Hoarding Ask The Experts
Hoarding Question: 1
Dear Experts: Has research shown any one OCD medication to be superior for the Hoarding variety of OCD? My father had a trial of Luvox, and his only response was needing more sleep. Which medication should he try next to treat his hoarding OCD? Thank you for any advice. ==> Angie
The treatment of hoarding as a form of OCD is behind some of the other types of OCD. In the last few years some very helpful work on cognitive behavioral work on this problem has come from R. Frost, G. Steketee and others. I think that it is important to understand that medication alone is very unlikely to solve problems like hoarding with out adequate CBT at the same time. As far as medications go there is no way to tell which one will work best for any individual. The trial of medication needs to be both long enough and at high enough dosage to know if it will work or not. Any of the commonly used medications for OCD can cause sleepiness.
J. Claiborn Ph.D., ABPP [anxietyshrink@comcast.net]
Psychologist
No one anti-OCD medication is more effective than any other for hoarding (or any other OCD symptom). If Luvox M.D. Your father too sleepy, he should try one of the medications that is unlikely to have this side effect. These medications would be Prozac, Celexa and Zoloft. He may also need behavior therapy, which would involve a family member helping him to sort items and throw unneeded items away.
L. Koran, M.D. [lorrin.koran@stanford.edu]
Dept. Of Psychiatry, OCD Clinic, Stanford, CA
Hello. Hoarding is not responsive to medication, but the depression that often occurs in hoarding is. Generally the only thing that will help is having a behavior therapist work closely with the hoarder. Since most hoarders "like" what they save, this is often a difficult situation. I will send you a chapter on hoarding by separate e-mail. All best wishes!
Michael Jenike, MD [jenike@comcast.net]
Not that I know of. In fact studies by Donald Black, M.D. Showed that hoarding symptoms respond poorly to conventional drug treatments.
Suck Won Kim [kimxx003@maroon.tc.umn.edu]
Associate Professor of Psychiatry, University of Minnesota Medical School
No one antiobsessional drug is better for hoarding than any other so far as I know. After a good solid trial (10-12 weeks at maximum dose), move on to another. But be aware that hoarding responds best to behavior therapy. Go to http://server.psyc.vt.edu/aabt/ to find a behavior therapist near you.
Bruce Mansbridge, Ph.D. [mansbridge@austinOCD.com]
Director, The Austin Center for the Treatment of OCD
Hoarding Question: 2
What is the best way to deal with my mother who is 73 and I believe is suffering from OCD. She hoards things and will not throw anything away. She lives alone and will not let anyone in her apartment. Getting her to see a medical professional will be difficult because she always denies there is a problem. We have tried to help her keep her place clean, but she always ends up hoarding again. Thanks. ==> John
Problems like hoarding are difficult to deal with even under the best of conditions but when the individual involved does not want to do anything about the problem it can become almost impossible to deal with. There are two things that make sense to me as a starting place. First have a conversation with your mother about what you see as the problem and consequences as well as what might be done to work with it. Second except in life threatening circumstances stop any behavior which serves to enable her dysfunctional behavior. This would include your cleaning up since it is unlikely to change the problem behavior and may increase her anxiety which she responds to by increased hoarding.
J. Claiborn Ph.D., ABPP [anxietyshrink@comcast.net]
Psychologist
Hello. John: hoarders who do not want to stop (the vast majority) are very hard to treat. If this is lifelong behavior, she will likely continue. sometimes when it really gets out of control, external agencies (like the board of health) get involved. People who hoard things see the stuff they hoard as having some value now or in the future. I will try to e-mail a chapter from our recent OCD book on hoarding, but it will often not go through. You could see if the library has a copy (Jenike, Baer, Minichiello: OCD: Practical Management; 1998; Mosby). Giving her information that she can read may help. All best wishes!
Michael Jenike, MD [jenike@comcast.net]
I have one suggestion for you. Please call me at 612:625-3210. It may not work so please don't expect much.
Suck Won Kim [kimxx003@maroon.tc.umn.edu]
Associate Professor of Psychiatry, University of Minnesota Medical School
Hoarding Question: 3
Are these OCD symptoms: Compulsive spending, compulsive collecting, compulsive saving of junk? Collecting/spending interfering with relationships and job? ==> Cindy
If your question is are the symptoms you list typical of OCD I would have to say a definite maybe. There is a form of OCD which involves collecting and hoarding things. People with this form may go out and buy excessive amounts of things or useless things feeling they need to have them. Some of what is called compulsive spending however is not typically OCD.
J. Claiborn Ph.D., ABPP [anxietyshrink@comcast.net]
Psychologist
Hi. Yes. They are symptoms of hoarding, a type of OCD. It responds to medications and behavior therapy as described on this Web site.
L. Koran, M.D. [lorrin.koran@stanford.edu]
Dept. Of Psychiatry, OCD Clinic, Stanford, CA
Hi. If these behaviors are getting in the way of your life, you should be evaluated by a psychologist or psychiatrist who specializes in OCD and related disorders. Compulsive hoarding is quite common. I will e-mail you some material. Best wishes!
Michael Jenike, MD [jenike@comcast.net]
Hoarding Question: 4
Please advise for supporting family member with OCD hoarding symptoms. Patient is single parent in treatment/meds for years. Home become unsafe (doors blocked, etc.), and shame factor for child in home is extreme. Patient expresses helplessness and anger about addressing symptoms. ==> db
The family member should seek professional help. It may be necessary or desirable to apply to a court for a conservatorship of the affected person on the grounds that he or she is unable to provide adequate food, shelter and clothing for himself because of mental disorder. Or it may be possible for the professional to empower other family members to begin discarding hoarded items gradually (e.g., old newspapers) in order to motivate the affected individual's participation in treatment. Meeting with a professional is the key step. call the OC Foundation at 203:401-2070 to locate one.
