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The Hoarders Among Us

Understanding the illness behind the reality TV images

Lester said her family was motivated by the fear that their mother, now age 65, would become homeless. "It's hard to live with the guilt that your mom lives like this and you didn't do anything," she says. "I flew across the country three times. … All I could get her to do was pack one box."

Clean out — or not?

Frost and other experts caution that involuntary clean-outs may be traumatic, and are little more than short-term fixes.

The preferred approach, which has shown modest success, is therapy, which combines regular, short discarding sessions with an attempt to systematically restructure the way a hoarder thinks about clutter. Goals are specific: clearing enough space to sleep in a bed or eat at a table. Therapists do not touch things without permission. Such sessions require extraordinary patience on the therapist's part: Imagine a 30-minute discussion about whether to keep an expired coupon.

People with dementia are not candidates for therapy, experts say. "There are people who hoard who have differing abilities to benefit from treatment," says Kellum, adding that it is "long and expensive" and has a high dropout and relapse rate. She says that some older people benefit from the approach adopted by a number of retirement communities: periodic inspections coupled with a weekly cleaning service.

John M., who fears his problem is growing worse, plans to resume therapy.

"In a way this stuff is an albatross," he says. "At some point in my life, I'm going to have to deal with it."

Sandra G. Boodman, a former staff writer for the Washington Post, writes about medicine and health for the Post and Kaiser Health News.

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