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Toxic Compulsion 5: Hoarding

Do you remember when saving things, or even being a pack rat, was considered a sign of frugality? Maybe that attitude was a holdover from the Depression-era generation that went through such privation during hard economic times that “saving for a rainy day” became an expression of their survival instinct.

Over the years I’ve been in homes that were so stuffed with belongings that I thought to myself, “There’s a problem here.” At the time, I just considered the chaos to be something temporary that I shouldn’t worry about. I didn’t have any knowledge that there might be a disease condition involved. I didn’t even know about the word hoarding until just before starting the research for this book. This is how far and how fast we’ve come in terms of identifying these brain compulsions.

Maybe you’ve seen one of the “reality” television shows about hoarders and their hoarding habits. These stories can be as riveting and gut-wrenching as watching a slow-motion train wreck. In the United States, both The Learning Channel (TLC) and the Arts & Entertainment (A&E) network feature dramatic and widely watched shows about the compulsion some people have to hoard consumer items and even animals, and the heartbreaking attempts of family and friends to intervene, with assistance from addiction treatment experts.

Compulsive hoarding has also been labeled “disposophobia” because the person with this disorder feels a real and palpable fear of throwing or giving anything away, even if the items are essentially worthless. If you’ve ever had the experience of throwing something away and then a few days later realizing you really needed that item and wishing you hadn’t discarded it, you have a small glimpse at what motivates some hoarders to keep everything they acquire. It’s a pathological fear that, to the hoarder, is intense and is fortified by endless rationalizations. You just never know when something that seems worthless today will prove to be useful or valuable tomorrow!

As the acquired items pile up over time, every square foot of living space becomes storage space. That includes the kitchen and bathroom. Eventually, cooking and cleaning and showering and sleeping are encumbered by the mess, a process that whittles away at the hoarder’s dietary health, bodily cleanliness, and self-respect. Some hoarders use their bathtubs and refrigerators to store items. Hoarding experts described for me studies in which 45 percent of hoarders were unable to use their refrigerators, 42 percent couldn’t use their kitchen sinks, and 42 percent couldn’t use their bathtubs, all because the clutter was so thick in their houses or apartments that these important parts of functional and healthy living had been hidden until the hoarder no longer made use of them.

Other hoarders allow uneaten or unopened food months past their expiration dates to accumulate in their refrigerators or on kitchen countertops until it becomes moldy and a magnet for mice, rats, and ants. If animals are kept around as pets, their urine and feces get buried under the accumulating piles of clutter. The stench can be unbearable for visitors, but the hoarder may slowly get used to it as a “normal” state of living.

Hoarding can take many forms. It might start out as collecting and evolve into cluttering. Many hoarders truly believe they are just messy collectors. Remember Imelda Marcos, wife of the late President of the Phillippines Ferdinand Marcos? When he was deposed in a pro-democracy coup a few decades ago it was found that Imelda kept a collection of several thousand pairs of shoes in her many closets. What reasonable person would have a need for several thousand pairs of shoes, most of which had never been worn? Her obsession with footwear bears a classic hallmark symptom of hoarders—their fixation with acquiring but never discarding.

Dr. Charles L. Whitfield, a psychotherapist and trauma recovery expert, noted that hoarding is one of those disorders that can rapidly go from a harmless habit into an unhealthy fixation. It’s not always easy to tell where a person is on the continuum from habit to fixation. “A library is a place of hoarding for books, for instance, but they are very well organized,” said Whitfield. “With the typical hoarder, the one where you can’t get through their house because there is no path, even that type of hoarder may know a path for how to get through it all. So there may be some semblance of organization to them that isn’t apparent to outsiders. Herb & Dorothy is a film out on DVD about a librarian and postal clerk who collected modern art. They were hoarders and took their meager salaries and bought art, about 4,000 pieces, which they had under their beds and on their floors until there was almost no room to walk around in their small home. They donated 1,000 pieces to the National Gallery of Art. They turned hoarding into something positive. So the severity of hoarding can sometimes be related to how disorganized or organized a person is in their categorizing and sorting out of what they hoard.”

