Feeling Bugged? Write Doctor Debug for "Psychological advice with punch!" (tm)
Dear Dr. Debug:
I have an older female friend who is retired. I think she is beginning to create a safety hazard in her home because of all the stuff she collects and keeps. The garage was filled long ago and she keeps her car parked outside. I have asked her if she needs any help to clean things up at her place and to make it safer. She says "no," and she always promises to do some cleaning, but she never does. Can you give me more information on hoarding disorders? Is it true that hoarding disorders are more common in older adults? -- Signed: Wondering About Hoarding.
Although these cases are obvious examples of abnormal hoarding, the question for most of us is "When does collecting things cross the line and become problematic, unhealthy, or a more severe 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?"
There is no official medical "hoarding disorder" diagnosis since the behavior is almost always a part of a more pervasive problem. Hoarding is only specifically a criteria found in the description of obsessive compulsive disorder. 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? Not by my definition.
Ultimately, 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 often leads 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 disorders are equally distributed between men and women.
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 hoarding behavior until you have addressed the underlying disorder of which it may be a part.
In a materialistic society such as ours, we often have much more than we need. We have been programmed by advertising and many other messages to focus on owning a lot of things. The simple, uncluttered life is not coveted by many. Even though the cluttered life tends to be more stressful with more things to worry about and to manage, most people have not learned how to want less and be happy with less.
We can blame that materialistic mindset for much of the cluttered, burdensome aspects of many of our lives. However, that mindset is not the cause of abnormal hoarding. At least one recent study using functional MRI scans has been able to show that the brains of abnormal hoarders work very differently when discarding an item than the brains of non-hoarders. The question of whether the hoarding brain works differently because of years of programming, or whether the hoarding brain starts out differently from the get-go, has not been fully answered. However, many abnormal hoarders report hoarding behavior that started when they were young children.
If you are aware of someone who is involved in abnormal hoarding, try to make non-confrontational contact 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. Abnormal hoarding, such as what your friend may be dealing with, almost always requires the intervention of governmental agencies to make a difference. So, don't hesitate to call the appropriate agencies and talk to them about your concerns. Clutterers Anonymous is a good resource for support and recovery from less severe hoarding.
I hope that is helpful. Letting spring cleaning include a focus on less materialism and a simpler, less stressful lifestyle, can be good for you. For those of you who have a very difficult time with getting rid of clutter and excess belongings, this spring might be a good time to find a counselor or coach to assist you in learning how to be happy with less. -- Best wishes, Dr. Debug.
Ron Sterling, M.D. (Dr. Debug) is an award-winning psychiatrist in Seattle, Washington. He has been writing for newspapers and magazines since 1998 on subjects ranging from good manners to senior mental health. He hosts and maintains the well-known Internet mental health center, DearShrink.com. The Doctor Debug column is dedicated to assisting with the "debugging of malfunctioning elements in our own personal programming."
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