It is an odd cultural moment when we are encouraging “Reduce, Reuse, Recycle” as the way to save the planet and in the same breath can’t stop pathologizing hoarders, those ultimate defenders of repurposing who never "got" the single-use, disposable mentality. Thanks to a whole industry of TV shows, decluttering books and “professional organizers,” there is unprecedented attention to hoarding as a medical condition; but the focus on unemployed cat ladies and poor hoarders who can’t afford bigger homes and storage units for their collections points to bias and socioeconomically driven diagnosing.  

The new Diagnostic and Statistical Manual of Mental Disorders, or DSM, a book often described as the bible of psychiatric diagnoses, now reserves a special category for hoarding that is independent of OCD, its historical kin. To meet the current diagnostic criteria for hoarding disorder, the person needs to experience persistent difficulty discarding or parting with possessions, accumulate large amounts of unnecessary things that make difficult the normal use of living areas, and experience marked distress and interference in daily activities as a result. Serious consequences include social isolation, falls from tripping accidents, and the frequent loss of important things as time-sensitive mail, keys, medications, etc., drown in a sea of clutter. And “clutter” seems to be the operative word here and has been enshrined in the new DSM definition. But what we choose to call clutter—and, therefore, what we choose to diagnose as hoarding disorder—is sometimes too targeted toward the less privileged.

There is a striking similarity between a hoarder’s attachment to his clutter and that of a “collector” to his objets d’art. Yet one is referred to Hoarders Anonymous and the other is treasured for his treasures.  We may find more value in a 19th century figurine than a yellowed 20-year-old cake recipe whose protector still hopes to try someday, but we should not automatically elevate the former’s owner and pathologize the putative baker... Whether one accumulates expensive porcelain or newspapers, a preoccupation with the cherished items often defines the person’s psychology, and much mental and physical energy is spent expanding the collections, organizing them, preserving them, justifying their existence, and finding additional room to house them. So why is it so unusual for an art collector whose habit has strained family finances and relationships to be diagnosed with hoarding disorder, when the culture liberally dispenses diagnoses to all sorts of other hoarders?

Hoarding is a serious condition; it should have nothing to do with a person’s net worth or a clinician’s take on what is worth collecting and what does not deserve getting attached to.

About the Author

Elias Aboujaoude M.D.

Elias Aboujaoude, MD, is a psychiatrist and author based at Stanford University. His most recent book is Virtually You: The Dangerous Powers of the E-Personality.

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