BACKGROUND: Hoarding refers to the excessive collection and retention of things or animals until they interfere with day-to-day functions like home, health, family, work and social life. Severe hoarding causes safety and health hazards. Collecting newspapers, magazines, old clothes and other items may cause fires. Animal hoarding can spread contagious diseases. To be diagnosed with compulsive hoarding, individuals must save large amounts of material others consider useless, have enough clutter that living spaces and work space are unusable and experience significant stress about the clutter. Compulsive hoarding can be linked to obsessive-compulsive disorder. Impulse control disorders, depression, social anxiety and bipolar disorder have also been linked to hoarding behavior. Compulsive hoarding may run in families. People with compulsive hoarding may not recognize the severity of their problem. Often, a family member must call attention to the problem.

WHY HOARD? Compulsive hoarding may result from problems in one or more of these areas:

» Information processing -- Individuals have difficulty categorizing their possessions and making decisions. They may struggle to decide what is valuable and what is not. They may struggle to decide what to do with possessions. They may avoid making decisions.

» Beliefs about possessions -- Compulsive hoarders often feeling a strong sense of emotional attachment toward possessions. They may feel the need to stay in control of their possessions.

» Emotional distress about discarding -- Compulsive hoarders often feel anxious or upset when they have to discard things. They may feel distress if they can't immediately acquire an object they want.

» Social insecurity -- Hoarders may think of objects as a security blanket and associate possessions with love not found from people. They may fear others will obtain their personal information.

INTERVENTIONS: Hoarding is recognized as both a mental health issue and a public health problem. Hoarding behavior generally occurs for a long time. Interventions without the individual's cooperation can lead to the development of dangerous behaviors. Here are a few tips for love ones:

» Respect the meaning and attachment to possessions
» Remain calm and factual, but caring and supportive
» Evaluate the individual's home for safety
» Work with other agencies to provide adequate medical and mental health evaluation
» Expect gradual changes -- compulsive hoarding cannot be cured overnight

PRESCRIPTIONS: Hoarders have less activity in the area of the brain known as the cingulate cortex -- the region responsible for making decisions. A category of drugs called SRIs may help compulsive hoarders. In the first study of its kind, SRIs combined with therapy sessions significantly improved hoarding tendencies. SRIs decrease anxiety and the distress produced by the indecisiveness and obsessions.

FOR MORE INFORMATION, PLEASE CONTACT: UCSD Obsessive Compulsive Disorders Clinic, San Diego, CA, (858) 543-6200