Although the Shelton case is an obvious example of abnormal hoarding, the question for most of us is "When does collecting things cross the line and become a hoarding disorder?" The other question most often asked is "Is abnormal hoarding a disorganization problem or a collecting problem?" The main question for mental health professionals is "Is abnormal hoarding primarily a learned behavior or is it a more biologically-based disorder?"

The Webster's dictionary definition of hoarding -- "to store up beyond one's needs" -- does not describe abnormal hoarding. There is no official medical "hoarding disorder" diagnosis since the behavior is almost always a part of a more pervasive problem. Abnormal hoarding is defined as "the accumulation of so many possessions that the storage of the items significantly affects the health and welfare of the resident(s) living in the same space as the stored items." To me, this definition begs the issue. Wealthy hoarders, for instance, may be able to purchase storage space that excludes the stored items from becoming a safety or welfare concern. Does that mean they are not experiencing a hoarding disorder?

In a very real sense, we each have to decide when our hoarding or someone else's hoarding is crossing the line into causing significant problems. For wealthier individuals, there may be no need to worry, but for the rest of us, hoarding can lead to safety hazards or financial problems. Wealthier individuals can get in trouble in other ways with a hoarding disorder that compels them to shoplift, burglarize, or scout through garbage in dumpsters to collect items.

Although many of the news reports of dramatic cases of abnormal hoarding have involved older adults, not enough good data has been collected to know whether abnormal hoarding is more common among older adults. However, older adults who have hoarded for years and become more frail or disorganized as they age may be more subject to safety hazards than younger hoarders.

Hoarding behavior can be part of obsessive compulsive disorder, post-traumatic stress disorder, attention deficit hyperactivity disorder, major depressive disorder, schizotypal, schizoid or obsessive compulsive personality disorder, psychosis or dementia. How a professional attempts to assist a person who is abnormally hoarding depends a lot on whether one of these disorders is part of what is taking place in the person's life. It is difficult to help someone with their hoarding behavior until you have addressed the underlying disorder of which it may be a part.

If you are aware of someone who is involved in abnormal hoarding, try to make non-confrontational contact with them in some way. If they are a friend or relative, provide support, and ask if you can help to clean up or organize. If the hoarding behavior appears to be a safety hazard or it is a neighborhood nuisance, you may need to call the your local Department of Health. Clutterers Anonymous is a good resource for support and recovery from abnormal hoarding.

I hope that is helpful. Since this is such a complex subject, I recommend visiting some of the links listed below for more information about abnormal hoarding. -- Best wishes, Dr. Ron.

Links to More Information About Hoarding

• Hoarding Fact Sheet at LA4Seniors.com.

• Pack rat or compulsive hoarder? When medical help is needed.

• Hoarding in obsessive-compulsive disorder and related disorders: a preliminary report of 15 cases.

• Never Enough: The Hoarding Mentality.

• 2004 Hoarding Conference at Cornell University.

  Author Bio:

  Ron Sterling, M.D. is a 61 year-old General and Geriatric Psychiatrist with a private practice in Seattle. He invites you to e-mail him at with any questions about mental wellness or emotional, relationship, or aging concerns. He is the only person who reads e-mail sent to Dr. Ron. Please be assured that your questions and identities are completely confidential and protected. For more information about Dr. Ron and for resources related to senior mental health, please go to SeniorMentalHealth.org. The content offered through Mind Matters is for information only and is not intended for medical, psychiatric, or psychological diagnosis or treatment. Never disregard professional advice or delay seeking it because of something you have read in this column. Read our Disclaimer. If you wish to understand more about Dr. Sterling's potential biases in health care advocacy, please check his Conflicts of Interest Disclosure Statement

Have a great day!