▶ Anxiety
With her long denim jumper, huge blue eyes, and helmet of gray hair, Thalia looked every inch the kindly grandmother that she was. Thalia was also a Stage 5 hoarder whose incessant talking and constant fluttering of her hands were classic signs of high anxiety. Time and again during her cleanup, she became so agitated that she would suffer a meltdown and the entire process would come to a halt. She admitted that she was in therapy, and she had prescription medication bottles littered through the house. But if any of it was antianxiety medication, it didn’t seem to be very effective.
Thalia’s house was full of knickknacks like salt and pepper shakers and other china figurines. She also had lots of memorabilia from her volunteer work in local elections in her Pennsylvania suburb—banners, yard signs, photos of her with the candidates.
Thalia’s anxiety was so high that she was unable to make any decision—ever. A stack of campaign flyers would send her into a tizzy. One can only imagine what was going on in her head:
What if there is something important in that stack of documents and it gets thrown away? What if one of these flyers is valuable because it is now history? Is all this memorabilia worth any money? Could anyone I care about use that flyer? Will my family finally love me because I saved them these valuable historical documents ? Wait, there may be some cockroaches in those papers, maybe they are too gross to move. I don’t want to make a mess because then I will have to clean up. Who would I call to take care of the roaches? Can I afford to hire pest control? Oh no, I don’t want anyone to see my house. Wow, what time is it? I really need to get working on these papers. But now I’m tired, I’ll lie down and rest. I’ll worry about the papers tomorrow. What do I have to do tomorrow? Do I have anything important I have forgotten? Where is my phone? Oh no, I can’t find my phone. Did I lose my cell phone or did someone steal it? I bet someone stole my cell phone. Oh no, I can’t afford a new phone. What am I going to do . . . ? Oh, here it is under some papers. Gosh, there sure is a lot of paper here. What am I going to do about all this paper? I wonder if there is something important in these papers. . . .
Anxiety can completely paralyze a hoarder. Thalia was simply unable to help herself. Even though she wasn’t physically active, her mental gymnastics exhausted her. When anxiety becomes this crippling, it needs to be treated with medication and/or therapy before cleaning can even begin.
Anxiety disorder is a general term that covers a range conditions including panic disorder, several phobias, obsessive-compulsive disorder, and post-traumatic stress disorder. (OCD hoarders have traditionally been grouped under anxiety disorder, but they have been discussed separately since they do portray distinctive behavioral characteristics.)
The latest studies on hoarding suggest that it may be its own subset of anxiety disorder and not part of OCD. Researchers are debating whether there should be a new category of psychology called “compulsive disorders,” which would include hoarding, OCD, and perhaps drug and alcohol abuse.
While the medical profession is still figuring out how all of these disorders are connected, in my experience, most hoarders have anxiety issues. Dr. Chabaud points out that a hoarder’s intense apprehensiveness is driven by fear—fear of real or imagined danger. All hoarders are attached to their objects, and so all of them will get anxious when someone starts taking those items away. A hoarder who has spent twenty years collecting something begins to identify with those items. Taking them away is like taking the person away. Anxiety is a natural reaction to such a severe threat.
Dr. Chabaud also says that hoarders who have a compulsive need to shop, for example, do so because it reduces their anxiety. The urge to buy is so intense that if someone tells the hoarder to stop, he or she starts to feel angry, irritable, scared, and anxious. People often ask me how a hoarder can have the energy to shop, but not have the energy to clean. For a hoarder, shopping has nothing to do with energy; it is completely about relieving anxiety and feeling good.
Hoarders are quick to go into anxiety mode when faced with making a decision about throwing items away. The anxiety is so overwhelming, and painful, that the hoarder avoids it by postponing decisions. Hoarders truly believe that they will get to the task tomorrow, but that day never comes.
