-scale cleanup can be emotionally distressing for the hoarder. Instead, experts recommend cognitive behavioral therapy (CBT) to help the person better understand why he or she is hoarding, and to improve decision making, organizational, and problem-solving skills. CBT can be done one-on-one with a therapist, or in a group or workshop setting.

It’s helpful to find a therapist who is trained in hoarding, Dr. Steketee suggests. You can find a database of providers in your area by visiting the International OCD Foundation’s website. Dr. Steketee has co-authored a book, Buried in Treasures: Help for Compulsive Acquiring, Saving, and Hoarding, which also can help hoarders dig out from the clutter.

Help for Pack Rats

Even many of us who aren’t true hoarders could do with a little downsizing, says Dr. Rasmussen. She suggests setting aside time on a regular basis—20 or 30 minutes—to go through and clean out your stuff.

To simplify the process, sort items into one of three categories:

• I’m definitely going to keep this item
• I’m definitely going to throw away or give away this item
• I’m not sure

Then follow through. “If you have a keep pile, everything should have a home or a place,” Dr. Rasmussen says. Get rid of the discard pile as soon as possible. With the unsure pile, ask yourself some simple questions like:

• Do I really need this?
• Am I going to use this?
• How often have I used this?
• Could I get something like this again if I need it?

Once you have an organizational system in place and can distinguish between what you need and what you want, you’ll have an easier time cleaning house and won’t feel as overwhelmed, Dr. Rasmussen says.