L. Koran, M.D. [lorrin.koran@stanford.edu]
Dept. Of Psychiatry, OCD Clinic, Stanford, CA
A reasonable percentage of people with OCD refuse treatment either in the form of medication or CBT. This is very unfortunate since it is a disorder that responds to treatment. Hoarding in particular is seen as a difficult problem and the treatment ideas are just now being worked out. Although medication may make the individual more able to accept treatment CBT is critical and will require a therapist who is both knowledgeable about OCD and also willing to do things like home visits. The best thing to do at this point is to inform the individual that treatment is available and does work. There is even a small e-mail list devoted to hoarding and if you are interested I will be glad to e-mail you how to find out more about it.
J. Claiborn Ph.D., ABPP [anxietyshrink@comcast.net]
Psychologist
Hi. Getting people who do significant hoarding to agree to treatment is exceedingly difficult if they are not motivated. There is a support group of people who hoard. You can email: Paula Kotakis at: disi@igc.apc.org to find out about this. Medications often help associated depression, but not the actual hoarding behavior that must be dealt with by behavior therapy (often in the home). I will also e-mail you a chapter on hoarding from out OCD book. Best wishes!
Michael Jenike, MD [jenike@comcast.net]
Hoarding Question: 5
I'm 15 and I don't think anything is wrong with me but I read an article in the Seventeen magazine and while reading it I saw something about "hoarders" and some of those things I see in my mother she saves magazine papers, magazines, bills from the stores, coupons, she buys a lot of little figurines, Tupperware, perfume and creams, she likes things done her way I'm having doubts that could be caused by OCD. Please write to me ASAP and tell me what you think. ==> Laurie Anne
She may have mild OCD, but many people save things like this. If it does not bother her or anyone else and the place is not a disaster area, I would not worry about it. You could talk to her about this if you think it is a problem with her. Best wishes!
Michael Jenike, MD [jenike@comcast.net]
It is impossible to be sure but your mother could have a problem with OCD or something else. If she is not disturbed by it she is unlikely to do anything to change or seek professional help.
J. Claiborn Ph.D., ABPP [anxietyshrink@comcast.net]
Psychologist
Lots of people have what is sometimes called "subclinical" or "shadow" OCD, meaning they have some of the symptoms, but the symptoms are relatively mild and don't interfere too much with their life. Also, lots of people collect figurines, and some can get carried away by it. Saving magazines and newspapers or truly useless pieces of paper is more likely to get you labeled as OCD, because there's less of a "good reason" to save that stuff. Most people I know, including myself, like to have things done "their way" (in my case, it's because it's the best, most sensible way). The bottom line is, does it interfere significantly in her life?
Bruce Mansbridge, Ph.D. [mansbridge@austinOCD.com]
Director, The Austin Center for the Treatment of OCD
Hoarding Question: 6
I read that for OCD partners it is important not to "enable." Why is advice so different for partners of hoarders? Every doctor I have consulted says NOT to clean up because the OCDer through CBT has to learn to do this for themselves. To clean out my firetrap garage seems as reasonable as moving that object or touching that "contaminated" thing and yet I am advised against it. Is hoarding that different from other OCDs? ==> Tracy
Hoarding is not different from other OCD in the sense that you need to not enable the OCD patient. Not cleaning up after a hoarder is recommended because if you do it the result will be a major emotional crisis for the OCD hoarder and they will not learn that this is a reasonable response. In fact it may worsen the desire to hoard and the vigilance about your touching their stuff. hoarders have strange beliefs about their stuff and anyone touching it. Enabling would be protecting them from the consequences of the hoarding which is not recommended. When working things like touching the contaminated object we don't drag them over and push them in to it. We get them to do it on their own. Similarly with hoarding they need to get rid of their own junk.
J. Claiborn Ph.D., ABPP [anxietyshrink@comcast.net]
Psychologist
I am not sure this "rule" is universally true. Safety hazards should be cleared. I have occasionally had family members clean up places with agreement of the hoarding person. I will send you a chapter on hoarding from our OCD book. It is treated with behavior therapy. Medication is not helpful for hoarding in my experience; although it will help depression that is commonly associated with hoarding for some reason. Also, there is a hoarding list on the Internet. You could contact Paula at disi@igc.apc.org and see if you can join the group Best wishes!
Michael Jenike, MD [jenike@comcast.net]
Hoarding Question: 7
I believe that my mother has OCD expressed as hoarding. Every room in her house is full of stuff piled literally five to six feet high. I have suggested that she has this disease and she gets very upset with me. I gave her the name and number of a local psychiatrist that specializes in OCD, but she thinks she just needs to "clean her house." ==> Debbie
I don't know what your question is but I would think you are on the right track. The hoarding you describe is most likely to be OCD. This is a type of OCD which is very difficult to treat. It almost always requires some intensive behavioral therapy and this from someone who is willing to do things like come to the house. Even then it is very resistant to treatment.
J. Claiborn Ph.D., ABPP [anxietyshrink@comcast.net]
Psychologist
Sounds like OCD. You should insist in any way you reasonably can that treatment must be sought. You can ask your mother to prove to you that she just needs to clean her house by cleaning one room in the next week or two, or prove it to you by going to the psychiatrist to ask for a professional opinion so that the two of you will not have to argue over who is right.
L. Koran, M.D. [lorrin.koran@stanford.edu]
Dept. Of Psychiatry, OCD Clinic, Stanford, CA
Hoarding Question: 8
A family member collects things (clothes others throw out, broken strollers from the street, doors from rehabbed apartments, etc.) and will throw nothing out. Her apartment is literally unusable because it is so full of junk. This has a serious impact on spouse and children. Is this OCD? ==> Alison Fiekowsky
It very well could be OCD. "Hoarding" is often a type of OCD symptom.
Teresa Pigott, M.D. [dastring@utmb.edu]
Professor of Psychiatry, University Of Texas & Director at Rebecca Sealy Hosp., Galveston TX
This could be OCD, or it could be a symptom of other conditions such as schizophrenia or dementia. Evaluation by a psychiatrist is in order. OCD is by far the most likely explanation, however. The spouse may have to insist that treatment be sought, since people with the hoarding form of OCD are often not bothered by their symptom and don't see the need to change their behavior. If the children are adults, their pressure can be added.
