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How do you tell if someone is a hoarder or just messy?

Difficulty getting rid of items The hallmark of hoarding behavior is not being able to let go of things. Throwing away, selling, donating or even recycling are very difficult for the hoarder. While, to most people, the objects saved may seem worthless, in truth, people who hoard can't let go of anything.

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MARIE GILBERT marieg@herald-mail.com

The Herald-Mail

It began with piece of junk mail.

Because you were busy, you tossed it on a table, and moved on to other, more important things in your life. But the next day, a magazine and a store catalog landed there, plus several birthday cards from friends and a week’s worth of newspapers. Every time you passed by, you considered sorting through the items and discarding what you didn’t need. Instead, you continued adding to the pile, telling yourself you’d get around to straightening things up as soon as you had some free time. By the end of the week, the table top was no longer visible and items were waterfalling to the floor. So, you found a cardboard box and set it in the corner, planning on filling it with trash. But the chore was soon forgotten when a package you had been waiting for arrived at your front door. You opened the box, removed the contents and stacked it on top of the other box, along with the packing materials.

Then, some plastic containers were added and an empty pizza box.

One week passed, then another and another and months later, the mess that filled one room had spread throughout the house. Clothes littered the floor, along with dirty dishes that never made it to the kitchen sink.

Before you even realized what had happened, clutter had turned to chaos.

But the process of sorting through everything was so time-consuming, so overwhelming, you felt stressed just thinking about it and paralyzed at the thought of where to begin. So the piles continued to grow.

Everyone has stuff.

After all, we are a society that prides itself on possessions. We try to find room for family heirlooms, our children’s artwork, photographs, memorabilia and books. We even make space for flea market items that other people have thrown away.

But at what point does affection turn to obsession? When does the inability to separate trash from treasure become dangerous?

When does the word hoarder enter the picture?

According to the International Obsessive Compulsive Disorder (OCD) Foundation, there are several characteristics of a hoarder. Some people acquire excessive numbers of items and neglect or refuse to get rid of them. Others clutter their living spaces to the point that they can’t be used for their intended purposes. About 75 percent of hoarders engage in uncontrolled buying, while 50 percent accumulate a large amount of free items. And most share a similar trait — an inability to organize. They also seem to have difficulty making decisions, which is a key component of organizing. “Possessions hold magical properties for all of us, giving us a sense of identity and personal history,” said Dr. Randy Frost, a professor of psychology at Smith College in Northampton, Mass., and an expert on obsessive-compulsive disorder. “For people with hoarding problems, however, this is greatly exaggerated.”

And the tendency can sometimes be deadly.

In some cases, older individuals have suffered bone-fracturing falls while trying to maneuver between piles of possessions. And, in a crisis situation, emergency crews have had trouble even entering a hoarder’s dwelling. “The most serious cases involve the loss of life, most often as a result of fire,” Frost said. “In fact, the Melbourne Fire Brigade in Australia collected data on the extent of hoarding in residential house fires for a decade. While hoarding was implicated in one-quarter of 1 percent of all house fires, those fires accounted for 24 percent of fire-related deaths. “Not only does hoarding increase the risk of death,” he added. “It increases the risk to firefighters and other residents, as well.” Frost is the co-author of several books on hoarding, including “Stuff: Compulsive Hoarding and the Meaning of Things,” as well as “Buried in Treasures: Help for Compulsive Acquiring, Saving and Hoarding.” He has published more than 140 scientific articles on hoarding and related topics, has provided consulting services to a variety of hoarding task forces and has presented hundreds of lectures and seminars on the topic.

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His work on hoarding and its treatment has been funded by the National Institute of Mental Health and the OCD Foundation. Frost will be sharing his expertise locally when he appears at a community program sponsored by Brook Lane called “Understanding Hoarding.” Free and open to the public, it will be held on Thursday, May 16, beginning at 7 p.m. at the Community Room on Brook Lane’s main campus. On Friday, May 17, Frost will present a professional continuing education seminar called “Stuff: Compulsive Hoarding and the Meaning of Things.” The seminar will be held at Cortland Mansion in Hagerstown from 8:30 a.m. to 4 p.m. Cost is $99, which includes six continuing education credits. This full-day seminar will present the clinical profile of compulsive hoarding behaviors. Frost will provide intervention strategies, including ways to enhance motivation, establish goals for treatment, increase skills for organizing and problem solving and change beliefs about possessions.

