During the course of daily life, people save things they haven’t used in years, but which might be useful someday.

They may have collections (stuffed animals, salt and pepper shakers, tools, books…the possibilities are endless). So, what is the dividing line between beneficial collecting and unhealthy hoarding?

Junk King in Rancho Cordova, which performs junk removal and hauling, has come across cases of hoarding in the course of their work. Don Ross, one of the owners and director of business development for Junk King, tells of a couple of cases in which his company was asked to clear out space for someone who might have moved over into the category of hoarding. “The lady had loads of paper, and the daughter was clearing out the mobile,” Ross says. “She said, ‘It’s a lot of paper.’ When we got there, there must have been two truckloads of newspapers and magazines. Each person has their own thing they like to collect. This lady evidently liked information, and collected newspapers and magazines.”

Another case he encountered was more serious. His company was called to clean out a house and found that there was so much miscellaneous junk piled in each room that there wasn’t even access to pass from room to room. “The person had fallen over in her pile of stuff and laid there for several days,” Ross says. “Fortunately for her there was food all over the place so she was able to survive, literally; then they missed her at work after a couple of days and someone went to check it out and found her.”

From the point of view of health, a problem with compulsive hoarding can bring great distress to a person and interfere with wholesome living.  

ASK THE EXPERT

Karl Zeff, M.D., medical director for Mercy Behavioral Health, answers some questions on the subject.

Q: What do you think would be the crossover point between a person who just saves things, versus a person for whom this has become an obsession, or an illness?

Dr. Zeff: The distinction between normal behavior and mental illness involves the individual experiencing significant distress from the symptoms or dysfunction in different areas of his life, such as social and occupational. Saving objects as keepsakes or even for future reference would not measure up to the level of distress or create dysfunction required for it to be an obsession or a sign of mental illness.

Q: What leads up to this kind of behavior, and does it go along with other issues that may indicate a problem?

Dr. Zeff: Hoarding can have many causes, but as a representative characteristic of obsessive-compulsive disorder is thought to have as the main mechanism the obsession that great harm will come to an individual if he is not able to store or maintain objects. The fear is that while unimportant now, some distressing event will occur if he does not have whatever objects he is collecting in his possession.

Q: Are there types of hoarding that might be healthy or at least justified?

Dr. Zeff: Mental disorders occur on a spectrum of behaviors, and the crossover between functional or rational and dysfunctional or irrational may not be clear. One might suggest for example that “hoarding” supplies such as food or water in the face of an impending natural disaster or when future supplies will be limited for some reason is a reasonable course of action.

Q: What other disorders may be related to a hoarding compulsion?

Dr. Zeff: Hoarding can be found as a behavior in many other medical and psychiatric conditions besides obsessive-compulsive disorder. Some examples include autism, anorexia nervosa, schizophrenia, and obsessive-compulsive personality disorder (the last condition should NOT be confused with obsessive-compulsive disorder, which has a different set of characteristics and underlying mechanism).

Q: I know it would depend on the individual and the situation, but what types of treatment could be indicated for a problem such as this?

Dr. Zeff: Psychotherapies, especially in the area of what is known as cognitive-behavior therapy or CBT, have a very good record of benefit for individuals with obsessive-compulsive behaviors, learning how to become more aware of the underlying thoughts, triggers for those thoughts, and how to refrain from carrying out compulsions associated with those thoughts. This type of therapy frequently involves practicing these techniques both in the office and out of the office and keeping a journal or log documenting frequency of occurrence. Medications can be very useful to lessen the severity of symptoms and improve quality of life—some antidepressants, for example, are specifically approved by the Food and Drug Administration for use in obsessive-compulsive disorders.

Q: What types of interventions can families carry out if they see this problem developing?

Dr. Zeff: Families have a strong role to play in bringing affected persons into treatment; in encouraging compliance with the treatment plan worked out with the person and the mental health professional, and in sometimes involving themselves in treatment if it is thought that certain family relationships might be contributing to the problem.

Q: Have you encountered hoarding in your practice, and what are your thoughts on this problem?

Dr. Zeff: I have encountered milder types of hoarding commonly in my practice, but it’s generally not the reason for the patient being there; it is seen in the context of other obsessive-compulsive symptoms, anxiety or other disorders where the presenting problems might involve deteriorating social relations with others or difficulties in the workplace. These problems are conditions that in modern psychiatry are more successfully treated, and I have a lot of hope for my patients’ eventual recovery.