Hoarding is a sub-type of Obsessive-Compulsive Disorder (OCD) typified by an inability to discard worthless items that have been acquired. It is estimated that roughly 20-30% of those with OCD engage in hoarding.
In my experience, mail is the most often hoarded item. Newspapers, books and magazines are also frequently hoarded. Items hoarded can also include old clothing and items that are more sentimental than functional.
Though hoarders often live within a cluttered and disorganized environment, paradoxically this may be due to perfectionism and the inability to take action is due to fear of making the wrong decision about discarding an item. Other obsessions that plague hoarders could include anxiety-provoking thoughts regarding the need to keep an item close at hand due to fear of a faulty memory, and emotional distress about the anticipated loss associated with discarding an item.
Hoarding is a compulsion of both acquisition and avoidance. The failure to discard may be not only the result of avoidance caused by indecisiveness, but may also be the result of severe problems with attention and an impaired ability to categorize. An assessment of compulsive hoarding needs to identify not only the hoarded items, but also the deficits in cognitive skills. Like all treatment for OCD, I use a Cognitive and Behavioral approach to the treatment of Compulsive Hoarding. My first goal is action: I urge hoarders to start to sort and de-clutter the items or areas which are the least distressing; I ask all hoarders to bring to therapy as many items as they can carry. As they sort items, I ask them to verbalize the decision making process. This helps with attention and helps highlight the themes associated with avoiding a decision. For hoarders who lack organizational skills, I teach a basic categorizing technique whereby all items are placed in one of three piles: discard, keep or decide later. The “discard” pile immediately goes into the trash in my office thereby prohibiting any tendency to check for a mistake.
The success of placing items in one of the first two categories reinforces the belief that a decision can be made and being able to decide to “decide later” establishes a pattern of making decisions at a rapid pace. I often urge the use of a timer at home to counter the pervasive slowness of the decision process.
I may use a variety of cognitive techniques to teach a decision process, for instance: “If you need the discarded item later, how would you cope?”. I use cognitive challenges to teach emotional distance by asking things like, “What would other people do?”.
A Cognitive-Behavioral Treatment that addresses indecisiveness, pervasive slowness, inattention, lack of organizational skills, and faulty beliefs responsible for emotional distress can not only improve life for the Compulsive Hoarder, but can also improve the functioning of those with ADHD, Depression and other Anxieties.
Compulsive Hoarding may never be cured but it can be managed.