Understanding hoarding

Hoarding was barely discussed a dozen years ago, reports the OCD Foundation, and before the early 1990s, there was little research on the topic. But hoarding has become more visible because of television shows such as A&E’s “Hoarders” and TLC’s “Hoarding: Buried Alive.” While many people consider hoarding an act of laziness or a bad habit, Frost said it’s a complex brain and behavior disorder. “In fact, when the American Psychiatric Association’s Diagnostic Manual of Mental Disorders is published later in May, it will officially become a disorder,” he said. The report will include diagnostic criteria and a numeric code, making psychologists and other professionals more aware of the problem and making it easier to get insurers and providers to pay for treatment. According to Frost, “hoarding is characterized by the inability to get rid of — discard, recycle, sell, give away — possessions. This may only be an eccentricity until the resulting clutter precludes the use of living areas of the home. It is important to note that having an attic or basement full of stuff does not constitute hoarding disorder. The behavior only becomes a disorder when it interferes with one’s ability to live.” And there are no exclusions to what a person will hoard. For some, it’s enough handbags, shoes and clothes to fill a store. For others, it’s the inability to dispose of trash, resulting in self-imposed squalor, inaccessible beds and a floor that hasn’t been seen in years.

Identifying hoarders

Frost said there are now at least five epidemiological studies that indicate that hoarding disorder occurs in between 2 and 6 percent of the population.

“This is remarkably higher than early assumptions,” he noted.

In most cases, Frost said, “hoarding begins early in life, usually by the age of 20. But it doesn’t become severe until decades later. Most people with severe hoarding disorder tend to be older.” One reason, he explained, is that the older you get, the more stuff you’ve been able to accumulate. Also, older individuals might have physical and cognitive limitations to deal with the situation. While the medical world isn’t 100 percent sure why hoarding occurs, “we know that it is at least partly genetic, that there are differences in the way information is processed in the brain,” Frost said. “There are differences in the attachments that form to possessions.” Most people with hoarding problems realize something is wrong and want help, Frost said. However, there is a sizable minority who do not seem to recognize the problem — which also directly affects others in the home, as well as extended family and friends. “Hoarding typically impairs family relationships,” Frost said. “In most cases, family members spend years, sometimes decades, in frustrated attempts to get their hoarding loved one to change. The result is usually a strained or severed relationship with little or no change in the hoarding symptoms.”

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And hoarding isn’t just a problem in the home, say experts. It can happen in an office workspace and even in cars. There also is animal hoarding — keeping large amounts of pets without the ability to care for them. Frost explained that hoarding does not appear to change over time without some type of therapeutic effort. “We have developed a form of cognitive therapy for hoarding that works reasonably well,” he said. “But we are continuing to revise it to work better.” Frost said his program at Brook Lane will cover hoarding from the phenomenology to treatment. “It will be comprehensive and include demonstrations of therapy techniques, as well as our latest research on using facilitate self-help groups,” he noted.

Discussion will include the difference between ordinary clutter and compulsive hoarding.

More information about hoarding

According to the OCD Foundation, hoarding involves three connected problems:

Collecting too many items:

Too much shopping is common among people who hoard. Three out of four shop too much.

Roughly one in two people who hoard report excessively collecting free things.

The collection can also occur without any effort — for instance, food wrappers or the packing material that comes with new purchases.

Difficulty getting rid of items

The hallmark of hoarding behavior is not being able to let go of things. Throwing away, selling, donating or even recycling are very difficult for the hoarder. While, to most people, the objects saved may seem worthless, in truth, people who hoard can’t let go of anything. The reasons for saving are largely the same as the reasons people who don’t hoard have for saving things. The most frequent reason is to prevent waste, followed by informational content, emotional attachment, and, finally, liking the way something looks or feels. Some people who hoard believe they can get rid of items, but the process is so time-consuming they often give up, leaving the clutter to grow. Clothes, newspapers and books are the most commonly hoarded items. But the list can include anything.

Disorganization:

In addition to collecting too many items and the difficulty of getting rid of items, most people with hoarding problems have difficulty with organizational skills. These problems may be associated with information processing, problems with attention, categorization and decision-making. Attempts at organizing usually result in hours of moving possessions around without any effective result. The disorganization results in piles of possessions throughout the home that consist of both worthless and valuable items, complicating efforts to de-clutter.

Recognition of the problem:

Not realizing the seriousness of hoarding is common among people who hoard.

For more information hoarding, go to the International Obsessive Compulsive Disorder Foundation’s website at www.ocfoundation.org. Information includes an overview of the organization, personal stories, current research and resources.

If you go ...

What: “Understanding Hoarding”

When: 7 to 8:30 p.m. Thursday, May 16

Where: Brook Lane community room, 12318 Brook Lane Drive, Hagerstown

Cost: Free

Contact: Seating is limited. For a reservation call 301-733-0331, ext. 349

What: “Stuff: Compulsive Hoarding: and the meaning of things”

When: 8:30 a.m. to 4 p.m. Friday, May 17

Where: Cortland Mansion, 19411 Cortland Drive, Hagerstown

Contact: To register, go to www.brooklane.org or for more information, call 301-733-0331, ext. 189.

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