When you can鈥檛 let go: What to do about hoarding

ARCHIVED CONTENT:聽As a service to our readers, 天博体育 Publishing provides access to our library of archived content. Please note the date each article was posted or last reviewed. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.聽

Many of us have trouble parting with our possessions鈥攅ven when we no longer need them. I have a collection of greeting cards I鈥檝e 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鈥� worth of receipts, newspapers, and other seemingly useless items. They have hoarding disorder鈥攁 mental health condition characterized by a compulsive need to acquire and keep possessions, even when they鈥檙e not needed. It鈥檚 the subject of a .

Exactly when a 鈥減ack rat鈥� crosses the line into true hoarding has to do with 鈥渢he intensity with which they鈥檙e saving, and the difficulty getting rid of things,鈥� 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鈥攈omes 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鈥攁nd 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 鈥渉oarding gene鈥� hasn鈥檛 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. 鈥淭here is some specific association to an object, or an object is seen to represent a person鈥檚 identity in some important way.鈥� 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鈥攍ike a shell they found on their first trip to the beach. They fear that if they throw away the object, they鈥檒l 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鈥攅specially in older adults who already struggle to get around. 鈥淚f the person has arthritis and is having trouble navigating the house, they can be at greater risk for falling,鈥� 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. 鈥淪ometimes people are frustrated by the notion of, 鈥榃hy can鈥檛 my loved one just throw this away?'鈥� Dr. Rasmussen says.

Often it鈥檚 a family member who finally makes the call for help, either because the person who is hoarding doesn鈥檛 recognize the problem or isn鈥檛 comfortable talking about it. 鈥淭here is a lot of shame people have, a lot of embarrassment,鈥� says Dr. Rasmussen. 鈥淭here鈥檚 still a lot of stigma around it.鈥�

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鈥檚 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 . 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鈥檛 true hoarders could do with a little downsizing, says Dr. Rasmussen. She suggests setting aside time on a regular basis鈥�20 or 30 minutes鈥攖o go through and clean out your stuff.

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

I鈥檓 definitely going to keep this item
I鈥檓 definitely going to throw away or give away this item
I鈥檓 not sure

Then follow through. 鈥淚f you have a keep pile, everything should have a home or a place,鈥� 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鈥檒l have an easier time cleaning house and won鈥檛 feel as overwhelmed, Dr. Rasmussen says.