L. Koran, M.D. [lorrin.koran@stanford.edu]
Dept. Of Psychiatry, OCD Clinic, Stanford, CA
This type of collecting of junk is usually a form of OCD generally referred to as hoarding. It is very difficult to treat and is most likely to respond to a cognitive behavioral therapy approach with a therapist who will make visits to the home as part of the treatment. Medication may make the person more responsive to CBT but is unlikely to do much by itself.
J. Claiborn Ph.D., ABPP [anxietyshrink@comcast.net]
Psychologist
This behavior certainly sounds like OCD hoarding, but several other psychiatric/neurological conditions are sometimes associated with such behavior. Recommend you consult with you doctor.
Dr. Lewis R. Baxter [lbaxter@psych.uabmc.edu]
The best way to obtain a clinical assessment for OCD is via an office visit with a trained mental health professional. By this means, a comprehensive history can be taken, so that other disorders can also be considered. Nonetheless, the symptoms you describe are quite consistent with a diagnosis of OCD. In particular, these sound like hoarding symptoms. If the behavior causes the person and/or their family distress, it is advisable to consider a formal clinical evaluation. I hope this information is helpful.
Scott Rauch, MD [rauch@psych.mgh.harvard.edu]
This is certainly hoarding behavior and it sounds like it is quite debilitating. Such problems usually stem from a combination of excessive attachment to and identification with objects, difficulty with categorizing and organizing objects and information, distress and avoidance of discarding items and also distress and inability to control the urge to collect items the person desires, even when collecting them would be detrimental. Treatment can be sought from someone familiar with OCD. Recent works by Dr. Randy Frost (for example a chapter in Jenike et al.'s 1998 book on OCD by Mosby Press) also might shed some light on the problems and possible treatment strategies. Unfortunately, motivation for treatment is often a problem for people with hoarding problems.
Gail Steketee, Ph.D. [steketee@bu.edu]
Professor, Associate Dean of Academic Affairs, Boston University School of Social Work
This sounds like a description of an OCD behavior called "hoarding." This behavior is sometimes more difficult to treat than other forms of OCD, but an evaluation by a psychiatrist to see if medication is warranted along with behavior therapy may be helpful. Often the person who has this behavior does not feel it is a problem, which makes it more difficult to get them to seek help.
Nancee Blum, MSW, LISW [NanceeBlum@aol.com]
Social Work Specialist
Hoarding Question: 9
My mom saves everything, and has filled my parents' large house from basement to attic. She wants very much to change, but knows she can't do it alone. She's asked me to find help because she hasn't been able to seek it herself - she's afraid. She's willing to go to "OCD camp' (if there is such a thing) for intensive therapy. Please advise. ==> Lynn
Dear Lynn: I'm not sure if "OCD Camp" is really the solution. Compulsive hoarders such as your mother are best treated with some type of home based treatment. If she were to go away from home to a hospital based program, she would not be able to work on throwing away her clutter, since it would not be accessible to her or her behavioral therapist. Home is where the real work must take place. Her best bet is to find a behavioral therapist and a good psychiatrist who are experienced in treating OCD in her area, and work with them. Medications can lower her anxiety and her symptoms, and raise her mood enough for her to then make a successful start in behavioral therapy. Facing a house full of junk can be pretty overwhelming to a sufferer, and they keep procrastinating because they just don't know where to start. Other types of OCD can be treated away from home, but this is just not one of them. Try contacting the OC Foundation for a copy of an article I wrote on hoarding a few years back called "Saving the World." It will lay out much of what she needs to do and why she needs to do it. Check with the OCF and any local support groups in your area to get the names of competent practitioners. Be a smart consumer! Ask lots of questions, and look for doctors who are experienced. This type of OCD is quite treatable with the right help, so tell her to not give up hope. Hope she makes a speedy recovery.
Fred Penzel, Ph.D. [penzel@attglobal.net]
Western Suffolk Psychological Services, Huntington, NY
Dear Lynn: There is help for hoarding and the biggest question is where do you live. There are some cities where there are a number of experts who can help directly or who would be willing to provide supervision to a willing local therapist.
Jon Grayson, Ph.D. [dway67a@prodigy.com]
Director, Anxiety & Agoraphobia Treatment Center
A chapter written by Randy Frost and Gail Steketee [myself] recently appeared in Jenike et al.'s (1998) book on obsessive compulsive disorders published by Mosby Publishers and might be useful to her. Some areas may have support groups for the seriously disorganized. In the Hartford area is one called "Messies Anonymous" and there may be others. If your mother lives near western Mass, she might contact Dr. Frost to obtain information about groups. Otherwise, treatment programs for OCD often incorporate work on hoarding problems. Good luck.
Gail Steketee, Ph.D. [steketee@bu.edu]
Professor, Associate Dean of Academic Affairs, Boston University School of Social Work
Dear Lynn: Use the OC Foundation at 203:401-2070 to find a knowledgeable professional in your area to help you mother, or try the local medical school Department Of Psychiatry, if there is a medical school near you. Hoarding may be a symptom of OCD, or of other disorders. Your mother should seek professional help and is highly likely to benefit.
L. Koran, M.D. [lorrin.koran@stanford.edu]
Dept. Of Psychiatry, OCD Clinic, Stanford, CA
OCD camp would not be the best choice since people with the hoarding form of OCD need to work on the stuff they have at home and learn how to stop hoarding. This is very hard work but the good news is she is willing to try. Although medication may help reduce her anxiety the most effective thing will be to find a cognitive behavioral therapist who knows about treating hoarding and OCD. They will need to do things that are unusual in this business like make house calls. If you locate a therapist and they know about OCD but not hoarding give them my e-mail address and I will direct them to some resources.
J. Claiborn Ph.D., ABPP [anxietyshrink@comcast.net]
Psychologist
There are several centers across the country that offer intensive therapy for OCD, either on an outpatient, residential, or inpatient basis. Check the Foundation's list of intensive treatment centers. However, wherever she goes, she will probably need follow-up therapy, so it will be helpful to find a therapist close to home who can see her after she returns. Sometimes home visits are useful for the type of problem your mother has. Good luck!