Some hoarders are prone to anthropomorphizing objects, which means they tend to treat the objects as if they had feelings like human beings. Dr. Gail Steketee, a dean and professor at the Boston University School of Social Work, described one such case: “It was a delightful woman who struggled with hoarding, quite successfully, in fact. But she continued to struggle with anthropomorphizing of objects. This woman worried that the dishes on the bottom of the dishwasher would be upset that other dishes were put on top of them. In her story is the clear problem of thoughts and beliefs that contribute to hoarding—that objects are given more value than they really have, that people have a strong wish to control their things so no one else can touch them, that they see beauty and opportunity in many things and save them, even if these attributes can never be realized.”

Who Are the Hoarders?

Mayo Clinic addictions specialists note that studies show about half of diagnosed hoarders have a history of alcohol dependence. Many experience eating disorders, making them overweight or obese. They are also particularly prone to experiencing major depression, anxiety disorders, and attention deficit hyperactivity disorder (ADHD). All of these maladies may be triggered by early childhood trauma, abuse, unstable upbringing, and parental neglect. This is a history also shared by many people with other types of addictive behaviors, such as drug and alcohol abuse.

A 2010 survey study of 751 adults with self-reported hoarding symptoms discovered that the onset of hoarding symptoms was typically between 11 and 15 years. Late onset of symptoms, after age 40, was rare. Stressful and traumatic events were commonly described by the survey respondents. (Source: “Course of compulsive hoarding and its relationship to life events.” Tolin DF, Meunier SA, Frost RO, and Steketee G. Depress Anxiety. 2010 Sep;27(9):829–38.)

The potential safety and health pitfalls of hoarding should be obvious. Messy homes become fire hazards and obstacle courses that increase the risks of falls and injury. Clutter creates unsanitary living conditions with insects and rodents proliferating. Financial repercussions might include eviction by landlords, fines from government agencies, and the cost of maintaining storage facilities when the home becomes overburdened. Hoarding often provokes conflicts with family members, creates social isolation, and interferes with a normal, productive life.

Studies have examined the economic and social burden of compulsive hoarding. The disorder is associated with an average of seven work-impairment days a month, which is equivalent to what has been reported by persons with psychotic disorders. Hoarders are “nearly three times as likely to be overweight or obese as family members … and 8 to 12 percent [have] been evicted or threatened with eviction due to hoarding,” a 2008 study reported. (Source: “The economic and social burden of compulsive hoarding.” Tolin DF, Frost RO, Steketee G, Gray KD, and Fitch KE. Psychiatry Res. 2008 Aug 15;160(2):200–11.)

If you are getting the impression that hoarding is a uniquely American problem, perhaps owing to our overly materialistic lifestyles, you would be mistaken. Few studies of hoarders have been conducted in other countries, but those that have been undertaken show patterns very similar to our own results. In Japan, a group of 186 OCD (obsessive-compulsive disorder) patients were assessed, and 54 were found to be compulsive hoarders, leading the researchers to conclude that hoarding “was similar to [results] reported in Western countries.” (Source: “Clinical features and treatment characteristics of compulsive hoarding in Japanese patients with obsessive-compulsive disorder.” Hisato Matsunaga et al. CNS Spectr. 2010 Apr;15(4):258–65.)

Is It Really Just Obsessive-Compulsive Disorder?

Until a decade or so ago, the prevailing opinion of the psychiatric profession held that hoarding compulsions were a subset of OCD and should be treated the same way. More recent science studies using brain scans have dramatically altered that consensus opinion.

