I watched the "hoarding show" when it was still on Discovery Health (when Discovery Health still existed!), but in visiting the homes of patients as an LCSW have seen the effects of real-life hoarding. Hoarding is a disease that acts, in many ways, like an addiction. As such, it affects the family much like addiction affects the family. Everyone needs help but, most often, the patient—the hoarder—is identified as the sick one, the "identified patient." Once that happens, it seems, the "judging" begins.
The show, with its cameras and varying views of the accumulation can lead you to believe that hoarding is always messy, dirty, disgusting. That if a person is a hoarder they are completely disorganized. I learned over the years that, while those things are true, that some who hoard are in fact quite anal about it. And proud. And maybe a little arrogant. For example, I once visited a patient who saved decades worth of daily newspapers. Like, five decades worth. He kept them stacked in meticulous, edge-to-edge order against the walls, and when he was out of wall space (which appeared to have happened a good decade or so before I met him) he constructed little pathways that traversed the living room and dining room. Each winding path was bordered by newspapers that stood waist or shoulder high, but every single one was very neat and tidy and a fire hazard. The house smelled musty and stale. But the patient liked it and had no intention of changing a thing, which is why, in addition to the danger of fire, and, in California, earthquakes, the fire department had been called in.
I tell this story because there have been recent reports and books written about this hoarding phenomenon, a disorder which, by the way, is not listed in the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Yet. That may change with the new edition, set to be published by the American Psychiatric Association (APA) in 2013.
In the current issue, the DSM-IV, hoarding is listed under Obsessive-Compulsive Personality Disorder, as one of 8 criteria for diagnosis. It's described as: "The inability to discard worn-out or worthless objects even when they have no sentimental value."
It seems as though it deserves its own category.
Last year National Public Radio aired a story about how researchers are realizing that hoarding behaviors begin in the mind. At the University of California, San Diego Department of Psychiatry, psychologist Catherine Ayers, a specialist in anxiety disorders and late-life hoarding, is researching treatment for older adults who hoard. Currently, she's using a form of behavior therapy and cognitive remediation that focuses on building concrete skills.
That's a good thing.
As I mention above, hoarding resembles an addiction, progressing in severity over time. If a parent is hoarding in older age, he or she may have always been a hoarder or, perhaps, that behavior has taken the place of another compulsive behavior that, for whatever reason, has been abandoned. A loved one's hoarding can make their caregiver—son, daughter, spouse, lover, caregiver—feel as out of control as the person who hoards feels deep down. For some people the worsening of symptoms is slow and steady, for others it's rapid and frantic.
For family members who are ashamed or saddened or overwhelmed or disgusted, the impulse is to get a dump truck in the house and toss everything. Of course, this would never work in the long run. If a big clean-up is imposed to rid the house of clutter but no follow-up treatment is offered to treat the underlying disease process, the person will typically replenish the clutter and then some, much to the dismay of the interveners. That's the pathological part. Remember that if you care about someone who hoards, so you don't find yourself too angry that your efforts to clean up once and for all failed, over and over again. Be gentle with them—and yourself. In fact, seek help for yourself. Admit, to yourself, that you need it and that you cannot control the hoarder in your life.
Which brings me back to the TV shows and those of us who watch. I have heard people who watch the show regularly say they feel "superior." They say it with a touch of arrogance, impatience, disdain, directed at the people, rather than the disease. The first time I heard it I thought it was odd, but I also thought it was a fluke. But then, I heard more people say the same thing.
I did my best not to judge that.