Alec Pollard, Ph.D. [pollarda@sluvca.slu.edu]
Anxiety Disorders Center, Saint Louis Behavioral Medicine Institute
Hoarding Question: 10
A friend of mine has a severe problem with collecting "stuff," to the point where he can barely get into his apartment, and his car is completely filled with junk . This has become overwhelming for him and thinks about it constantly, though he rarely summons the energy to do anything about it. He claims this is a form of OCD. Is it? If not, what might it be? ==> Vicky
Dear Vicky, our best judgment now is that hoarding is a form of OCD in which the obsession is about losing important things, making mistakes, and forgetting important life experiences or information that one may need in future. There also seems to be a stronger emotional attachment to objects among people who collect items excessively, and they tend to have considerable difficulty organizing their things and making decisions about how to categorize items and papers so they can put them away in useful places. Randy Frost and I have a chapter in Mike Jenike and colleagues new 1998 book that may be of use to him. Some therapists who treat OCD feel qualified to help with hoarding problems also and your friend may wish to contact an on-line support group devoted to active work on their hoarding problems. I believe information about this group is available through the OC Foundation.
Gail Steketee, Ph.D. [steketee@bu.edu]
Professor, Associate Dean of Academic Affairs, Boston University School of Social Work
This type of hoarding behavior is actually usually a part of OCD although there are other problems that can lead to it as well. It is a difficult problem to treat although some new ideas have been developed. The treatment involves cognitive behavior therapy and usually requires a therapist who will make a home visit.
J. Claiborn Ph.D., ABPP [anxietyshrink@comcast.net]
Psychologist
Hoarding (collecting junk, etc.) can be a symptom of OCD.
Teresa Pigott, M.D. [dastring@utmb.edu]
Professor of Psychiatry, University Of Texas & Director at Rebecca Sealy Hosp., Galveston TX
Dear Vicky: This sounds like a type of OCD known as 'compulsive hoarding.' Ask the OC Foundation for a copy of an article I wrote in there newsletter several years ago, titled "Saving the World." It will lay out all the basics about this problem for you. Often, OCD is accompanied by depression, either as a biological problem, or as a reaction to having OCD itself. It really can be a rather overwhelming experience. The junk can become a serious fire or safety hazard, and sufferers have also been known to get evicted due to it. The best approach is for your friend to get treated with a combination of behavior therapy and medication. I have seen many cases successfully treated, and homes restored to normal again. All best wishes!
Fred Penzel, Ph.D. [penzel@attglobal.net]
Western Suffolk Psychological Services, Huntington, NY
Hoarding Question: 11
My mom is 82 and ill. During recent hospitalizations we showed pictures to her doctors. They said worst case of ob/comp hoarding desire they had ever seen. She is collecting again. We need HELP in caring for her and a way to help her stop filling up the house with newspapers/boxes/etc. She is clinically depressed and has taken Zoloft. She won't see a doctor about it. HELP. ==> Judy
Hoarding can often be a severe form of OCD that afflicts older adults more often than younger ones. You might consult a chapter on hoarding In Jenike, Baer & Minichiello's 1998 book on OCD published by Mosby press for information about hoarding and treatment suggestions. Some services providers in social service agencies may be helpful assistants, along with family members, in helping clear out clutter but it is important to include your mother in the process so that she does not feel victimized but part of the decision-making and change process.
Gail Steketee, Ph.D. [steketee@bu.edu]
Professor, Associate Dean of Academic Affairs, Boston University School of Social Work
OCD with hoarding may be more common in the elderly for reasons that are unclear to me. This type of OCD is very difficult to treat and is not likely to respond to medication alone. What is required is a therapist trained in CBT and its application to OCD and hoarding who is willing to come to the house or use other assistants who will do this. Even then people who hoard are often uncooperative with treatment. If your mother is elderly it may come to your taking control of where she lives and what happens there via guardianship or similar action.
J. Claiborn Ph.D., ABPP [anxietyshrink@comcast.net]
Psychologist
Judy: in my experience hoarding in older people often comes on along with severe depression, and often goes away when the depression is treated. She needs to talk to a doctor - focus on the depression. Other options besides Zoloft are other medications, cognitive therapy, or ECT, which is safe and effective in elderly people.
Lee Baer [Baer@psych.mgh.harvard.edu]
Hoarding Question: 12
I have OCD symptoms primarily saving, collecting, and hoarding. From shopping near ruinous finances. Cluttered house with small pathways through rooms. 200mg Zoloft has helped with other symptoms such as carrying too much in multiple pockets and bags, but not with the acquisitiveness. Shopping seems to sublimate a desire for closeness with other people not present, while the result keeps people away as per the house. Any thoughts on other medications or approaches to breaking up the cycle of acquisition? ==> D. Ross
I don't think the solution to hoarding and acquisition problems is found in medications although they may make treatment more workable. The answer that works is cognitive behavioral therapy. This will be likely to require a therapist who among other things will make visits to your home to help you get rid of things.
J. Claiborn Ph.D., ABPP [anxietyshrink@comcast.net]
Psychologist
Dear D. Ross: Hopefully, you are getting your medication through a qualified psychiatrist, and if you tell them that the current approach is not working, they will be able to add a second medication to your Zoloft to make it work even better, or will switch you to another antidepressant. Above and beyond this, you should be getting cognitive/behavioral therapy. Behavioral therapy will help you to gradually clear out your house, stop acquiring things, and give you guidelines to keep things in order in the future. Cognitive therapy will help you to explore your thinking with regard to problems you may be having with establishing relationships with other people. It sounds like you need work in both areas. For some people, acquiring possessions can be a way of dealing with depression and loneliness, as well as being a form of OCD. A good therapist will help you explore all of this and help you to find some answers. Be sure to find experienced help. Be a wise consumer, and get referrals from those you trust who have had good therapy experiences, or from the OC Foundation. It may also be a good thing for you to find a local support group, if there is one in your area. It may help you in meeting other sympathetic people, and keep you from feeling as if you are alone with this. Best wishes!