▶ Attention Deficit (Hyperactivity) Disorder (ADD/ADHD)
Lucy, the craft hoarder who baked all the cakes, wanted to finally clean out her house after she retired. As long as someone was there working alongside Lucy, she was on it. She was hyper-focused on cleaning, and she could get through a room more quickly than most hoarders I’ve worked with. But on the days that nobody was helping her, and she had boxes to sort through on her own, she got too distracted to do the job. Unfortunately, she would go shopping instead.
Lucy would go shopping and load up on craft items, not stopping to think about the reality of what she really had time to do. “I can crochet a hundred fifty baby blankets this year,” she would tell herself. “I know I only made three last year, but this year will be different. I have to buy all this yarn now so I can have my materials on hand when I’m ready to get started. If I go ahead and buy the yarn, then that will motivate me to actually get it done! And these cookie sheets are on sale; if I buy them, I will finish the blankets faster since I also want to make cookies. I know! I’ll give cookies along with the blankets! I just have to stay focused and I can totally do it.”
Lucy’s ADHD drove her hoarding in that she was distracted by too many hobbies and bought endless supplies for each one. Also, she didn’t keep track of what she already had, so she was buying duplicates.
Lucy was smart, and she wanted to stay clean. This wasn’t about laziness or a lack of education. Lucy’s brain just worked differently. Hoarders like her have got to treat the ADHD first, usually with a combination of medication and therapy, or they just won’t be able to master the processes required to stay clutter-free.
The connection to ADHD is an easy one to make. Someone who is easily distracted and has difficulty sticking to a plan could become overwhelmed by keeping track of his or her possessions.
Dr. Chabaud has found that with ADHD, it’s difficult to tell which comes first. For example, do people start hoarding because they have ADHD issues, can’t focus, and overbuy when shopping? Or is it that a hoarder is so confused by the collecting compulsion that his or her brain starts to get easily distracted in other areas?
Because Lucy was easily distracted, she just wasn’t going to reliably follow through with things like folding laundry, washing dirty dishes, or even getting basic housekeeping done. And once she fell behind on those tasks, she felt so overwhelmed that she had no idea where to even start.
The hallmark of ADHD is that the “executive function” part of the brain doesn’t work very well. This is the brain’s “boss,” essentially, driving the person’s ability to sort, prioritize, and categorize tasks. A hoarder with ADHD can’t really make rational decisions about what to do. This hoarder also tends to fight structure and order, preferring to be spontaneous. Organization can look too controlling to a person with ADHD, like it might stifle the person’s creativity and impetuous nature.
Throwing items away seems risky, because in the ADHD world things are always getting misplaced. If an item with sentimental value gets lost, the memories might disappear with it, so the hoarder prefers to just keep everything. The most important items—whatever the ADHD person is holding at the moment—go “right here on top” of the piles. That’s how the piles grow. Everything in every pile is in some way important to a hoarder.
Also, ADHD hoarders have trouble thinking through “what-if” scenarios. For example, how likely is the hoarder to actually fix that broken clock radio? What are the chances the hoarder will actually find the missing pieces to the board game? More important, with whom is the hoarder going to play that game? These scenarios probably aren’t going to end satisfactorily, but someone with impaired executive function in the brain can’t weigh the likelihood of that.
Fin
ally, another hallmark of ADHD is the tendency to overfocus on a process or event and lose sight of the big picture, which means Lucy may not have even seen the house in its entirety. She may have seen only one pile at a time, and not realized—or subconsciously chosen not to accept—the extent of the problem.
▶ Addiction
Kurt was a shopping hoarder whose house, like Marcie’s, was filled with purchases still in their original bags and packaging. He was a compulsive shopper who lived for the thrill of finding a sale item, of comparing pricing and getting value for his money. Kurt liked nothing better than to deck himself out in a suit, gold chains, and watch; spritz on a little cologne; style his toupee—and go shopping. He felt important and totally in control.
