Fugen Neziroglu on Overcoming Compulsive Hoarding

Thousands of Americans feel an overwhelming need to acquire and save items of little or no value. This disruptive and often dangerous condition is called compulsive hoarding. People who hoard wrestle with a range of psychological and social issues that have a great impact on their quality of life. The subject of increasing media attention, hoarding is also of ever-greater interest to psychologists, who are actively researching the causes and best treatments for the condition. New Harbinger’s book Overcoming Compulsive Hoarding: Why You Save and How You Can Stop is the first self-help book written for people who hoard and their loved ones. It offers a workable program for dealing with compulsions, clearing away clutter, and achieving realistic lifestyle goals. We asked psychologist and professor Fugen Neziroglu, one of the book’sauthors,a few questions about this disorder.

New Harbinger Publications: How can you tell whether someone hoards compulsively or just likes to collect things?

Fugen Neziroglu: The indicator is the way the individuals feel about their collections. People who hoard are embarrassed by their possessions and often take pains to conceal them, while collectors feel proud of their caches and enjoy showing them off. People who hoard tend to keep their possessions in disarray and disrepair, but collectors tend to organize and dote on their prized objects. The acquisition of new possessions is a source of shame and distress for someone who hoards, whereas a new item will excite and delight a collector. In general, people who hoard suffer some impairment due to their behavior and collectors experience some kind of enhancement.

NHP: What are some items that people who hoard typically save?

FN: People who hoard can save anything. Most commonly they save newspapers, magazines, paper, flyers, plastic bags, mail, tools, clothing or shoes, and food.

NHP: You say that there is some indication that hoarding is a symptom of obsessive-compulsive disorder (OCD). Can you tell us a little about why some clinicians suspect this?

FN: People who hoard, like other individuals with OCD, experience obsessions, compulsions, and doubting. They obsess about their possessions, have compulsions to save them, and doubt what to discard. Their doubts can also focus on whether they’ve accidentally thrown something valuable away, how best to organize their possessions, or whether someone has touched their belongings. These persistent thoughts are similar to the obsessions or compulsions experienced by people with OCD.

NHP: What are some different types of hoarding?

FN: People hoard for sentimental, instrumental, and aesthetic reasons. Sentimental saving happens when a person associates an object with a particular emotion and event–- You might hear things like, “My husband wore these shirts during our last cruise,” or “These clothes and toys belonged to my children when they were young.” Instrumental saving refers to the fear of losing some valuable information or object that may be needed in the future. People may buy several of one item, believing that they might need it in the future. Aesthetic hoarding is less common than the other two, but it is often seen. Someone who hoards for aesthetic reasons might save things like vases or plates because they are pretty or have a particular interest in a class of objects like airplane models.

NHP: What effect does hoarding have on the family, particularly the children and the spouses of people who hoard?

FN: Hoarding can be devastating for the family. You have to remember that people who live with someone who hoards don’t get to choose how they want to utilize their space. The person who hoards has total control over what goes where. This can cause a lot of anger. Also, because most hoarders are ashamed of their behavior, they usually won’t let others into their homes. This can cause all sorts of problems: leisure activities and social behaviors get disrupted, routine maintenance of things around the house becomes impossible. Functional spaces in the home like beds, kitchen tables, couches, and so forth can get lost under collections. And, of course, the collections themselves can create health problems.

NHP: What causes people to hoard?

FN: We don’t really know what causes hoarding. There are some theories.

Neurobiological bases are being investigated. It is believed that serotonin, a substance in our bodies, might be involved. On a psychological level, it seems that hoarding almost serves as self-preservation. People who hoard might associate loss of possessions with loss of identity and self. This feeling might be related to deprivation. We also live in a society that puts a lot of emphasis on acquiring objects, and this kind of sentiment might incline people to save things. Our self-worth is often equated with the number of possessions we have.

NHP: People who hoard may be evicted or lose their children because of the safety hazard posed by clutter. Can you tell us what the hazards typically are and what local governments are doing to address the problem of hoarding?

FN: There are currently many task forces being formed to deal with hoarding.

Previously, many tenant-landlord disputes led to the eviction of people from their homes and the dumping of their possessions. Some of these people attempted suicide or simply quit functioning after they lost their belongings. Now we recognize that hoarding is a disorder that needs to be dealt with seriously and somewhat therapeutically. More and more, landlords and civic authorities who are familiar with hoarding try to work with tenants that hoard to help them deal with their possessions in more constructive ways, like letting people who hoard decide for themselves what to discard. The welfare of children with parents who hoard, of course, is a major concern for local governments. Some children may be removed from their homes if they don’t have a bed to sleep on, a place to do homework, or space to walk and play around in. It’s certainly the case that their physical health can be endangered by molds, infestations, and excessive dirt – conditions that can cause asthma and other health problems.

NHP: Hoarding must cause a lot of problems for the spouses and partners of people who hoard. What would be your advice to the partner of someone who hoards?

FN: Now that it’s available, I’d recommend that he or she read our book and then offer it to his or her mate. I’d suggest they talk about the problem in a non-threatening way and acknowledge together that the hoarding is a serious problem causing further serious problems in their relationship. I’d advise them to go to a therapist together to work on the problem–-after, of course, first checking to make sure the therapist is familiar with hoarding and will actually do the type of therapy we suggest in the book. If the person who hoards refuses to see a therapist for hoarding, I’d try to get him or her to go for the relationship issues. Getting your foot through a well-trained therapist's door is the first step. If all else fails, the partner of the person who hoards can do the intervention technique we suggest in the book, organizing friends and family members to talk to the person who hoards about the problem.

NHP: What are some of the treatment options for compulsive hoarding?

FN: We recommend treatment using a cognitive behavioral approach because it directly addresses the problematic thoughts and behaviors that incline someone to hoard. We feel strongly that talk therapy, in particular, doesn’t help hoarders at all. We also recommend cleaning and clutter-reduction techniques as part of treatment. In particular, the three-and-a-half-box technique we’ve devised and described in the book is very effective at helping people who hoard deal with clutter. It is important for therapists to engage clients in therapy, but this is also very difficult to accomplish. We think it’s imperative that people who hoard seek out therapists with experience in treating hoarding. It is not like other forms of OCD.

NHP: Once people who hoard have overcome their compulsion to save, what can they do to prevent relapse?

FN: Probably the most important thing for someone recovering from hoarding to focus on is the careful use of functional space for its intended purpose. If a recovering individual experiences a relapse, it’s important for them to return immediately to the techniques we describe in the book without letting themselves feel overwhelmed or defeated. The good news is that once someone who hoards accomplishes his or her goals and overcomes an urge to hoard, he or she will probably never hoard with the same degree of severity as before. I advise people to keep plugging along, setting up new goals and working on them everyday.