Fred Penzel, Ph.D. [penzel@attglobal.net]
Western Suffolk Psychological Services, Huntington, NY
Hello. You need to work closely with a skilled behavior therapist to alter these maladaptive behavior patterns. It will be hard work, but worth the effort if you can make changes.
Michael Jenike, MD [jenike@comcast.net]
Hoarding Question: 13
My 46 year old brother collects junk to the point where he has lost his wife and job, and the city has fined him and made him go to court and jail. Nothing wakes him up. Is this a symptom of OCD? Is it treatable by medication or psychiatrist? ==> Pat Davis
Yes, it's a symptom of OCD called hoarding. It can be treated with behavior therapy, and medication can help the process along. The primary difficulty in treating hoarding is when the hoarder doesn't see any problem and doesn't want to change. Unfortunately, this is fairly common. For more info on hoarding, e-mail my friend Paula Kotakis at disi@igc.org
Bruce Mansbridge, Ph.D. [mansbridge@austinOCD.com]
Director, The Austin Center for the Treatment of OCD
Some but not all people who collect junk or hoard things have OCD. The treatment is very difficult and although medication may be some help it is not going to make a big difference by itself. Cognitive behavioral therapy specifically designed to deal with this problem has been described and can be effective. Findings someone who knows how to do this type of work is very difficult.
J. Claiborn Ph.D., ABPP [anxietyshrink@comcast.net]
Psychologist
Your brother could have a type of OCD known as compulsive hoarding. Yes there is treatment. Certain medications generally effective with OCD may help your brother's hoarding, but he will likely need behavior therapy as well. However, he is unlikely to do well in therapy if he does not perceive his behavior as problematic. It is sometimes the family that has to pressure the hoarder to seek help.
Alec Pollard, Ph.D. [pollarda@sluvca.slu.edu]
Anxiety Disorders Center, Saint Louis Behavioral Medicine Institute
Dear Pat: Your brother's problem sounds a lot like a type of OCD we call compulsive hoarding. It is treatable via medication and also via behavioral therapy in the form of Exposure and Response Prevention. Find a psychiatrist who is experienced in treating OCD, and also a psychologist who is a well qualified behavioral therapist. Sometimes you can get good referrals through local OCD support groups. Your brother will first need to get a proper diagnosis, to make sure it really is OCD, and then will have to follow treatment for some time to come, with both types of practitioners. Jail is a useless and inhumane way to treat someone who is mentally ill. It sounds like the dark ages. What kind of attorney does your brother have? A good one would have gotten court mandated treatment for someone like your brother, rather than jail time. You might try contacting the Center for Mental Health Law in Washington, D.C. To get information on what your brother's rights are in a situation like this. You might also be able to locate a mental health advocate through the National Association for Mental Illness. Unfortunately, there are many like your brother who are being sadly mistreated by an ignorant legal system. Best wishes!
Fred Penzel, Ph.D. [penzel@attglobal.net]
Western Suffolk Psychological Services, Huntington, NY
Hoarding Question: 14
Having just discovered that my hoarding/saving is an OCD, I'm immersing myself in the literature & want to start treatment with an experienced BT. I'm not depressed, but have spent years in/out of therapy with non-BT's. Can you advise (without an actual assessment) if BT alone might be effective (with aggressive goals and compliance)? ==> Marie
The hoarding type of OCD is less well understood and less well researched then some other types. The best thinking about it comes from Randy Frost and Gail Steketee who have written some material and done some research on it. At this point it looks like medication alone is unlikely to be effective but may help a person comply with treatment. Cognitive behavioral therapy is the only thing that really seems likely to make a difference. This will be hard to find as most therapist are not trained and even those who are may not know much about hoarding. You will need a therapist who is willing to make a home visit or supervise someone doing this part of things. hoarders are often not that motivated to change which makes this problem even more difficult to treat.
J. Claiborn Ph.D., ABPP [anxietyshrink@comcast.net]
Psychologist
Absolutely. For more info on hoarding and its treatment, e-mail my friend Paula at disi@igc.org.
Bruce Mansbridge, Ph.D. [mansbridge@austinOCD.com]
Director, The Austin Center for the Treatment of OCD
From your description, it sounds highly possible that your friend has OCD. The dislike of touching or being touched sounds like a contamination fear. Have you ever talked with him and brought up the term OCD? Perhaps you could suggest that he visit the OC Foundation's Web site and assure him that there is help available. Actually handwashing responds well to behavior therapy and/or medication or a combination.
Nancee Blum, MSW, LISW [nanceeblum@aol.com]
Social Work Specialist
You may wish to consider treatment with both medication and behavior therapy. An example of a behavioral approach would be that with the permission of the behavior therapist, a daily goal of a certain amount of paper be set, for example, three or four shopping bags full, and that the you agree that if you have not accomplished this by the end of the day, then a cooperating friend is authorized to pick the papers to discard (I assume newspapers and magazines and junk mail). Your friend could also be authorized to help you sort mail into discard and respond (e.g. Bills) for a certain number of minutes per day. You should be required by your therapist to stop all subscriptions except 2-4, all newspapers except 1, which must be discarded within 5-7 days of receipt of each copy. You should also try various of the effective anti-OCD drugs, and perhaps some augmenting agents if necessary. All of this material and more is discussed in my book (written primarily for clinicians, but understandable by patients and families), "Obsessive-Compulsive and Related Disorders in Adults: A Comprehensive Clinical Guide, Cambridge University Press," released this month.
L. Koran, M.D. [lorrin.koran@stanford.edu]
Dept. Of Psychiatry, OCD Clinic, Stanford, CA
Hoarding Question: 15
My mom, first cousin and another cousin have the hoarding OCD that I know of. How possible is it that I too will acquire this in later life. They all did it mainly in their later years of life to the point of having no home left. ==> The Daughter
At this point we really don't know very much about whether hoarding problems are likely to recur in children of hoarders, but it seems that at least some people with hoarding have come from homes where one or more parent also had this problem to some degree. Whether you will cannot be foretold, but you might watch out for some of the following tendencies: strong emotional attachments to papers, objects or mementos rather than to people and memories; difficulty with organization and categorizing objects so you don't put things away where you can find them in future but instead leave them all in sight, eventually creating many piles in which you can find little when you need it; beliefs that your memory is poor when actually it is about as good as other people's; a tendency to acquire things you really don't need or have an immediate use or plan for. These can snowball into problems with hoarding that you may need to guard against by counteracting problem behaviors. However, it is best not to become worried or concerned unless you and others around you can clearly see a problem developing. Then, just treat it like any other problem and take some action.
