Helping someone who hoards

Mar 10 2009

Even though Elizabeth Nelson was raised in an upper-middle class suburb, she felt a deep sense of shame about her living conditions growing up.

The spacious basement where she rode her Big Wheel at age 3 was filled to the brim by the time she was 8.

As years went by, the home's empty spaces disappeared, replaced with clutter.

She was so used to piles, it took Nelson years to realize her mom's compulsion to collect and save was a psychiatric condition. She recounts a visit to her parents' home as an adult.

“My dad was using portable urinals in the living room because my mother had blocked his access to the bathroom,” Nelson says. “I got really concerned.”

Nelson searched the Web and read about hoarding. Someone who hoards collects items with limited or no value, such as newspapers and trash, and then is unable to discard them, she learned. Entire rooms become filled with clutter and homes are left with narrow pathways to walk through.

People who engage in hoarding put themselves and neighbors in danger, say experts at the University of Michigan Health System. Their living conditions can present a fire hazard and are often unsanitary and unsafe. Hoarders face the real prospect of becoming buried under an avalanche of trash. Treating hoarding is difficult because people who suffer from it often don't see the squalor they live in as a problem.

“We all collect, we all save,” says James L. Abelson, M.D., Ph.D., an anxiety disorders expert in the U-M Department of Psychiatry. “We apply the term ‘hoard' when it's a more extreme version of acquiring and not discarding.”

It is believed hoarding afflicts one- to one-and-a-half million people in the United States, Abelson says.

Hoarders, he says, succumb to forces within their brains such that the overflowing garbage in their homes isn't seen or isn't experienced as distressing, Abelson says.

“Whatever they see in terms of clutter doesn't seem to matter to them,” Abelson says. “What matters is the fact that these things have importance to them and the loss of these things would trigger distress.”

Those who suffer the most are family members of hoarders, he adds. “I have heard stories of hoarders whose children took to the streets in their teens because there was no more room in the home for them.”

Children suffer because they can't have friends over, they have a sense of embarrassment, and they have some confusion about what is and isn't normal behavior, he says.

U-M researchers who have studied animals like squirrels that ‘hoard' food for the winter are now using insights from that work to study hoarding behavior and its neurobiology in humans.

Why people save to the point where it becomes maladaptive is the kind of question that can be applied to every psychiatric disorder because they are all exaggerations of adaptive traits, he says.

Hoarding is challenging and frustrating to treat, he says.

“There are no simple drugs that have an impact on it,” he says. Therapy is helpful but challenging because it requires the person who needs treatment to be highly motivated.

“We basically set up a program of practice so that they can become desensitized to reduce the amount of pain they experience when they let go of objects,” Abelson says. “If we make sufficient progress with that, we can help them ultimately clean out their homes, but it's a very challenging process.”

If someone wants to help a person who hoards, they first need to assess if the person is willing to talk to a professional.

“If cooperation can be obtained, it's much more likely to lead to a positive and successful outcome.”