HOARDING

Hoarding is usually considered a subtype of Obsessive Compulsive Disorder (OCD). Like other compulsive behaviors, hoarding is an effort to manage the anxiety raised by obsessive doubts. There are varying levels of hoarding behavior. A diagnosis of OCD of the hoarding type is made when there is significant distress or disruption to feelings of self-worth, interpersonal relationships, education, occupation, housing, finances, legal issues, or health as a result of hoarding behavior.

Symptoms vary from person to person, but may include:

Saving items seen by most people as unneeded or worthless, (i.e., not true collectibles).

Compulsively buying or saving excessive quantities of items of any kind.

Treating all saved items as equally valuable--whether or not the object has sentimental, financial or functional value.

Experiencing intense anxiety or distress when attempting to discard-or even think about discarding-what most others view as useless objects.

Engaging in saving activity to combat anxiety-provoking thoughts such as: "What if I run out?" "What if I need to know something and don't have the information available?" "What if I put it away and can't find it?" "What if the way I organize it isn't the right way?" "What if I throw it away but the day comes when I really need it?"

Being unable to use furniture, rooms, or entire homes in standard ways due to saved items.

Significant deterioration in housekeeping due to excessive clutter.

CAUSES: There appears to be a strong genetic component to Obsessive Compulsive Disorder of the hoarding type. Modeling and conditioning may also play a role in the development of this disorder. OCD usually involves over-activity and/or under-activity of brain regions that underpin the observed behaviors. Hoarding worries and behaviors can begin in childhood, even as young as age five.

TREATMENT: Combining psychotherapy, exposure therapy, and medication can help individuals to make beneficial changes in their lives. Psychotherapy involves exploring the impact of learning, triggers, worrisome thoughts, and intense emotions. Exposure therapy involves practicing new ways of responding to uncomfortable thoughts and feelings that arise when hoarding behavior is challenged. Exposure therapy is often conducted in the home with pragmatic emphasis on both reducing the clutter and managing the doubt and anxiety that perpetuate the clutter. The key is learning to "allow" feelings of anxiety to be present without attempting to neutralize them by saving things. Medications used to treat anxiety and OCD (e.g. Paxil, Luvox, etc.) and to sharpen attention (e.g. Ritalin) can be helpful. Co-morbid conditions such as depression may also need to be addressed.

THERAPY GOALS:

Avoid repetitive questioning (e.g., "Why? Why do I hoard? Why did I let this get out of hand?").

Understand that recovery doesn't require an answer to "Why?"

Remember: OCD and/or hoarding are/is not logical.

Ask instead: "What is my objective? How can I best get there?"

Develop the ability to tolerate intense emotions.

Rate the intensity of feelings on a scale of 1 to 10.

Observe changes in the intensity of feelings.

Notice that feelings come and go; saving things is not required to reduce anxiety.

Accept that less than perfect is "good enough."

Towels do not have to be folded with military precision, cans do not have to be arranged in alphabetical order, etc.

Take care with items of consequence (e.g., bills, medicine, safe deposit box keys), but relax with things of less consequence (e.g., today's newspaper, "junk" mail, spare toothbrushes). Correctly making that distinction is often the key to recovery.

Practice a "so what" attitude if you make a mistake. Ask yourself what is the worst that could happen and how could it be fixed.

Ask yourself if it is worth the time and effort to change something you have done or whether you have better things to do.

"Only Handle It Once." (OHIO)

Deal with each item only once.

Check things only once instead of storing them to check more thoroughly later.

Deal with things as soon as they come into the house.

Do not retrieve items from the trash when second thoughts intrude and raise doubt.

Simplify decision making.

Limit choices, (e.g., keep, recycle, sell, give away, throw away).

Make clear decision rules for each choice, (e.g., keep 10 hole-free plastic bags, throw away dirty bags, recycle remaining bags).

Use broad categories instead of many specific ones, (e.g., "gift wrap items" instead of paper, lace ribbons, small, medium & large bows).

Accept that others, including experts, may do things differently.

Organize and file systematically.

Place like things together in a designated place, (e.g., place grain products in one cabinet, bottled and canned goods in another).

Use broad headings when filing, (e.g., house, cars, medical, insurance, job, education).

File only important papers.

Buy and keep "just enough."

Sales will be repeated.

If you run out, it is not a disaster.

Keep items you use--throw out others, (e.g., You have five handbags--you use one; one has a broken handle; one has a hole in the bottom; one is too small; and, one is a color you do not like. Keep the one you use; throw away the damaged ones; and, give away the other two).

Focus on functionality.

Select a target, (e.g., an area such as the kitchen or even a corner of a particular room).

"Excavate" the target by throwing away and organizing.

Maintain the clear space.

Use the cleared space only for its intended purpose.

Seek assistance or another opinion.

Individuals who hoard often have a difficult time determining what is "important vs. unimportant," "just enough vs. excessive," or "necessary vs. inconsequential." Enlisting the aid of a trusted friend or professional can provide guidance in developing appropriate guidelines and persevering with your goals.

ADDITIONAL RESOURCES:

International OCD Foundation