Gail Steketee, Ph.D. [steketee@bu.edu]
Professor, Associate Dean of Academic Affairs, Boston University School of Social Work
Hoarding as a form of OCD may become more pronounced as people get older but OCD itself usually appears much earlier in life. If you have OCD your self and the family history is filled with hoarding OCD then the risk for you may be high. If you don't have OCD and are an adult you may not develop it so the hoarding problem would not be an issue. If you do have OCD getting proper treatment may avoid problems later in life.
J. Claiborn Ph.D., ABPP [anxietyshrink@comcast.net]
Psychologist
Hi: There is evidence that one is more likely to have OCD if one has close relatives who suffer from it than someone who does not have a relative with OCD. This may be due to a combination or both genetic and environmental factors. However, by no means does everyone who has a parent or close relative with OCD develop OCD themselves, or anywhere close. And you can certainly take preventive measures by informing yourself about OCD and treatments available so that if you do see signs of it in yourself or other loved one you may be able to nip it in the bud, so to speak. There is lots of good info about OCD, including hoarding, on this web site and its Online Bookstore.
Thomas H. Styron, Ph.D. [Thomas.Styron@yale.edu]
If you have OCD in your family, you have a somewhat higher chance of developing a similar problem than someone without a family history of OCD. However, there is a very good chance you will not develop OCD. The good news is there are treatments available. Hopefully, with your awareness of this syndrome, you will seek help early on if you see signs of OCD emerging and nip it in the bud.
Alec Pollard, Ph.D. [pollarda@sluvca.slu.edu]
Anxiety Disorders Center, Saint Louis Behavioral Medicine Institute
Dear "The Daughter:" This is a difficult question to answer, and no one can really tell you precisely whether or not you will develop OCD. The statistics tell us that if you have one parent with OCD, you have roughly a 25% chance of having OCD yourself. On the other hand, it is not extremely common for people to develop OCD in their later years without ever having shown any signs earlier on. If you have shown no signs at all thus far, it seems less likely that you, too, will develop OCD. Otherwise, there is not much more anyone can tell you as reassurance. My advice would be to go about living your daily life, and don't waste your time worrying about something that may not even happen. If it does happen, you will deal with it then. Hopefully, years from now we may have even better treatments than we now have. Best regards.
Fred Penzel, Ph.D. [penzel@attglobal.net]
Western Suffolk Psychological Services, Huntington, NY
Hello "Daughter:" It is highly unlikely. I already sent you the chapter on hoarding. If you notice the urge to hoard things as you get older, see a behavior therapist. Don't get paranoid about this, however. I save some things and only my wife thinks I am a hoarder. All best wishes!
Michael Jenike, MD [jenike@comcast.net]
Hoarding Question: 16
I come a family that has exhibited hoarding behavior for 3 generations. My mother, brother and uncle all have houses that are impossible to enter. My siblings and I are at our wits end as to how to intervene and things are becoming monetarily complicated with so many properties in total disarray. Any suggestions on how to assist people in getting help? There is a lot of shame and my brother who is a doctor insists that nothing is wrong. ==> Kathy
You might start with a doctor who knows about OCD. The treatment of hoarding is difficult and not yet well known. Dr. R. Frost and G. Steketee have written some material on treatment of this problem including a chapter in the book, "obsessive compulsive disorder s: Practical Management" edited by Jenike et al. A therapist familiar with this material may be of help. WebMaster Note: Dr. Michael Jenike is the head of the OCF's Scientific Advisory Board, and a regular contributor to this Ask The Experts Message Board.
J. Claiborn Ph.D., ABPP [anxietyshrink@comcast.net]
Psychologist
If you feel you have done everything you can to convince the hoarding family members that they have a problem and they still refuse help, then I suggest a new approach. Find a therapist who works with OCD, and make an appointment. The OCF has a list of clinicians. Take along any other family members who feel that the hoarding is a problem and want to do something about it. The therapist should be able to advise you how to handle the situation. There may not be any easy answers, but there are often options available to you that you may not have considered. Good luck!
Alec Pollard, Ph.D. [pollarda@sluvca.slu.edu]
Anxiety Disorders Center, Saint Louis Behavioral Medicine Institute
Dear Kathy: My colleagues and I will have an article on hoarding coming out in the next issue or so in the Journal of Clinical Psychiatry. It is mostly descriptive, but talks a bit about treatment. A more extended review of treatment approaches is included in Chapter 3 of my book, recently published by Cambridge U. Press. You and your siblings who wish to arrange treatment should meet with a psychiatrist (since medications are probably indicated) knowledgeable about OCD. The OCF can help you find someone (203:401-2070) or perhaps your local medical school's Department Of Psychiatry can help. You will need to figure out together how to obtain leverage in this situation in order to motivate your relatives to get treatment they either are afraid of or don't see the need for.
L. Koran, M.D. [lorrin.koran@stanford.edu]
Dept. Of Psychiatry, OCD Clinic, Stanford, CA
Dear Kathy: The only solutions which have been shown to be helpful are behavioral therapy (exposure and response prevention) and medication via antidepressants. Call the OCF or the Association for the Advancement of Behavioral Therapy in New York City for copies of their referral lists. A trained behavioral therapist can assist the hoarder in learning how to throw things away and not accumulate more. They may also be able to come to the house, or send a paraprofessional to help as well. If you relatives are uncooperative, or won't accept that they have problems, there may not be much you can do. If they are motivated, there is much that can be done. Also see if you can get them some reading matter on OCD - this may help to wake them up to what is going on. Call the OCF and get a copy of an article I wrote for the OCF newsletter called "Saving the World." Some sufferers feel so overwhelmed by all their junk that they just don't know where to start. A helping hand such as yours may be what it takes to get them going, if they are open to it. Good luck! Best regards.