Brain imaging studies using positron-emission tomography (PET) scans have demonstrated that cerebral glucose metabolism patterns in hoarders are quite different from the patterns seen in nonhoarding OCD patients. The most important difference was decreased activity among hoarders in the part of the brain responsible for attention, decision-making, and focus, which can lead to poor judgment and emotional disturbances. Any damage to the right medial prefrontal cortex of the brain can stimulate the compulsion for hoarding. (Source: “Cerebral glucose metabolism in obsessive-compulsive hoarding.” Sanjaya Saxena et al. Am J Psychiatry. 2004 Jun;161(6):1038–48.)

Writing on behalf of the International OCD Foundation, Dr. Gail Steketee, dean and professor at the Boston University School of Social Work, has made these four behavioral distinctions between OCD and hoarding:

1. Few hoarders experience unwanted thoughts about hoarding, whereas this is a defining feature of OCD sufferers.
2. Hoarders generally feel distress only when they are forced to discard something and it’s more grief-like than the anxiety seen with OCD.
3. Hoarding can be experienced as pleasurable when objects are acquired, which almost never happens with OCD people.
4. At least 80 percent of hoarders never exhibit any other OCD behavioral features.

It’s now clear that compulsive hoarding is a separate disorder from OCD and needs to be classified by mental health professionals with its own diagnostic criteria, along with separate intervention and treatment approaches.

10 Signs and Symptoms of Hoarding

This summary of hoarding clues was posted by the Mayo Clinic staff (www.mayoclinic.com). A general rule of thumb is that a hoarder will show most if not all of the following tendencies:

1. Living spaces are cluttered far beyond “normal” standards.
2. The person regularly exhibits an inability to discard unneeded items.
3. Stacks of newspapers, magazines, or junk mail are kept.
4. Items are moved from one pile to another, but nothing is discarded.
5. Seemingly useless or unneeded items are acquired, such as other people’s trash or even straws and napkins from a restaurant.
6. Difficulty occurs in organizing items that are acquired.
7. The hoarder engages in procrastination and exhibits difficulty managing daily activities or making important decisions.
8. Embarrassment or shame is shown by the hoarder about their living conditions.
9. There may be discomfort in allowing other people to touch or borrow their possessions, which indicates an excessive attachment to these items.
10. Over time the hoarder becomes increasingly isolated from other people.

Some Inconvenient Truths About Hoarding

Some of these pieces of information defining hoarders and hoarding may come as a surprise to you, as they did to me. For example, I certainly had no idea that more males than females meet the criteria for hoarding.

• Hoarding is more prevalent in older than younger people, though the initial onset of symptoms usually occurs in childhood.
• With each decade of life, the severity of hoarding increases.
• Half of older adults with a hoarding problem also suffer from major depression and mood and anxiety disorders.
• Study evidence is mounting that hoarders’ brains have executive functioning deficits that affect judgment.
• Research has found that hoarding is genetically influenced and that up to 80 percent of hoarders had first-degree relatives who were considered “pack rats” or hoarders.
• Most hoarders live on fixed incomes and experience financial problems from having to pay for extra storage space, purchasing unneeded consumer items, and being hit with housing fines by landlords or government agencies.
• A persistent public perception of hoarders is that most are women; in fact, according to study surveys done in the United States and Britain, the numbers of men who hoard outnumber women.

(Source: International OCD Foundation, www.ocfoundation.org.)

Time to Get Honest with Yourself

(Source: “A brief interview for assessing compulsive hoarding: The hoarding rating scale-interview.” Tolin, DF, Frost RO, and Steketee G. Psychiatry Res. 2010 Jun 30:178(1); 147–52. doi: 10.1016/j.psychres.2009.05.001.)

Proposed Diagnostic Criteria for Hoarding

Here are the proposed diagnostic criteria for hoarding that will go into the DSM-V (Diagnostic and Statistical Manual), the so-called “psychiatric Bible” used by treatment specialists for guidelines on how to diagnose disorders:

Five Warning Signs That a “Hobby” Has Become Hoarding

“It can be difficult to sort out whether someone has a compulsive hoarding problem,” said Dr. Daniel K. Hall-Flavin, an addictions psychiatrist and professor at the Mayo Clinic and former medical director for the National Council on Alcoholism and Drug Dependence. “Hoarders typically deny that they have a problem.”

