Hoarding can be a serious, even deadly, business. The clutter may reach such proportions that living spaces become essentially uninhabitable, and patients may need to construct narrow tunnels or “goat paths” to get from one location to another. In a 2008 study psychologist David Tolin of the Institute of Living in Hartford, Conn., and his co-workers reported that 2 percent of hoarders had been evicted because of their mess. In a 2009 investigation, psychology student Gregory Lucini and his colleagues at the Worcester Polytechnic Institute Project Center in Melbourne, Australia, revealed that hoarding contributed to 24 percent of preventable deaths in house fires. In other cases, hoarders have been smothered to death by their clutter; this past April a 68-year-old New Jersey woman was found dead underneath piles of rotting garbage, clothing, tote bags and other possessions.
No one knows for sure why hoarders hoard. One clue to the condition, however, is that they often report a powerful emotional attachment to objects; some may imbue them with humanlike qualities, such as feelings, while recognizing that doing so is irrational. In other cases, hoarders insist on maintaining old items, such as clothing, “just in case.” Hoarding runs in families; in a 1993 study by Frost and psychology student Rachel C. Gross, now a professor at American University, 85 percent of pathological hoarders described one or more first-degree relatives (parents, children, siblings) as “pack rats”; this percentage significantly exceeded that of nonhoarders. In a 2009 study of more than 5,000 twin pairs, psychologist Alessandra C. Iervolino of King's College London and her collaborators found that this family pattern is genetically influenced; they estimated the heritability of severe hoarding at 50 percent.
Hoarding may have evolutionary origins. The behavior is present in a host of species, including honeybees, crows, rodents and monkeys, as psychologist Jennifer G. Andrews-McClymont, now at Morehouse College, and her colleagues pointed out in a 2013 review. This observation raises the possibility that the condition reflects a naturally selected urge to stockpile resources for times of scarcity.
Help for Hoarders
Hoarding disorder is challenging to treat, but some types of cognitive-behavior therapy can reduce its severity, according to a 2007 literature review by Tolin and his colleagues. The treatment focuses on altering irrational beliefs about the value of objects and providing supervised practice with organizing and discarding things. This intervention is not a panacea, however, given that many people with hoarding disorder do not complete their “homework,” which typically involves rearranging and tossing out clutter.
The limited treatment options for hoarders partly reflect our relatively poor understanding of this serious ailment. With the formal recognition of hoarding disorder in DSM-5, however, research into the causes of pathological hoarding will likely increase and, along with it, the promise of more effective therapies.
This article was originally published with the title Clutter, Clutter Everywhere.