Fred Penzel, Ph.D. [penzel@attglobal.net]
Western Suffolk Psychological Services, Huntington, NY
Hoarding Question: 17
My dad (77) has been hoarding junk for 30 years. He lives alone and refuses treatment. I have just been to his apartment the 1st time in 10 years (without his knowing). It is so filled with junk; there is no place to walk. He must crawl over 4 feet of piles to get around. It is an extreme fire hazard (he has electrical problems and has seen sparks), putting other families in the building. I am planning to clear the apartment while he is in hospital for surgery in 3 weeks. What are the possible consequences? How might he react and feel? Is there any way to prepare him? ==> Carolyn
Compulsive hoarders often minimize the problem and resist seeking help. The situation you describe is a very difficult one for family members. You do not want to violate your father's privacy and independence, but your concern about his welfare is reasonable. If you decide to clean his apartment without his consent, be prepared for him to be very upset. Even without OCD, most people do not want others "messing" with their stuff if they haven't asked them to do so. The fact that you are waiting until he is away suggests you already suspect he will not respond positively. If he has OCD (which sounds likely), he will probably be especially distressed and anxious. Occasionally, a compulsive hoarder will feel relief afterwards, that the deed has been done and grateful to have been spared the responsibility for deciding which items to keep and what to do with the items to be discarded. Don't count on this reaction though. More often, the response is anxiety followed by anger. I am not suggesting you are doing the wrong thing, just be prepared. There is no simple answer to this kind of problem. As an alternative, some families tell the hoarder ahead of time or give the individual a deadline by which things have to be discarded. If you can persuade the OCD sufferer to tackle the problem, there is a better chance for recovery and often less family conflict. You might consider getting consultation from a therapist who specializes in OCD. It is sometime helpful to have someone help guide you through this difficult family process, whether you do this with or without your father's consent. Good luck!
Alec Pollard, Ph.D. [pollarda@sluvca.slu.edu]
Anxiety Disorders Center, Saint Louis Behavioral Medicine Institute
Do be careful in undertaking this for him. I would want to let him know your plans and to discuss them so that he has some say in this process. Most hoarders whose relatives do this willy-nilly simply begin hoarding again immediately, usually back to the same level within a year or two. On top of this, they are very angry with the relative who empties the home. So I would proceed with caution and extensive discussion with him. He can learn to improve on acquisition and discarding problems if he gets personal practice working on this with help. We have a chapter on hoarding that might be useful to you in understanding this problem in Jenike, Baer and Minichiello's 1998 book on "OCD-Practical Management." There are also several on-line groups related to hoarding. You might get a list from disi@igc.org
Gail Steketee, Ph.D. [steketee@bu.edu]
Professor, Associate Dean of Academic Affairs, Boston University School of Social Work
For reasons of health or safety you may have to clear out your fathers place and you can expect he will be very upset by your doing so. He may refuse to let you ever go to his home again or otherwise take a very strong stand. Also it is important to understand that the problem is likely to reoccur unless he is willing to try treatment. Even then treatment of hoarding is difficult.
J. Claiborn Ph.D., ABPP [anxietyshrink@comcast.net]
Psychologist
Hello. Sounds like he is a major hoarder. If it is a fire or health hazard, you really have no choice. It might save you some aggravation if the manager of the apartment complex mandated this or the health or fire department so you do not have to take the heat. I will E-mail you a chapter on hoarding. It is treated with behavior therapy. Medication is not helpful for hoarding in my experience; although it will help depression that is commonly associated with hoarding for some reason. Also, there is a hoarding list on the Internet. You could contact Paula at this E-mail address and see if you can join the group: disi@igc.org
Michael Jenike, MD [jenike@comcast.net]
He could become very angry and/or depressed, or he might surprise you by not reacting as much as you might expect. To protect your relationship with him and to avoid lying to him, you might arrange for the landlord or the fire marshall to be the bad guy by demanding that you clean it out. After he's recovered from the surgery, tell him in a matter-of-fact way what you were required to do.
Bruce Mansbridge, Ph.D. [mansbridge@austinOCD.com]
Director, The Austin Center for the Treatment of OCD
It is very difficult to predict his response. In my experience some react positively to the cleaning since the hoarding is often compulsive and anxiety producing as well. Some react with anger and rage. I suggest you seek a consultation with an expert on OCD in your area. Perhaps in a cleaned home your dad can be convinced to see someone to keep it clean. Good luck!
Dr. Steven Friedman [Steven_Friedman_at_hscb-uh1@netmail.hscbklyn.edu]
Hoarding Question: 18
Symptoms of OCD, saving, collecting, and hoarding; also shopping pushed by anxiety, relieved by raising my Zoloft to 250mg a day. What is the relationship between "magical thinking" and OCD. Dr. Fruth of Milwaukee gave me an excellent tape of a lecture on "the illusion of absolute safety" we get from our parents and carry into adult life. I am currently in therapy, and we are discussing my personal magical thinking related to objects I carry, and purchase compulsively. Any comments on the relationship between the "thinking" and OCD, or sources of reading in this area? WebMaster Note: Although it is generally against policy to mention a "3rd Party Person" such as "Dr. Fruth," in this case this particular doctor may have a resource which may be of benefit for OCD people; therefore, I have kept their name in this message. ==> David Ross
It is interesting that Zoloft at 250 mg worked on your hoarding; several reports now suggest that medications aren't as effective for hoarding symptoms as they are for other OCD symptoms, so it is helpful to hear of exceptions. For reading on magical thinking, you might wish to look at articles that have appeared in the past few years in Behavior Research and Therapy, a professional journal. Several articles have been published there on obsessions and thought-action fusion, as magical thinking is sometimes called. Try looking at articles by Rachman, Rassin et al., 1999, and Shafran and colleagues' work, 1996.
