Q. How intractable a problem is hoarding?
A. Hoarding is a difficult problem to treat. Animal hoarding is especially difficult, in part because it seems to be associated with more serious mistaken beliefs that animals are happy and healthy, when in fact they are just the opposite.
Q. What is “clutter blindness”?
A. In our work with people suffering from hoarding, we’ve noticed something peculiar: They often do not notice the clutter. We describe Nell, a grandmother in her 70s who does not notice the clutter when she comes home from work each day. But when I showed up at her door, she noticed. As long as I was there, she felt horrible about it.
Q. You mention that forced clean-outs can be traumatic, even fatal, for hoarders.
A. They should be a method of last resort. A forced clean-out may change the condition of the home temporarily, but it does nothing to change the individual’s behavior. In most cases, the condition of the home deteriorates quickly, and the person is less likely to cooperate in the future when others try to help.
Q. Describe your therapeutic methods.
A. We’ve developed a form of cognitive behavior therapy to treat hoarding, focusing on excessive acquisition, difficulty discarding, and disorganization/clutter. For example, people with hoarding problems acquire too much stuff, usually by buying more than they need or picking up free things. We teach them how to tolerate their urge to acquire in much the same way we would conduct a physical conditioning program, by gradually exposing them to increasingly more difficult situations.
Q. For example?
A. We often begin with what we call “drive-by non-shopping,” where we drive by a store that is difficult for them to resist. By the time we are through, they can walk through the store and leave without buying anything.
Q. Is there a pill to control hoarding?
A. Very little research exists on the effectiveness of medication. Several early studies seemed to suggest that antidepressants used to treat OCD did not work for hoarding. A more recent study, however, suggested there might be some benefit. The answer to this question is still pending.
Q. How can people help hoarders they know?
A. The first thing is to find out more. The International Obsessive Compulsive Disorder Foundation is launching a Hoarding Center on their website to coincide with the publication of Stuff. The second thing is to make a connection with their loved one about the hoarding. Get them to talk about it, both what they enjoy about their possessions and what troubles them. Once they can talk freely about the behavior, it is much easier to take the next step and seek help.
Julia M. Klein is a cultural reporter and critic in Philadelphia and a contributing editor at the Columbia Journalism Review.