Kurt admitted that he knew he was getting himself into debt and worsening his hoarding, but the act of shopping made him feel so good that he justified it to himself. On any given day he’d head off to his favorite big-box store, and he might tell himself that he’d just see what the sales were but wouldn’t actually buy anything. But then he would come home with hundreds of dollars’ worth of items. One could imagine his rationalization: “I know I shouldn’t do this; my credit card is maxed out. But this jacket fits me perfectly and it’s such a bargain. And my sister would love this silk flower arrangement. If I buy it for her, then she will come over and we can sit and have coffee like we used to. I should get new coffee mugs since this set is on sale. What the heck, my credit card will probably get turned down anyway.”
When Kurt’s card went through and he had toted his new purchases home, the guilt would set in. “I shouldn’t have bought that much stuff,” he would think. “I have got to stop shopping so much. I will bring those mugs back tomorrow. I’ll put them on this pile of other things that I have got to take back. Boy, this place is a mess. I have got to start sorting through this stuff and sell some of it online. I know I can get a lot of money for it.” But instead of sorting, Kurt would just go shopping again the next day.
According to Dr. Chabaud, researchers are still debating about whether hoarding is an impulse disorder, a compulsion, or an addiction. While one may casually use the term “shopaholic” to describe people like Kurt and Marcie, a true “addiction” would indicate that the addict goes through physical withdrawal symptoms if he or she tries to stop the behavior. Anecdotally, I don’t see this happening with hoarders. To me their behavior looks more like a compulsion, which is a behavior that feels so good that a person does it to excess. I do see serious hoarding compulsions that have a lot in common with addictions like alcoholism and drug addiction, and I’m not a psychologist, so I tend to use the word “addiction” to describe hoarding, even though it may truly be more of a compulsion.
Hoarders who shop, or who go “Dumpster diving,” definitely do it because it feels good. These hoarders get a primal rush from the “hunt and gather” experience. This rush helps them avoid the reality of what is truly going on in their lives. Rescuing a broken television set from someone’s alleyway trash pile is a thrill. These hoarders don’t stop to think about whether or not they have the time to fix that TV, along with the dozens of other broken appliances they have gathered.
For collectors, the excitement of finding a long-sought, rare Michael Jackson album on vinyl is all about scoring. They’re never going to play it. But they feel powerful and happy when they buy it. The hoarder feels like a success because he or she just got a valuable item. There’s a level of excitement that releases adrenaline in the brain, and when that adrenaline high fades, the hoarder goes back for more. That’s when it begins to look like an addiction, because the hoarder’s happiness is linked to the item, not to any sense of self-worth.
Animal hoarders have a similar thing going on, with the constant love they get from their pets. Anytime an animal hoarder feels down, there’s a cat right there to share some affection, which can quickly become a substitute for human relationships. Receiving love endorphin hits all day is a happy way for anyone to live. Hoarders get to feel that exciting rush every time they go shopping, go Dumpster diving, or reach for one of three dozen affectionate dogs. Especially when the rest of a hoarder’s life isn’t going well, it’s easy to see how this behavior could become an addiction.
Some experts argue that addicts never change their personalities; they just substitute healthy addictions for unhealthy ones. So a smoker might give up cigarettes and turn instead to the exercise addiction of running marathons. I see this sometimes with hoarders, and I encourage the replacement behavior if it seems positive.
For example, as we cleaned Kurt’s house, it became clear that it needed major repairs. The bathrooms had extensive water damage and needed to be redone, the kitchen needed new cabinets and appliances, and the whole downstairs required new walls and flooring. I encouraged Kurt to channel his shopping energy into the remodel. He threw himself into choosing appliances and researching subcontractors. This work kept him focused on making positive decisions. Suddenly, Kurt’s shopping had purpose. Luckily, when the remodel was over, Kurt became very involved in his church’s upcoming remodel. Although Kurt hasn’t had counseling to deal with the real issues behind his hoarding, he has successfully rechanneled that energy into more positive behavior.
