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This article is from the WebMD Feature Archive

Harmless collector or compulsive hoarder?

Three questions to help you decide if you've crossed the line into hoarding, and how treatment can help you declutter.
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Profile of a hoarder

At first glance hoarders may be viewed as untidy, uncaring slobs. However that’s not the case, say Saxena and Frost. They describe some traits that may be surprising:

  •  An urge to acquire. Some hoarders may be shoppers, others masters of finding freebies or near-freebies, from coupons to car-boot sale bargains. For some the "stuff" gives them comfort. Others may form emotional attachments to the items.
  • Perfectionism. "It doesn't seem to fit at first", Frost says. But consider the thinking pattern of a typical hoarder: when faced with a pile of things, the first thought in deciding to clear it out, Frost says, is often this: "If I throw this away, I might be making a mistake". Saxena agrees, saying that hoarders often tell him, "I can't do any task unless I do it perfectly". For instance faced with towering piles of newspapers, they think there is no way they can do an outstanding job - so they don't even start.
  • Indecision and avoidance. Hoarders also tend to have trouble making decisions - to throw it out or not? - so the clutter accumulates. Suppose an empty shoe box is found in the middle of clearing out cupboards. A non-hoarder may bin it without thinking twice, reasoning that the shoes, even if they still have them, are on a shoe rack or on the cupboard floor. But Frost finds a hoarder's thinking process is often different. A hoarder might think, "But it could hold something else. Maybe I should save it for bills". Then indecision may creep in. "Maybe my bills won't fit", the hoarder may think. More indecision. "My cousin does a lot of eBay business and he needs boxes, so I’d better save it". Saxena says, "Saving stuff is an avoidance behaviour. You don't need to decide whether to throw it away".
  • A sense of responsibility. Some hoarders hate to waste anything and feel guilty about binning things. They feel as if they’re a bad person, they often tell Frost, if they are wasteful. For others - including Paula Kotakis - a sense of responsibility can keep them in cluttered surroundings. Why does she tend to hold on to printed materials? "Someone might need this information one day", she says was her reasoning. "And I'm responsible for providing it".

Inside a hoarder's brain

When Saxena examined the brains of compulsive hoarders with positron emission tomography (PET), he found lower than normal activity in the anterior cingulate cortex. That area is associated with such tasks as focused attention and decision making - perhaps explaining the inability to decide what to throw out and to keep with a clean-up task.

He suspects structural problems in the brain may also play a role and is researching that possibility.

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