What may be obvious to outside observers—that the person has a serious hoarding problem—will be rationalized by the hoarder in numerous ways. For one, many hoarders choose to believe they are just collectors with a clutter problem. But real collectors, whether it’s of old newspapers and magazines, model cars, plates, antiques, or any other item, tend to organize, categorize, and carefully display the items as a collection. Hoarders generally don’t do that.

Here are Dr. Hall-Flavin’s five warning signs you can look for to determine if a “collecting hobby” has become an unhealthy obsession:

1. The person is constantly acquiring things they don’t need and doing so by acquiring duplicate items that often lay unopened.
2. The person has piles of clutter everywhere, without organization, making it difficult to move around in the dwelling.
3. The person can no longer sort, organize, or make rational decisions about his or her possessions.
4. The person has tremendous difficulty throwing anything away, so he or she rarely if ever does.
5. You and other visitors are discouraged from entering the person’s home, or certain areas of the home have been closed off to hide a clutter problem.

Animal Collecting May Not Be Compassion

At what point does a person’s desire to shelter homeless animals and save them from death in municipal animal control facilities become motivated and controlled by something more than human compassion?

It’s a tricky question. What feels like genuine, caring concern for animal welfare on the part of pet collectors can appear to be animal hoarding and pet cruelty to outside observers.

Hoarded animals can be of one species—cats or dogs are a common choice—or multiple species living together in the same indoor or outdoor space. One fellow featured on a reality television show kept thousands of rats in his home, all uncaged, until they literally overran the place. His rat hoarding began after his wife died in a car accident. A woman on another reality show kept pet chickens everywhere in and around her home, even after they had died and become mummified.

Studies of pet hoarders indicate that most also live in homes that are “cluttered, disorganized, and dysfunctional,” according to the journal Depression and Anxiety. (Source: “Comparison of object and animal hoarding.” Frost RO, Patronek G, and Rosenfield E. Depress Anxiety. 2011 Oct 3;28(10):885–91. doi: 10.1002/da.20826. Epub 2011 May 23.)

Pet hoarders meet the same diagnostic criteria that mental health experts apply to object hoarding. Sampling of case reports from animal control agencies in various cities have determined that 76 percent of animal hoarders were female and half of them were 60 years of age or older living in single-person households. The animals were usually cats, dogs, birds, and farm animals, and the median number of animals involved totaled 39, though in some cases more than 100 animals were found densely packed together. In 80 percent of the cases, the animals were either found dead or in poor condition. (Source: “Hoarding of animals: An under-recognized public health problem in a difficult-to-study population.” Patronek GJ. Public Health Rep. 1999 Jan–Feb;114(1):81–7.)

In another study of animal hoarding, 16 people who fit the criteria were compared to 11 people who owned large numbers of animals but didn’t meet the mental health standards for hoarding. Both groups were mainly middle-aged white women who owned an average of 31 animals. “Themes found significantly more often among animal hoarding participants than controls [the nonhoarding group] included problems with early attachment, chaotic childhood environments, significant mental health concerns, attribution of human characteristics to animals, and the presence of more dysfunctional current relationships.” (Source: “Characteristics and antecedents of people who hoard animals.” Steketee G, Gibson A, Frost RO, Alabisco J, Arluke A, and Patronek G. Rev Gen Psychol. 2011 Jun;15(2):114–24.)

Pet hoarders are usually deeply attached to the animals they keep. Many hoarders have turned to animals for the loving relationship they have failed to achieve with other humans. Yet they cannot comprehend that having dozens or hundreds of animals around may be doing more harm than good to these creatures. Like hoarders of consumer goods, animal hoarders have lost sight of boundaries.

