Trash or Treasure

Hoarding Disorder (HD) has received a lot of media attention in recent years. Oprah Winfrey and Dr. Phil have dedicated several shows to this disabling and sometimes even lethal problem. Furthermore, the American hit show ‘Hoarders’ is now being aired in the Netherlands. Our fascination for those who accumulate excessive clutter, animals or in some extreme cases, feces, seems insatiable. The fact that this affliction is surrounded by mystery is partly responsible for this fascination. Until recently researchers weren’t certain how to define or treat HD. Nevertheless, two different initiatives might be the breakthrough extreme hoarders and their loved ones have been waiting for.

Greedy or Needy Historically, hoarding has been discussed in the works of many psychoanalysts, for example Sigmund Freud’s anal stage of development. He suggested that the loss of control and what went down the toilet was a traumatic occurrence and that, therefore, the collector is trying to gain back not only control but “possessions” that were lost so many years ago.

The term ‘hoarding‘ was originally coined in order to discuss animal behaviors regarding the storage of food. In a 1966 study conducted

by Bolman and Katz, the concept was used for the first time to describe this behaviour in humans. They used the term ‘compulsive hoarding’ to discuss their findings in an anecdotic case report. It took another 30 years before an operational definition was published. Randy Frost and Tamara Hartl characterized hoarding by “the acquisition of and failure to discard a large number of possessions that cover the living areas of the home and cause significant distress or impairment.” Since this pioneering publication, research on hoarding has increased significantly. Hoarding has been found to be far more prevalent than previously thought - somewhere between six and fifteen million people in the US alone are believed to be hoarders.

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Trash or

Treasure?

Creativity run amok Randy Frost has spent nearly twenty years researching hoarders and is a pioneer in the treatment and psychopathology of compulsive hoarding. Together with his colleague, Gail Steketee, he published ‘Stuff: Compulsive Hoarding and the Meaning of Things’ in September 2010. The authors draw upon various case studies spanning decades of field work and narrate their spectacular journey through piles of accumulated stuff.

Whereas TV shows like ‘Hoarders’ only scratch the surface, ‘Stuff’ explores the depths of this disorder. Frost and Steketee examine the illness from a psychological, sociological, genetic and neuroscientific angle. Frost observes: “People who hoard save everything, and it’s the good stuff as well as the crummy stuff. Hoarders are very interested in the physical world and see it in a different and more complex way than the rest of us do. Most of us look at a bottle cap and see just that. Hoarders look at it and see the shape the color, the unusual details that the rest of us overlook. By noticing this, it gets valued and offers a whole host of potential uses. But it’s potential that they never follow up on. It’s creativity run amok.”

Hoarders feel a very strong sense of emotional attachment towards their possessions and feel a need to stay in control of their things. They 9

don’t want anyone touching or moving their stuff. These traits make living with a hoarder very difficult and traumatic. A child of a hoarder remembers: “My mother taped strands of hair to door jams and cupboards so she could tell if the kids tried to: ‘Get in and touch or move her stuff.’ Another anonymous statement on the website ‘childrenofhoarders.com’ reads: “I feel that ‘things are put first and more important than her children are.’ I was accused of stealing her ‘things’ all the time, blamed for stuff she misplaced.” The stories are heartbreaking and really emphasize the fact that hoarding is a disabling disorder, for those who suffer from it and especially for their loved ones.

It becomes clear that HD is an incredibly complex phenomenon. It is frequently found in patients with other diseases, including dementia, Alzheimer’s, schizophrenia and anorexia.

HD is a behavioral syndrome that has always been considered a type of obsessive-compulsive disorder (OCD), but unlike most patients with OCD, those with hoarding disorder often display poor insight into the severity of their behaviour which makes treating this problem very difficult. Frost has observed that psy-

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chologists, who are quite comfortable treating OCD patients, often describe frustration with hoarding cases. Patients passively resist treatment and only attend therapy sessions at the behest of others.

No catch-all solution Hoarding is believed to be a pathological brain disorder and often runs in families, although it is uncertain whether DNA is involved. Out of embarrassment, many hoarders avoid inviting friends or family, which leads to social isolation and family conflict. In their book, Frost and Steketee conclude that because there is no catch-all cause, there is no catch-all solution either. ‘Stuff’ offers perspective for those who need to understand hoarders but doesn’t construct a new vision of compulsive hoarders. Frost relates this to a lack of research.

He remarks: “The research on hoarding is in its infancy. We still need to study what’s happing in the brain that drives this behavior.

And what part of the brain is involved in decision making and forming attachments to possessions? How does the brain sort it out, and what needs to happen to break the attachments?”

