There is a loud rustling sound as the door to a two-bedroom apartment in an upscale Virginia high-rise slowly opens, catching on a knee-high mound of discarded plastic bags and junk mail. The sole occupant, a 68-year-old retired government consultant named John M., whose last name is omitted to protect his privacy, greets the first visitor he's allowed to see his home in months.
Unlike collectors, whose items tend to be neatly organized and who thin their collections periodically, hoarders closely resemble pack rats, says Randy O. Frost, a psychology professor at Smith College who pioneered the study of hoarding in the early 1990s. Frost, who has coauthored several books on the subject, the latest of which is Stuff: Compulsive Hoarding and the Meaning of Things, says hoarders' collections are wildly chaotic: yellowing newspapers, old junk mail, bags of cat hair and rotten food may be mixed with valuables such as stock certificates.
Psychologist Charles Mansueto, director of the Behavior Therapy Center of Greater Washington, has treated people who hoarded dust bunnies, bicycles, even garbage. Other hoarders prefer animals, typically cats, including an 82-year-old woman who was barred by a judge from owning cats after authorities found 488 of them, many sick or dead, in two townhouses she owned in Fairfax County, Va.
Hoarders think you're the problem
Although hoarding can coexist with dementia, obsessive-compulsive disorder (OCD) and depression, experts believe it is a distinct psychiatric disorder best treated through intense behavioral therapy and sometimes medications, including antidepressants, says Catherine Ayers, an assistant professor of psychiatry at the University of California, San Diego, who studies older hoarders.
Denying the problem and resisting change are common, says social worker Henriette Kellum, who adds, "To them, you're the problem." Kellum helped found one of the country's first hoarding task forces in Arlington, Va., bringing together officials from the fire department, housing division and human services to contend with a problem that, in extreme cases, can result in eviction and even homelessness.
"It tends to be a lifelong problem that gets worse with age," says Maryland psychologist Elspeth N. Bell, who heads the Behavior Therapy Center's hoarding program and is a consultant to the Montgomery County Hoarding Task Force in Maryland. Both sexes are equally affected, but more women seek treatment, Bell says. Some of her patients are compulsive collectors, scooping up dozens of free newspapers, rummaging through dumpsters or haunting thrift shops. They loathe discarding things like empty milk cartons and tend to be paralyzed by indecision, perfectionism and procrastination. Many hoarders feel sentimental attachments to possessions, which they regard as extensions of themselves.
"One of the biggest fears I have is throwing away something of value," says John M., a graduate of Columbia University who has a friendly, engaging manner. He spends his time overseeing his stock portfolio and half a dozen rental properties, attending ballroom dancing classes — and going to meetings of self-help groups, including Messies Anonymous. His clean clothes, trimmed hair and fashionable wristwatch belie the condition of his apartment. Standing in his living room — a jumble of empty cans, used paper towels and outdated bus schedules (he owns four cars) — John gestures in defeat. "It's totally overwhelming to get rid of it," he says.
A relative's death
Like many hoarders whose problem is exacerbated by the loss of a spouse or a parent, the death of John's 93-year-old mother in 2003 triggered the crisis that propelled him into treatment. His mother was a hoarder, he says, and as the youngest of three children, John, who never married, had moved into her home to care for her. To clean out her house so it could be sold he needed three years — and the help of a therapist.
John says he began having a "problem with clutter" decades earlier, in his 30s.
"Say you're 60 or 70 and a parent dies and you're the recipient and you have until the end of the month to clean it out," says Hoskins of Princeton. "There's a sense of betrayal of the parent for getting rid of the stuff. So you bring it home." The death of a spouse, who may have kept the hoarding in check, can trigger a loss of control in the hoarder.
"For a long time I had trouble getting rid of stuff because everything reminded me of my mother," says Kelly Ferjutz, 72. A writer who lives in Cleveland, Ferjutz describes herself as a pack rat. She says she hates to throw things away "that are usable, even if I can't use them."
Filmmaker Cynthia Lester has grappled with the dilemma confronting some families: what to do when hoarding becomes dangerous. In her documentary My Mother's Garden, Lester chronicled the experience of her mother, who was living in her backyard, crowded out of her rat-infested house in Los Angeles by a lifetime of severe hoarding. The property was about to be condemned when Lester took her mother to New York for several weeks while her brothers shoveled out the house, filling 10 industrial dumpsters.
Their mother was so upset by the result, even though she knew about the clean-out in advance, that she was briefly hospitalized. She quickly recovered and, Lester says, has resumed hoarding in a new apartment.
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.