Hoarding is a disorder in which the individual has great difficulty with items — buying and collecting too many items, not being able to throw objects away, and being unable to maintain organization in the home. Hoarding often begins in early adulthood and progressively worsens over the person’s life until the disorder has become highly debilitating by middle age and beyond.

Jon Lukas

Jon Lukas

What is often seen on television shows about hoarding are the advanced stages where individuals have lost complete control over the clutter in their homes, which results in avoidance of family and friends, and ultimately in an inability for the individuals to even care for themselves. The torment that hoarders feel is overwhelming because the mountain that one must climb to overcome the disorder feels so huge, and their self-esteem becomes so badly damaged that without successful intervention, they lock themselves away from society and continue to be buried deeper and deeper into isolation, loneliness and depression.

Hoarders often become very sedentary as they spend a great deal of their lives trapped in their heads and in their homes. The shame that hoarders feel often leads to self-loathing as they feel a sense of hopelessness and despair. The cycle of negative self-esteem, isolation and anxiety only leads to more of the same dysfunctional behavior.

At this point, it becomes necessary for family or friends to intervene, reduce the social isolation and help find a trained behaviorist to start the process of cognitive behavioral therapy and dehoarding — if the individual is willing to step up to the challenge of getting his or her life back.

People with hoarding disorder experience many different emotions and cognitive dysfunctions that ultimately lead to the severe hoarding seen in the media. Some people struggle with compulsive shopping and obsess about an item until they feel compelled to buy something. Some people save items such as newspapers, receipts or mail, and struggle with organizational problems to the point that tables and bookshelves become overrun with items. When hoarders then try to organize, they often end up moving the stack of items from one side of the room to another, thus refusing to solve the problem but only postponing the need to actually throw items away.

Some hoarders fear that throwing out receipts will lead to their information falling into the wrong hands, where it will be used against them, i.e. credit card fraud. Some hoarders fear contamination of their own piles of old books, paper bags and garbage, and then will avoid the items out of fear they will be sickened if they touch these items.

Homes of hoarders often become so overcome with stuff that they give up cleaning their environment at all. The anxiety about how to even get started is so great that they just give up before they begin. Unsanitary conditions develop for the sufferer and even those who enter the home.

I have seen hoarders with multiple pets — and when sanitary issues and the care of animals spin out of control, it leads to the potential for eviction and the loss animals to shelters because hoarders could no longer care for themselves or their animals. As you can imagine, this is a vicious cycle in which one feels trapped and is often unable to overcome without outside intervention.

The good news about hoarding is that it is treatable, and the most important predictor of success is willingness — a willingness to accept that they have a serious disorder that is literally burying them alive, a willingness to let family and other support into their homes (if those people are willing), and a willingness to work with a cognitive behavioral specialist who can help them identify the dysfunctional thoughts and behaviors that they have been engaging in. There needs to be a willingness by sufferers to let go of items they have been holding onto, even if there are sentimental connections, fears of bad things befalling them or their loved ones if certain items are thrown away (called “magical thinking”), and a willingness to let go of emotional attachments and memories from the past that have been stunting any forward progress.

Dehoarding is an extremely anxiety-provoking experience for hoarders, and the process must be carried out with a great deal of empathy and compassion. But hoarders also must experience the feeling of being pushed to throw things away in order to see that the unpleasant feelings of anxiety, loss and grief will give rise to a new freedom and potentially peace of mind. As hoarders experience the hard work of letting go of these material things, they will feel that a great weight has been lifted and that they can step outside into the world and start living again.

Hoarding is a very challenging anxiety disorder to treat because the relapse rate is high. Hoarders must challenge thinking errors constantly and engage in daily exposures of throwing out items before they take over once again. With consistent hard work and a willingness to get back to life outside the home, find employment or volunteer, exercise, socialize and have regular cognitive behavioral therapy, then the long term outlook for a hoarder in treatment can certainly be positive.

As with all obsessive-compulsive spectrum disorders, there must be a team approach with the patient, his or her family/support system and the behavior therapist for a successful outcome.

Jon Lukas MFT is a psychotherapist specializing in cognitive behavioral therapy. He is in private practice and runs The OCD Treatment Center of Santa Barbara, working with adolescents and adults with anxiety disorders. Click here for more information or call 805.453.2347.