There is no ‘cure’ for compulsive hoarders: no treatment will make the problem go away completely. However some treatments may help to manage the symptoms, for example anti-depressants and cognitive-behavioral therapy. As Frost points out, it is hard to come up with a treatment for a disorder that is still in many ways a mystery. Nevertheless new research might change this status quo.

The Case of the Collyer Brothers The first and most infamous case of hoarding that hit the headlines, was that of the Collyer brothers in 1947. Langley and Homer Collyer were two well-off brothers living in New York City. After their parents died in the mid 1920s, Langley and Homer remained in the old family home, a three storey mansion in Harlem. The eccentric pair completely withdrew themselves from the outside world. Curious burglars tried to break into the house many times, which made Langley decide to board up the windows and set up booby traps inside the house.

The two brothers failed to pay the bills and consequently, electricity, water and gas were turned off in 1928. Langley, who didn’t leave the house during the day, began to wander the streets at night to fetch water from parks. He picked up all sorts of trash: newspapers, old furniture boxes and even tree branches. Soon the house became an inhabitable labyrinth filled with towers of newspapers and other clutter. In the meantime, Homer had lost his eyesight and was cripple with rheumatism. He was completely dependent on his brother Langley for food and water.

In March 1947, after an anonymous tip from someone who insisted that there was a dead body in the house, police officers tried to break into the brownstone mansion. After hours of removing junk, they found Homer’s body. He had died of the combined effects of malnutrition, dehydration and cardiac arrest. Although a very foul smell indicated that there was another decomposing body in the house, the police weren’t able to find the source of the smell. It took the police 20 days before they finally found Langley. His body was eaten by rats and covered by bundles of newspapers. He had been crawling through his newspaper tunnel to bring food to his brother when one of his own booby traps fell down and crushed him. Rescue workers removed over 103 tons of rubbish from the house and subsequently, the fear of throwing things away is therefore also called the Collyer Syndrome.

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More Love Less Stuff The recent realization that HD is not a subtype of OCD but a distinct disorder, means a radical change in the way HD is assessed and studied. Based on this notion a group of renowned HD researchers have published new findings and suggested new treatments for hoarding problems in this month’s Journal of Clinical Psychology. Randy Frost, Veselina Hristova and David Tolin recognize past mistakes when it comes to HD treatment: “On both clinical and research grounds, we discourage use of hoarding subscales embedded within instruments designed and validated for OCD”.

The authors suggest tailor made therapy sessions and home visits by therapists: “Many hoarding clients have not allowed anyone into their homes in years; a common treatment goal is to get clients to allow family and friends into their homes on a regular basis”.

When it comes to designing effective treatment for hoarding problems, Edward Lemay’s recent study will have a significant impact. Lemay, assistant professor of psychology at the University of New Hampshire, together with colleagues at Yale University and the University of Geneva studied the link between feelings of security and materialism. Prior research had focused primarily on examining effects of threats to felt security on heightened materialism. Lemay and colleagues, on the other hand, decided to demonstrate that enhancing felt security, the feeling of being loved and accepted by others, would reduce the value people place on goods. “Throughout history, the availability of responsive relationship partners and of possessions such a food, clothing, and housing provided literal protection from harm, Lemay writes, “We suggest that, to some extent, these sources of protection are interchangeable and that people often substitute one source of protection for the other.” To test their assumption ex-

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periments were conducted in which these researchers measured how much people value specific items, such as a blanket and a pen.

Lemay and colleagues came to the conclusion that people who did not feel secure placed up to five times greater value on items than more secure people. “People value possessions, in part, because they afford a sense of protection, insurance, and comfort,” says Lemay, “but what we found was that if people already have a feeling of being loved and accepted by others, which can also provide a sense of protection, insurance, and comfort, those possessions decrease in value.” Lemay is confident that his study will be of great use in the development of an effective treatment for people with hoarding disorders.

There is no doubt that compulsive hoarding will continue to fascinate both scientists as well as the general public. Research has shown that this disorder is not only a simple matter of collecting ‘stuff’, nor is it a subtype of OCD. HD is a much more complex phenomenon.

As research is still in its infancy more studies need to be undertaken to increase awareness of the issue of hoarding to the general population. Nevertheless studies like those of Lemay and Frost are paving the way towards effective treatments. Through these groundbreaking studies we know now that hoarding doesn’t stop once a home is cleaned out. Increasing a patient’s sense of being loved and accepted by others, together with intensive therapy, might just be the way to break the attachment to possessions.

By Elke Weesjes 13