Thread: Hoarders Are Mentally Ill, NOT Lazy.

Inspired by comments in the Random Thoughts section. For the complete Mayo Clinic report
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Definition
Hoarding is the excessive collection of items, along with the inability to discard them. Hoarding often creates such cramped living conditions that homes may be filled to capacity, with only narrow pathways winding through stacks of clutter. Some people also collect animals, keeping dozens or hundreds of pets in unsanitary conditions.

Hoarding, also called compulsive hoarding and compulsive hoarding syndrome, can be a symptom of obsessive-compulsive disorder (OCD). But many people who hoard don't have other OCD-related symptoms, and researchers are working to better understand hoarding as a distinct mental health problem.

People who hoard often don't see it as a problem, making treatment challenging. But intensive treatment can help people who hoard understand their compulsions and live a safer, more enjoyable life.

Symptoms
In the homes of people who engage in compulsive hoarding, countertops, sinks, stoves, desks, stairways and virtually all other surfaces are usually stacked with stuff. And when there's no more room inside, the clutter may spread to the garage, vehicles and yard.

Hoarding affects emotions, thoughts and behavior. Signs and symptoms of hoarding may include:

* Cluttered living spaces
* Inability to discard items
* Keeping stacks of newspapers, magazines or junk mail
* Moving items from one pile to another, without discarding anything
* Acquiring unneeded or seemingly useless items, including trash
* Difficulty managing daily activities, including procrastination and trouble making decisions
* Difficulty organizing items
* Perfectionism
* Excessive attachment to possessions, and discomfort letting others touch or borrow possessions
* Limited or no social interactions

People who engage in hoarding typically collect items because they believe these items will be needed or have value in the future. A person also may hoard items that he or she feels have important emotional significance — serving as a reminder of happier times, for example, or representing beloved people or pets. People who hoard may report feeling safer when surrounded by the things they collect.

When to see a doctor
Hoarding ranges from mild to severe. In some cases, hoarding may not have much effect on your life, while in other cases it affects you on a daily basis.
Clutter and difficulty discarding things are usually the first symptoms of hoarding. These early indications of a problem usually surface during the teenage years. As an affected person grows older, he or she typically starts acquiring things for which there is no need or space. By middle age — when the condition is usually diagnosed — symptoms are often severe and difficult to treat.

If you or a loved one has symptoms of hoarding, talk with a doctor or mental health provider as soon as possible. Some communities have agencies that help with hoarding problems. Check with your local or county government for resources in your area.

As hard as it might be, you may also need to contact local authorities, such as police, fire, public health or animal welfare agencies, especially when health or safety is at stake.

Causes
It's not clear what causes hoarding. Some researchers believe that hoarding occurs on a continuum — some people may simply be considered harmless pack rats, while others have a much more severe form of collecting that is life-threatening. The condition is more likely to affect those with a family history of hoarding, so genetics and upbringing are likely among the triggering factors.

Hoarding is currently considered a subtype of obsessive-compulsive disorder (OCD), but this classification is under debate. Many mental health researchers argue that, while some people with OCD have hoarding behavior, hoarding is not specific to OCD. In fact, one study found that hoarding was no more likely to be associated with OCD than with other anxiety disorders.

Ongoing research is aimed at understanding the biological and environmental factors that seem to play a role in hoarding. The findings from these studies may lead to the classification of hoarding as a new and separate mental health disorder.

Risk factors
Hoarding can affect anyone, regardless of age, sex or economic status. It's not clear how common hoarding is, though. That's partly because researchers have only recently begun to study it and partly because some people never seek treatment.

Here are some risk factors and features about hoarding that researchers have come to understand:

* Age. Hoarding usually starts in early adolescence, around age 12, and it tends to get worse with age.
* Family history. People are more likely to hoard if they have close family members who engage in compulsive hoarding.
* Stressful life events. Some people develop hoarding after experiencing a stressful life event that they had difficulty coping with, such as the death of a loved one, divorce, eviction or losing possessions in a fire.
* Social isolation. People who hoard are typically socially withdrawn and isolated. In many cases, the hoarding leads to social isolation. But, on the other hand, some people may turn to the comfort of hoarding because they're lonely.
* Perfectionism. People who compulsively hoard are often perfectionists. They worry about making the right decision about what to do with each possession — should they keep it or discard it? Trying to decide causes distress, so they avoid making a decision and simply keep everything.

Complications
Hoarding can cause a variety of complications, including:

* Unsanitary conditions that pose a risk to health
* An inability to perform daily tasks, such as bathing or cooking
* Poor work performance
* Loneliness and social isolation
* A fire hazard

What to expect from your mental health provider
The mental health provider is likely to ask you a number of questions and may also talk with your close friends and family members to gain an understanding of how hoarding is affecting your life. The mental health provider may ask:

* Do you avoid throwing things away because you believe you might need them later, or because they have emotional significance?
* How often do you decide to acquire or keep things you don't have space or use for?
* How would it make you feel if you had to discard some of your things?
* Does the clutter in your home keep you from using rooms for their intended purpose, such as cooking, washing dishes or taking a bath?
* Does clutter prevent you from inviting people to visit your home?
* How does clutter in your home affect your family members?
* Does it take you a long time to perform daily tasks because of clutter or because you feel a need to do things perfectly?
* Do you have so many pets that you can't care for them properly?
* Have others encouraged you to seek professional help?
* Do you have a first-degree relative — a parent or sibling — who is a "pack rat"?
* Are you currently being treated for any other medical conditions, including mental illness?

Because other mental health disorders often go hand in hand with hoarding, your mental health provider may also ask questions to see if you may have symptoms of depression, social phobia, anxiety or other problems.

Tests and diagnosis
Hoarding isn't yet considered an official, distinct disorder. However, it can be diagnosed as a subtype or symptom of obsessive-compulsive disorder or obsessive-compulsive personality disorder.

To help diagnose obsessive-compulsive disorder, mental health providers perform a thorough psychological evaluation. They ask many questions about your obsessions, compulsions and emotional well-being and may also ask your permission to talk with your relatives and friends.

To diagnose hoarding, mental health providers check for three main characteristics:

* Acquisition of a large number of possessions that others would consider useless, along with an inability to discard them
* Having an overly cluttered home or living spaces — so cluttered that living spaces can't be used as intended, such as not being able to sleep in your bed, take a bath in your tub, or prepare food in your kitchen
* Having significant distress over your hoarding or an impaired ability to accomplish your daily activities

There are two main types of treatment for hoarding — psychotherapy and medications.

Psychotherapy
Cognitive behavior therapy is the most common form of psychotherapy used to treat hoarding. As part of cognitive behavior therapy, you may:

* Explore why you feel compelled to hoard
* Learn to organize and categorize possessions to help you decide which ones to discard
* Improve your decision-making skills
* Declutter your home during in-home visits by a therapist or professional organizer
* Learn and practice relaxation skills
* Attend family or group therapy
* Be encouraged to consider psychiatric hospitalization if your hoarding is severe
* Have periodic visits or ongoing treatment to help you keep up healthy habits.