Failure to provide proper care for animals is a crime in every state of the United States and in many other countries. So there can be definite legal ramifications to the out-of-control hoarding of animals that must be factored into any concerned person’s decision to intervene. Public health agencies may also have a role to play in any situations that involve animal crowding and unsanitary conditions.

If you collect large numbers of animals, or know someone who does, ask this series of questions to help you determine whether the situation is a problem that needs addressing:

• Has the number of animals grown beyond an ability to care for them properly?
• Are they being given proper nutrition, veterinary care, and adequate sanitation?
• Does the pet owner fail to act on the deteriorating condition of the animals (starvation, disease, and death)?
• Are the animals crowded together, whether indoors or outdoors, in ways that limit their movements unnaturally? Are they suffering from neglect?
• If other family members live with the pet collector, have their lives been negatively impacted by the numbers of animals present?
• Does the presence of a large number of animals affect neighbors with day and night noise and odor problems?

At www.animalconcerns.org you will find information about the Hoarding of Animals Research Consortium at Tufts University, a group of researchers who have assembled a wealth of information about animal cruelty, the legal issues involved, hoarder intervention and treatment approaches, and general resources about animal hoarding, all under the guidance of veterinary epidemiologist Dr. Gary Patronek and social worker/rehabilitation counselor Jane N. Nathanson.

Hoarding and Compulsive Shopping Are Related

Most of the experts I interviewed for this book drew connections between hoarding and the impulse-control disorder known as compulsive buying. You don’t need to be a shopaholic to be a hoarder. Some hoarders collect from trash cans, or they simply can’t bring themselves to throw away what they purchase based on otherwise normal buying habits. But a significant number of hoarders support their compulsion with excessive spending on items they may never use or even remove from its packaging.

From psychologist and compulsive buying specialist Dr. April Lane Benson of New York City, author of two authoritative books on this disorder: What shopping addiction looks like is when somebody is spending so much time, energy, and/or money shopping, or even thinking about shopping, that it is impairing their life in some significant way. Financial impairment is the most obvious. But there are people on welfare who are compulsive buyers. What they buy is not very expensive, but they can’t stop. There is also all kind of damage done to relationships, to occupational functioning, to their spiritual health. They feel hollow. One-third of the people I work with are not in debt. It’s the other consequences that are making them seek treatment.

They use shopping as a quick fix for the blues. In the short-run, that actually works. We have research studies that look at three different time points: before the purchase, at the point of purchase, and after the purchase. And compulsive buyers start out below the normal buyer, but at the point of purchase, their moods shoot way up above the normal buyer. And then after the purchase, it dies down, but it doesn’t go down quite as far as it was before the purchase. Whereas the normal buyer starts at a particular point; at the purchase they feel better and after the purchase they feel even better.

There are other addictions that co-occur with shopping. What I see the most are eating disorders along with compulsive buying. There is also panic disorder and major depression. I see less alcoholism and drug addiction, but that may just be my sample. Study results suggest that 5.8 percent of the U.S. population might be compulsive buyers. It’s almost evenly distributed between the two genders. It’s almost as prevalent as eating disorders and substance abuse.

There are new studies showing what kind of brain function is related to compulsive buying. Some people are just hardwired for this addiction and that makes it much more difficult to treat. It depends on how soon the person gets help and how good the help and support is. I think that people who have this problem, if they do the hard work of really developing the muscles [in the mind] they need to resist the urge to buy, and if they understand what they are really shopping for [to relieve a mood] and the consequences of compulsivity, they can succeed in treatment and regain control over their spending habits and their life.

Are you a chronic spender and shopaholic? Find out!

Though only a trained clinician can diagnose compulsive buying disorder, asking yourself the following questions can provide you with some clues as to whether you have a compulsive buying problem or not.

Choose the response that best describes you.

Add up your score on the six questions. A score of 25 or more is suggestive of compulsive buying disorder.

