Off the Couch

Thoughts about the therapeutic process, and the dynamics of client-therapist interactions.

Can you be a hoarder without hoarding?

Are there links between hoarding and compulsive discarding?

My friend Mattie throws away everything. She does not have a broken knife or a slightly melted spatula in her kitchen, a beloved moth-eaten sweater in her dresser drawer, or a torn or tattered or read long-ago book on her shelves. I cannot say the same for myself.

As a person who does not like to separate, I wonder how Mattie tosses out and gives away without, it seems, a single sentimental twinge.  Of course she has a lovely home – neat, clean, elegant, and uncluttered. The beautiful items she has kept from her parents and other loved ones are easily viewed and honored, so it isn’t as though she refuses to hold onto anything at all. It’s just that she seems to have to get rid of many things that she might still enjoy.

I found myself wondering if this need to throw away is another side of the coin of hoarding when three different clients complained that they had tossed out something they really wanted to keep. They just couldn’t help themselves, it seemed. Bethany* had given away a book she longed to re-read. She has always followed the rule that anytime she brings something into her house, she takes something out. So if she buys a new blouse or skirt, she gives an old one away. The same for books, even if she might want to read them again. After discovering bedbugs in his apartment, and even though he was told that an exterminator could get rid of them, Terence* tossed everything – furniture, clothes, books, old photographs. “It’s all just material stuff,” he said. “I’d rather not have it than have it with the bugs.” But later he felt tremendously sad that he had discarded pictures of childhood friends, of himself as a young man, and of family members who were no longer living. And Libby, after a fight with her mother, threw out the beautiful china she had inherited from her grandmother. “I don’t want anything to connect me to them,” she said. But later she regretted it.

Unlike hoarding, the compulsive need to discard is not a formal psychiatric diagnosis. Still, the WiseGeek site reports that “obsessive compulsive spartanism” is a term that has “developed on the Internet to describe people who habitually throw possessions out or give them away.”

The Mayo clinic describes hoarding as “the excessive collection of items, along with the inability to discard them. Hoarding often creates such cramped living conditions that homes may be filled to capacity, with only narrow pathways winding through stacks of clutter.” Although many people think of hoarding as a symptom of OCD (obsessive compulsive disorder), the fifth (and upcoming) edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM 5) suggests that it is a diagnosis that stands on its own, although it can also be a symptom of other psychological difficulties, such as OCD, depression, grief and even certain kinds of schizophrenia.

While psychoanalysts have searched for underlying psychological meaning of the behaviors, there appears to be some hard-wiring link to hoarding, and one might suspect to spartanism as well.  A variety of studies, including one done at Johns Hopkins, have found that many hoarders have family members who also hoard, suggesting a biological or genetic connection.The best form of therapy for hoarding appears not to be trying to understand the psychological issues behind the behaviors, but a specialized form of Cognitive Behavioral Therapy that targets the symptoms directly.

The same is probably true of compulsive spartanism, if we want to use that name for it. If Terence’s need to divest himself of all of his bug-infested possessions is part of a larger picture, for instance perhaps representative of his need to get rid of anything that intrudes into his personal space (although I do understand his anxiety about the bugs themselves!), and if it causes him pain, could he benefit from the same kind  of CBT work that is used to treat hoarding? And if Libby’s impulsive tossing of her grandmother’s china is part of a pattern of behaviors that she later regrets but feels she cannot stop, would this form of therapy help her?

I don’t know the answer to these questions. I don’t know if there is indeed a connection. But I also find myself wondering if it would be at all helpful to explore some of the meanings of the behaviors of compulsive hoarders and tossers – certainly not instead of CBT, but maybe along with it? For example, I know that my friend Mattie sometimes has difficulties managing the messier parts of her life, and that her need to keep a pristinely perfect house is reflective of her anxiety about letting those other parts show themselves. Libby, on the other hand, has difficulty tolerating complicated and often conflicting feelings, so she often tosses things that make her feel confused. Her relationship with both her mother and her grandmother was extremely complicated, so I thought that her throwing the china away was in part, at least, a physical gesture representing her desire to get rid of all of the complexities of those relationships.  

I’m still pondering these questions. I’d love to know what you think.

 

*names and identifying information changed to protect privacy

 

For more information:

http://www.mayoclinic.com/health/hoarding/DS00966

http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=398

http://www.ocfoundation.org/hoarding/dante_to_dsm-v.aspx

http://www.wisegeek.com/what-is-the-opposite-of-hoarding.htm

 

Teaser Image Source Page: http://www.epharmapedia.com/diseases/profile/1398/Hoarding.html?lang=en

Neat room image source:Image Source Page: http://www.tripadvisor.co.uk/LocationPhotos-g274707-d607439-w2-Ho...

 

 

 

F. Diane Barth, L.C.S.W., is a psychotherapist, teacher, and author in private practice in New York City.

more...

Subscribe to Off the Couch

Current Issue

Let It Go!

It can take a radical reboot to get past old hurts and injustices.