May 10th, 2016
Hoarding Disorder (HD) has received a lot of media attention in recent years. Oprah Winfrey and Dr. Phil have dedicated several shows to this disabling and sometimes even lethal problem. Furthermore, the American hit show ‘Hoarders’ is now being aired in the Netherlands. Our fascination for those who accumulate excessive clutter, animals or in some extreme cases, feces, seems insatiable. The fact that this affliction is surrounded by mystery is partly responsible for this fascination. Until recently researchers weren’t certain how to define or treat HD. Nevertheless, two different initiatives, a study conducted last year at the University of New Hampshire (UNH) and a collaborative research of a group of renowned HD specialists this year, might be the breakthrough extreme hoarders and their loved ones have been waiting for.
Greedy or Needy
Historically, hoarding has been discussed in the works of many psychoanalysts, including Sigmund Freud’s anal stage of development. He suggested that the loss of control and what went down the toilet was a traumatic occurrence and that, therefore, the collector is trying to gain back not only control but “possessions” that were lost so many years ago.
The term ‘hoarding‘ was originally coined in order to discuss animal behaviors regarding the storage of food. In a 1966 study conducted by Bolman and Katz, the concept was used for the first time to describe this behaviour in humans. They used the term ‘compulsive hoarding’ to discuss their findings in an anecdotic case report. It took another 30 years before an operational definition was published. Randy Frost and Tamara Hartl characterized hoarding as “the acquisition of and failure to discard a large number of possessions that cover the living areas of the home and cause significant distress or impairment.” Since this pioneering publication, research on hoarding has increased significantly. Hoarding has been found to be far more prevalent than previously thought – somewhere between six and fifteen million people in the US alone are believed to be hoarders.
Creativity run amok
Randy Frost has spent nearly twenty years researching hoarders and is a pioneer in the treatment and psychopathology of compulsive hoarding. Together with his colleague, Gail Steketee, he published ‘Stuff: Compulsive Hoarding and the Meaning of Things’ in September 2010. The authors draw upon various case studies spanning decades of field work and narrate their spectacular journey through piles of accumulated stuff.
Whereas TV shows like ‘Hoarders’ only scratch the surface, ‘Stuff’ explores the depths of this disorder. Frost and Steketee examine the illness from a psychological, sociological, genetic and neuroscientific angle. Frost observes: “People who hoard save everything, and it’s the good stuff as well as the crummy stuff. Hoarders are very interested in the physical world and see it in a different and more complex way than the rest of us do. Most of us look at a bottle cap and see just that. Hoarders look at it and see the shape the color, the unusual details that the rest of us overlook. By noticing this, it gets valued and offers a whole host of potential uses. But it’s potential that they never follow up on. It’s creativity run amok.”
Hoarders feel a very strong sense of emotional attachment towards their possessions and feel a need to stay in control of their things. They don’t want anyone touching or moving their stuff. These traits make living with a hoarder very difficult and traumatic. As one child of a hoarder recalls: “My mother taped strands of hair to door jams and cupboards so she could tell if the kids tried to: ‘Get in and touch or move her stuff.’ Another anonymous statement on the website ‘childrenofhoarders.com’ reads: “I feel that ‘things are put first and more important than her children are.’ I was accused of stealing her ‘things’ all the time, blamed for things she misplaced.” The stories are heartbreaking and really emphasize the fact that hoarding is a disabling disorder, for those who suffer from it and especially for their loved ones.
It becomes clear that HD is an incredibly complex phenomenon. It is frequently found in patients with other diseases, including dementia, Alzheimer’s, schizophrenia and anorexia. HD is a behavioral syndrome that has always been considered a type of obsessive-compulsive disorder (OCD), but unlike most patients with OCD, those with hoarding disorder often display poor insight into the severity of their behaviour which makes treating this problem very difficult. Frost has observed that psychologists, who are quite comfortable treating OCD patients, often describe frustration with hoarding cases. Patients passively resist treatment and only attend therapy sessions at the behest of others.
“There is no “cure” for compulsive hoarders: no treatment will make the problem go away completely”
No catch-all solution
Hoarding is believed to be a pathological brain disorder and often runs in families, although it is uncertain whether DNA is involved. Out of embarrassment, many hoarders avoid inviting friends or family over, which leads to social isolation and family conflict. In their book, Frost and Steketee conclude that because there is no catch-all cause, there is no catch-all solution either. ‘Stuff’ offers perspective for those who need to understand hoarders but doesn’t construct a new vision of compulsive hoarders. Frost relates this to a lack of research. He remarks: “The research on hoarding is still in its infancy. We still need to study what’s happing in the brain that drives this behavior. What part of the brain is involved in decision making and forming attachments to possessions? How does the brain sort it out, and what needs to happen to break the attachments?”
There is no “cure” for compulsive hoarders: no treatment will make the problem go away completely. However some treatments may help to manage the symptoms, for example anti-depressants and cognitive-behavioral therapy. As Frost points out, it is hard to come up with a treatment for a disorder that is still in many ways a mystery. Nevertheless, new research might change this status quo.
More Love Less Stuff
The recent realization that HD is not a subtype of OCD but a distinct disorder, means a radical change in the way HD is assessed and studied. Based on this notion a group of renowned HD researchers have published new findings and suggested new treatments for hoarding problems in this month’s Journal of Clinical Psychology. Randy Frost, Veselina Hristova and David Tolin recognize past mistakes when it comes to HD treatment: “On both clinical and research grounds, we discourage use of hoarding subscales embedded within instruments designed and validated for OCD”. The authors suggest tailor made therapy sessions and home visits by therapists: “Many hoarding clients have not allowed anyone into their homes in years; a common treatment goal is to get clients to allow family and friends into their homes on a regular basis”.
When it comes to designing effective treatment for hoarding problems, Edward Lemay’s recent study will have a significant impact. Lemay, assistant professor of psychology at the University of New Hampshire, together with colleagues at Yale University and the University of Geneva studied the link between feelings of security and materialism. Prior research had focused primarily on examining effects of threats to feelings of security on heightened materialism. Lemay and colleagues, on the other hand, decided to demonstrate that enhancing felt security, the feeling of being loved and accepted by others, would reduce the value people place on goods. “Throughout history, the availability of responsive relationship partners and of possessions such a food, clothing, and housing provided literal protection from harm, Lemay writes, “We suggest that, to some extent, these sources of protection are interchangeable and that people often substitute one source of protection for the other.” To test their assumption experiments were conducted in which these researchers measured how much people value specific items, such as a blanket and a pen.
Lemay and colleagues came to the conclusion that people who did not feel secure placed up to five times greater value on items than more secure people. “People value possessions, in part, because they afford a sense of protection, insurance, and comfort,” says Lemay, “but what we found was that if people already have a feeling of being loved and accepted by others, which also can provide a sense of protection, insurance, and comfort, those possessions decrease in value.” Lemay is confident that his study will be of great use in the development of an effective treatment for people with hoarding disorders.
There is no doubt that compulsive hoarding will continue to fascinate both scientists as well as the general public. Research has shown that this disorder is not only a simple matter of collecting ‘stuff’, nor is it a subtype of OCD. HD is a much more complex phenomenon. As research is still in its infancy more studies need to be undertaken to increase awareness of the issue of hoarding to the general population. Nevertheless studies like those of Lemay and Frost are paving the way towards effective treatments. Through these groundbreaking studies we know now that hoarding doesn’t stop once a home is cleaned out. Increasing a patient’s sense of being loved and accepted by others, together with intensive therapy, might just be the way to break the attachment to possessions.