(Source: The Richmond Compulsive Buying Scale (assessment tool). “An expanded conceptualization and a new measure of compulsive buying.” Ridgway NM, Kukar-Kinney M, and Monroe KB. J Consum Res. 2008 Dec;(35)4: 622–39. doi: 10.1086/591108. Epub 27 August 2008.)

Hoarding Symptoms Often Appear in Childhood

Stressful life events play a crucial role in triggering the hoarding compulsion. Experts generally agree that hoarding often develops as a result of childhood trauma, the death of a loved one, divorce, or other dramatic and troubling events in a person’s life.

Because hoarding often starts in adolescence, perhaps as a seemingly innocuous collecting “hobby” or a preoccupation with saving broken toys, outdated school papers, or other unneeded items, there appears to be an association with having an older family member who has compulsive hoarding tendencies.

“There are genetic and neurological features that seem to mark people with hoarding compared to those who don’t hoard,” said Dr. Gail Steketee, dean and professor, Boston University School of Social Work. “We do know that hoarding runs in families, but we don’t yet know enough about the nature/nurture questions. Geneticists working on this do think that genetic linkages will be identified.”

Most of us collected something as kids. Maybe it was baseball cards, dolls, stamps, coins, comic books, or whatever else we placed value on. Our parents probably encouraged the hobby as a harmless way to occupy our time and develop specialized interests.

At what point does such an activity become obsessive-compulsive, one of the first symptoms of a hoarding disorder whose severity can intensify later in life?

Such questions about child hoarders are the career focus of Dr. Lisa Merlo, assistant professor of psychiatry, chief of undergraduate education, and director of Addiction Medicine Public Health Research Group, University of Florida.

“Many kids go through a hoarding phase without developing the full-blown disorder,” Dr. Merlo explained. “Often the disorder starts off as something like a rock collection. Then it becomes a string collection, or gum wrappers, and other items of less and less value. Maybe the child keeps old school assignments long after they have lost their learning value. That progression may be a sign that the compulsion to keep things is developing into the disorder.”

It’s important to detect a hoarding tendency early in life, Dr. Merlo stressed, because early intervention can make treatment much more effective. Hoarding and related obsessive-compulsive disorders often begin as a result of childhood traumas, events which may seem trivial to adults but which may be profound and life-altering for sensitive children.

“Traumas that can cause hoarding for a child include getting a bad grade in school or getting rejected for the cheerleading squad or the basketball team,” said Dr. Greene. “The developing brain is more vulnerable to these sorts of experiences. With kids it can be hard to determine whether the hoarding is primary or secondary to obsessive-compulsive disorder. Again, that is why if we can treat it early in childhood, we can prevent the disorder from growing in severity.”

An Effective Hoarding Treatment Approach

Experts on hoarding disorders whom I consulted are in agreement that the most effective treatment strategy for hoarding is to combine motivational interviewing with cognitive behavioral therapy (CBT), a combination of therapies that work irrespective of the hoarder’s age.

Motivational interviewing is an effective type of brief intervention that involves a way of talking to people to encourage the emergence of their own internal motivation for change. The therapist or counselor asks a series of questions. These might include:

• What is the downside of your hoarding?
• What would be some advantages to changing your behavior?
• How would you go about making these changes?
• What would it take for you to succeed?

Once a person begins talking about their own motivations, they begin to see that the cost of their hoarding behavior has gotten to the point where it isn’t worth continuing it anymore. Most hoarders begin to desire change and healing.

As a next step, the hoarder will be given an effective self-help tool known as cognitive behavioral therapy. This exercise enables the person to explore the reasons why hoarding occurs, learn how to improve decision-making skills and then to organize and categorize possessions for disposal, and learn to practice relaxation skills to reinforce healthy habits and decision-making.

