How much stuff is too much stuff?
3/29/2018 by Dr. Craig Sawchuk and Dr. Dagoberto Heredia
We all like to acquire and hold onto things for a variety of reasons — this item is unique, it reminds me of an important event in my life, it's a great deal, I could have a use for it one day. Most of us have a balance between what we obtain, hold onto and let go. However, for some, having too much can lead to significant problems in day-to-day living.
Hoarding disorder affects about 3-6% of the population. Common characteristics of hoarding include:
- Excessive acquisition of items with limited objective value or immediate use
- Difficulties discarding, giving away or recycling accumulated items
- Problems with organization, attentiveness, memory and decision-making
- Excessive build-up of clutter in living spaces
- Avoidance of managing the clutter
Hoarding disorder isn't the same as being a collector or pack rat. Collectors tend to focus on a specialized area of interest rather than a wide range of different things. They also may collect items that have recognized value. Pack rats may hold onto a lot of sentimental items, but it may not result in problems with their living spaces.
A unique aspect of hoarding disorder is that living spaces no longer can be used for their intended purpose due to excessive clutter. For example, an individual's kitchen counters and stove become so cluttered they can't prepare meals. A bathroom is so filled with miscellaneous office supplies they can't use the toilet or shower.
The most commonly hoarded items are information (books, magazines, mail, scraps of paper), clothing, household items (coffee mugs, towels, pens), and crafts. In more serious cases, some people excessively accumulate food or pets, which can result in unsanitary living conditions.
Individuals who hoard hold very strong beliefs about their possessions, including their uniqueness, future use and not wanting to be wasteful. They also tend to have a strong degree of emotional attachment to their possessions, feel highly responsible for retaining their items and can become increasingly territorial when there is any threat to discarding or losing their things.
Continued hoarding behavior increases the risk for other health and safety problems:
- Narrow pathways between piles of newspapers, books and bags of clothing can be a significant fall risk, especially among the elderly and others with mobility problems.
- Attempts to conceal hoarding from others can result in isolation, feeling more disconnected from others increases the risk for depression.
- Others may struggle financially by spending a great deal on storage facilities for their possessions rather than covering important expenses such as food and utilities.
Hoarding behaviors can start during teenage years. However, the problems with clutter in living spaces and other responsibilities in life gradually develop over time, so impairment usually starts to show up in middle aged and older adults. Hoarding is equally common in men and women and often is associated with other mental health problems, such as depression.
Researchers have found that hoarding may be related to:
- Family history. Hoarding tendencies or the full disorder may tend to run in families. This may be due to shared genetics or by learning patterns of acquiring and retaining items.
- Personality. Indecisiveness and perfectionism are common traits among those who hoard.
- Stressful life events. Sustaining significant losses in life, such as the death of a family member or destruction of possessions in a fire or natural disaster, can increase the risk for developing hoarding disorder.
Treatment for hoarding disorder can be challenging, since the problem usually has been going on for several years in private. Plus, the prospect of decluttering can be extremely distressing for the individual, due to the high degree of emotional attachment to their items, general avoidance tendencies and strong beliefs about acquiring and retaining. Sometimes treatment is motivated by external factors, such as the threat of eviction, legal action or frustrated family members. Addressing personal motivators for treatment is essential for engagement.
Cognitive behavioral therapy (CBT) is the most evidence-based treatment approach for hoarding. There are no medications indicated for hoarding, although the use of antidepressant medications may be helpful when a depressive disorder is present. In some cases, family therapy also may be helpful.
CBT for hoarding tends to be more intense and takes longer than other anxiety conditions, such as panic, post-traumatic stress or social-anxiety disorders. Treatment focuses on:
- Gradually changing patterns and learning new skills
- Encouraging engagement with healthy others who can offer practical assistance
- Conducting home visits to directly apply skills to manage the clutter
- Providing follow-up to prevent relapse
Among the skills CBT teaches are:
- Identifying and challenging beliefs about acquiring and retaining items
- Resisting urges to accumulate more items
- Organizing and making decisions over where to start in their home, including how to make the best use of storage space
- Increasing tolerance for sorting through possessions, including making decisions over keeping, recycling or throwing them away
- Preventing clutter taking over cleaned areas of the home
- Increasing engagement with more meaningful activities and social supports
Hoarding disorder is a treatable, but challenging condition. Some communities, counties and social service agencies may have additional resources and specialists available.
Dr. Craig Sawchuk is a clinical psychologist in Employee and Community Health's (ECH) Division of Integrated Behavioral Health (IBH). He is the co-chair of IBH and co-chair of professionalism within the Department of Psychiatry and Psychology at Mayo Clinic's Rochester campus.
Dr. Dagoberto Heredia is a clinical psychology fellow in Employee and Community Health's (ECH) Division of Integrated Behavioral Health (IBH).