Many of us like to keep various items, but compulsive hoarding can lead to physical and mental strife, writes JOHN HOLDEN
THERE ARE two kinds of people: those who hoard and those who don’t. Keeping ostensibly useless stuff in the expectation that it might one day become useful makes perfect sense to one person, while it is complete madness to another.
Everyone knows someone they might label a hoarder, but compulsive hoarding is on a whole different level, and the disorder can lead to serious physical and mental strife.
According to the International Obsessive-Compulsive Disorder Foundation in the US, hoarding is made up of three connected problems: “collecting too many items, difficulty getting rid of items, and problems with organisation”.
“The disorder is most commonly found among people over 40,” explains Leslie Shoemaker of OCD Ireland. “It was thought to be a side effect of having lived through financially stressful times or maybe through a war.” The fear that lean times could return leads the hoarder to believe they should keep everything “just in case”.
Increased research, however, has found that such life experiences are but one source of its origin. “Signs of compulsive hoarding can show themselves in the teenage years,” says Shoemaker.
The types of things hoarded range from the obsessive to the bizarre. “Coffee cups, food, newspapers, used McDonald’s wrappers, magazines and flyers are just some of the items hoarded that I’ve come across with my clients,” says Shoemaker.
A recent Liveline segment included a contribution from a 29-year-old Dublin man who hoarded brand new €5 notes. The problem was, however, he couldn’t spend them. At the time of the radio show he claimed to have exactly €16,500 worth of fivers and, even at times in his life when he couldn’t pay his rent or utility bills, he said he still couldn’t use the money.
Another contributor commented on a woman he knew in London who hoarded chinchillas (small rodents indigenous to South America). The contributor said she had approximately 300 chinchillas living in her house.
“There’s no rhyme or reason as to what is hoarded,” says Shoemaker. “It may seem illogical, but the reasons make sense to the people doing the hoarding, which is really important in terms of treating the disorder through cognitive behavioural therapy (CBT).”
Dr Michael McDonough, director of the Anxiety Disorders Programme at St Patrick’s University Hospital, Dublin, specialises in the treatment of patients suffering from OCD. He has found that CBT can be an effective treatment for hoarders.
“There are neurological and biological models used in understanding OCD sufferers, but the main breakthroughs in treatment have come through psychological and behavioural therapies.
“In hoarding, the main difficulty for the sufferer is letting go of things. We all struggle with getting rid of items that we consider precious to us – receipts, maps, books. Most of us can connect with this experience to some degree. But compulsive hoarding is the norm multiplied manifold. Those who work with sufferers face quite a few challenges.”
The idea of getting professional cleaners in to a hoarder’s home is a terrifying prospect for someone with the condition. “They often don’t feel the clutter is interfering significantly with their lives, despite all the evidence to the contrary,” says HSE cognitive behavioural therapist Fionnuala MacLiam. “Clients I’ve had can be quite incensed when the council finally comes and empties out their homes. To them it is not the rubbish that everyone else seems to think it is.”
What is required in treatment is passive discussion, where it is pointed out how distorted the hoarder’s perspective on life has become. “You start by experimenting with the disposal of a few small things,” says McDonough, “then fairly rapidly moving towards a more proactive approach to cleaning the home.”
According to McDonough, about 5 per cent of OCD sufferers don’t see the cycle they’re caught in. Among hoarders, however, a much higher proportion would have what’s known as “low insight” into their behaviour.
“This makes it very difficult to treat,” says MacLiam. “The success rate of CBT with other OCD conditions is quite high for people who complete treatment – around 70 per cent. With hoarding it’s only about 30 per cent.”
This is but one of the unique characteristics of the disorder that is leading experts to reconsider its clinical status as a form of OCD. “Over the last decade it has become apparent that hoarding stands separate from other types of OCD,” says McDonough. “In the next version of the Diagnostic and Statistical Manual of Mental Disorders, I expect it will be in a separate category.”
Obsessive-compulsive behaviour is usually characterised by two features – the obsession and the compulsion. “The compulsion – like washing your hands 10 times on the left and again on the right – is done to make the anxiety of the fear of germs go away,” says Shoemaker. “So continuous praying or counting or thinking about the same thing over and over helps to relieve an anxiety. Such compulsive behaviour is often done in a ritualistic way.
“Hoarding, however, isn’t ritualistic like other forms of OCD. There is some anxiety attached to it – in extreme cases – like when your home becomes a health hazard. But there’s no rhyme or reason as to where or why hoarders leave their stuff where they do.
Some will feel more comfortable eliminating hoarding new things rather than getting rid of what’s already there. “It has also been argued that removing items complicates the situation and provokes anxiety. That if you just attack the thoughts, people will get rid of stuff on their own,” says Shoemaker.
“It’s a difficult disorder to treat. You have to laugh a lot with your clients. It’s very important that you have good solid relationship because, in cases like this, recovery is a collaborative effort.
See ocdireland.org and ocfoundation.org
SPARTANISM: GETTING RID OF EVERYTHING
Collector or hoarder? Minimalist or Spartan? While rarely, if ever, treated in this country, the opposite of hoarding, Obsessive Compulsive Spartanism, is a condition that is being seen elsewhere. The desire to throw everything away has, according to some contributors to online OCD discussion forums, led people to live without furniture or even clothes. Some will throw away not only their own stuff but everyone else’s too.