I have done this in my own life. I replaced my gambling addiction with work. Some may say I’m just as addicted to cleaning as I was to gambling, and they might be right. For me it worked to substitute a positive addiction for something negative. I haven’t gambled since 1999, and I’ve refocused my life to revolve around my family and my work. I’m not saying that’s scientifically or psychologically correct, but for me it worked.
▶ Depression
Roxanne, the hoarder who saved all of her daughter’s items, showed all the classic signs of depression. She didn’t make eye contact or smile when she spoke in a colorless monotone. She wore the same clothes for several weeks in a row, even when they were covered with food stains. Her dirty brown hair was pulled into a messy ponytail, and she admitted that she didn’t wash herself regularly. Roxanne ate a lot of fast food, and she was overweight.
When Roxanne opened a package of food, she tossed the wrapper on the floor with a “why bother” attitude. She had basically given up—some days, she just stayed in bed.
Depression is a crippling illness, erasing a person’s desire and ability to make daily life decisions. Someone who is depressed usually knows what to do in order to get better but can’t muster the energy to actually do it. To a depressed person, even a small job like getting out of bed or taking a shower can look overwhelmingly hopeless and impossible.
A depressed person withdraws from normal life in the same way that a hoarder does. Depression is marked by decreasing interest in organization, self-care, and interaction with the outside world, which are all traits I see often in advanced hoarders.
Depressed people seem to be perpetually sad, angry, or anxious. Eventually, if the disease isn’t treated, depressed people can become so frustrated and worn down by their negative outlook that they become suicidal. I’ve seen this in hoarders too, and it should be taken seriously.
This is another situation where it’s not clear which comes first—depression or hoarding. Dr. Chabaud says that depression in someone who is genetically predisposed may be triggered by a traumatic event. That same event can also trigger hoarding behavior, and the two disorders can develop simultaneously.
Ironically, I’ve noticed that hoarders who are depressed usually don’t fight a cleanup. They just lack the initiative to make the push and get it done themselves, and they generally accept help. However, under these circumstances, it is even more important to understand that the cleanup on its own will not solve the problem. Unless the underlying issues are resolved, the hoarding will come back. Depression isn’t just an annoyance; it can lead to a seriously life-threatening situation.
▶ Social Phobia
Ben, the “pizza man” who also hoarded vintage airplane parts, was shy and uncomfortable around people.
He avoided group settings because they made him anxious. Ben seemed to have an issue that Dr. Chabaud says is sometimes linked with hoarding—social phobia.
Hoarders who have a social disorder connect more with the world of objects than with people. Their possessions become their friends. Those possessions won’t threaten them with pressing questions or awkward social moments. Hoarders can control their relationship with these items more than they can control relationships with friends or family members.
This disorder, Dr. Chabaud says, isn’t necessarily a symptom of hoarding, or a cause. Like depression, social phobia can show up in hoarders, but it’s not clear which disorder came first, or if one triggered the other.
One of the keys to success on a hoarder cleanup is to get the hoarder back into the world and involved in outside activities and a social life. For that reason, any social disorder needs to be treated as part of a hoarder’s recovery therapy.
▶ Dementia
Rick, the retired professor with a house full of paper, was showing signs of dementia when the cleanup began. He was very forgetful, often standing in the living room hunched over in confusion and asking the same question over and over. Sometimes he didn’t recognize an item he had in his hand, or remember why he was holding it. His sister commented that the problem had been worsening over the past year.
He had focused on information hoarding during a lifetime as a professor, but his forgetfulness had exacerbated the problem. He would pick up something, intending to use it or throw it away, and then forget why he was holding it. Confused, he would just set it down again on a growing pile.
A study published in the American Journal of Geriatric Psychiatry found that 23 percent of patients with dementia also showed hoarding behavior. As the population ages, dementia—and hoarding—will increasingly become severe problems, which need to be addressed in tandem. When a hoarder isn’t even able to have a coherent conversation about the issue, interventions are essential if the hoarder is living in conditions that are physically dangerous or unhealthy.
The Secret Lives of Hoarders: True Stories of Tackling Extreme Clutter Page 6