In the book Overcoming Compulsive Hoarding the authors (Jerome Bubrick, Fugen Neziroglu, Patricia B. Perkins, and Jose Yaryura-To-bias) provide several detailed chapters on CBT, showing with exercises how to use this strategy to identify and change thought patterns that keep people stuck in their hoarding habit. Another excellent book, Digging Out by Michael A. Tompkins, PhD, teaches readers how to create a “harm reduction” plan for a hoarder that applies an effective step-by-step process for reducing problems associated with hoarding, though not necessarily “curing” the hoarder. This approach is especially useful if the hoarder is resistant to change.

Once a psychological reconditioning structure is in place, a professional organizer can be brought in to the home to help the hoarder go through the process of de-cluttering the living space.

Hoarders get better quicker when the combination therapy of motivational interviewing and CBT is used. That was borne out in a 2010 study of such a combination on 16 children who received 14 sessions of 90 minutes each over a three-week period. Children in combination treatment significantly reduced the time needed for treatment compared to a control group of kids. (Source: “Cognitive behavioral therapy plus motivational interviewing improves outcome for pediatric obsessive-compulsive disorder: A preliminary study.” Lisa J. Merlo et al. Cogn Behav Ther. 2010 Mar;39(1):24–7.)

Dr. Gail Steketee, dean and professor, Boston University School of Social Work, described her treatment approach this way: “A combination of motivational interviewing whenever the person expresses ambivalence; skills training in organizing, problem solving, and decision-making; cognitive therapy; and behavioral practice to resist acquiring and discarding. We also must go into the home to make sure the treatments are applied regularly, daily, where the hoarding occurs. We need at least 26 sessions and often this will take nine months or more to make a real dent in the clutter if it’s severe. The only predictors of better outcomes that we’ve been able to identify so far are being female, having less severe hoarding, having fewer other symptoms of OCD and social anxiety. If you expected treatment to work, it was more likely to do so.”

Beyond identifying and treating hoarders, we have much work to do as a culture educating ourselves about this disorder. “It’s difficult for some people to understand how anyone can get to this severe point of hoarding without it being their fault,” said the University of Florida’s Dr. Lisa Merlo. “As a society we have this immense stigma toward disorders where loss of control is a primary component. People need to have empathy as opposed to blaming the hoarder, because it’s not a choice. Hoarders aren’t hoarding because it’s enjoyable. They are trapped and are prisoners of their own disorder. It has literally taken over their life. We are pulling them out of a prison when we give them treatment. It’s never too late to help a hoarder. You should never give up hope on them no matter how severe their disorder.”

Some Treatment Options

For more information about the self-help oriented treatments mentioned most frequently by the experts interviewed for this book, along with valuable tips about how to utilize these methods and tools, consult the following:

• Cognitive Behavioral Therapy, Seven Self-Care Tools, p. 235
• Paroxetine: a medication used to treat the symptoms of OCD; in one 2007 study only 28 percent of hoarders given the drug responded favorably.
• Support Groups: Children of Hoarders (www.childrenof-hoarders.com), Clutterers Anonymous (www.cluttersanony-mous.net), Messies Anonymous (www.messies.com)

Your 30-Day Challenge for Hoarding

Do you have a bad habit or a dependency? Here is another chance to find out.

You have answered the questionnaires for this toxic compulsion. You have read through what the experts have to say. You have thought about the extent to which you exhibit the behaviors associated with either a nondependent use disorder or a dependency.

Do you still have any doubt about whether you have just a bad habit, or whether your behavior meets the criteria for a dependency?

Create a 30-day challenge for yourself.

Every day for 30 days, you will sort your mail and immediately discard into the trash anything that isn’t a bill or must be quickly responded to.

Once you put something into the garbage, you can’t take it out, and you must empty your garbage into outside receptacles for pickup.

You will also go into your pantry and refrigerator and throw out all food that has expired or appears to be uneatable.

If you can stick to this plan for 30 days without cheating, you may not have a hoarding compulsion that is a problem.