Gail Steketee, Ph.D. [steketee@bu.edu]
Professor, Associate Dean of Academic Affairs, Boston University School of Social Work
Magical thinking is a common problem in people with OCD but not exclusive to OCD. Since you have OCD and mention therapy I will comment on what does and doesn't work in treating OCD. There are many types of therapy but only Cognitive behavioral therapy has been shown to be useful in treating OCD. This can include some discussion of things like magical thinking but should also include exposure to the things that cause anxiety and prevention of compulsive rituals.
J. Claiborn Ph.D., ABPP [anxietyshrink@comcast.net]
Psychologist
Maybe in some cases our parents inculcate us with their neuroses, e.g., illusions of absolute safety, which we then carry through our own lives, or maybe it just seems that way. In many other cases, people develop their own neuroses or illusions without any help from their parents. It turns out not to make much of a difference (if at all) where they come from, and time spent investigating the source is simply time wasted. Instead of discussing the (presumably symbolic) meaning of the objects you carry, I suggest you get into behavior therapy, which will focus on getting you to the point where you don't need to collect, hoard, or carry them. That is where you want to get, isn't it? Magical thinking is simply a term to describe irrational thinking along the lines of, "If I don't buy/carry this object with me, something terrible will happen to my kids." There is absolutely no reason to investigate "why" you have this irrational idea, although lots of therapists still believe there is. They need to catch up on the current thinking in this area. Good luck.
Bruce Mansbridge, Ph.D. [mansbridge@austinOCD.com]
Director, The Austin Center for the Treatment of OCD
Hoarding Question: 19
My grandmother has OCD with poor insight, hoarding newspapers and garbage. The apartment is covered in mounds of garbage, dust and fungus. My grandmother is asthmatic and the situation is seriously hurting her health. We have been trying to convince her to let us clean her place, but she reacts to our attempts as though they are attacks on her kingdom. It seems too cruel to do anything without her consent, and she does not think there is a problem. Would it be wrong for me to notify her physician about this health problem? ==> Drew
No, it would be appropriate. I have discussed management of hoarding in a number of replies to earlier questions, which you can access by scrolling back in the question series.
L. Koran, M.D. [lorrin.koran@stanford.edu]
Dept. Of Psychiatry, OCD Clinic, Stanford, CA
It is reasonable to notify your grandmothers physician. However it is also reasonable to expect that he may not have a good understanding of the problem. The reaction to your suggestions about cleaning up is not unusual. Most hoarders will put up a big fight if you try to intervene that way. If you can get her to accept some help she may be able to make progress with cognitive behavioral treatment.
J. Claiborn Ph.D., ABPP [anxietyshrink@comcast.net]
Psychologist
You could notify her physician, but I'm not sure what the doctor can do about it. Your grandmother either does not feel she has a problem or is unwilling to acknowledge it. Unless your family determines that your grandmother is a serious and obvious threat to herself or others and decides to pursue formal guardianship, you cannot legally force her to clean her home. You are correct that she will probably be very upset if you attempt to do so without her consent. You can provide her with information about OCD and hoarding and the availability of treatment. You can also offer to help her get to therapy or to begin cleaning things up. Beyond that, no matter how painful it may be to see her in this situation, you may have to allow her to live the way she chooses. If this continues to be difficult for you, consider getting consultation regarding how to handle the situation.
Alec Pollard, Ph.D. [pollarda@sluvca.slu.edu]
Anxiety Disorders Center, Saint Louis Behavioral Medicine Institute
This sounds like a difficult dilemma, but because of the health concerns, you may have no choice but to intervene. Talking to her physician seems like a reasonable step. I recently received a call from our city housing authority regarding a similar situation in which a city-owned apartment was involved -- other tenants complaining, concerns about fire hazard, etc. You might talk with your grandmother about the fact that a fire inspection might result in her losing her apartment, etc. Good luck.
Nancee Blum, MSW, LISW [nanceeblum@aol.com]
Social Work Specialist
Dear Drew: I suppose you could contact her physician, but as long as your grandmother is deemed to be mentally competent and not an immediate danger to herself or others, there may not be much that anyone can do. Perhaps he might have some influence with her. Is there anyone whose opinion she respects or would seriously listen to, such as a clergyman or another relative? I am surprised her landlord tolerates her keeping an apartment this way. Have they given her any warnings? I have heard of individuals being evicted for this type of behavior. If you try to forcibly clean her apartment, she will probably become extremely anxious, angry, and depressed. She will also not have learned anything, and will most likely resume her previous behaviors. It is a sad fact that you cannot force a person to change. Even when they want to change, it is hard work. Probably, the only way someone could intervene would be the danger she may be posing to herself with regard to her asthma. Why don't you get some literature and reprints of articles from OCF for her to read. They might kindle some awareness. I wouldn't expect any miracles, but you never know. You can also ask OCF for a reprint of an article I wrote for them on hoarding some time ago, called "Saving the World." It outlines the basics you need to know about this type of OCD. Best regards.
Fred Penzel, Ph.D. [penzel@ibm.net]
Western Suffolk Psychological Services, Huntington, NY
Dear Drew: Often unfortunately, people with OCD have very poor insight. As your grandmother gets older and it seems to seriously be affecting her health, it may not be cruel but in fact necessary to discuss this with her physician or have the entire family try to do an "intervention." As long as you are discussing it with all members of the family arrive at a consensus then I believe you'd know that you're doing the right thing rather than just being idiosyncratic and "torturing or being cruel." There is no easy option her! Good luck!
Dr. Steven Friedman [Steven_Friedman_at_hscb-uh1@netmail.hscbklyn.edu]
Hoarding Question: 20
I have come to recognize myself as a hoarder, but I don't seem to have any of the other symptoms of either OCD or OC Personality Disorder -- at least not to any clinical degree. What implications does that have for treatment (given that the consensus seems to be that hoarding in OCD is extremely tough to treat)? Would the treatment be different? Is hoarding ever a symptom of any other disorder? Is there a non-OCDers syndrome? Thanks for any info you can provide. ==> Packrat
I have provided a good deal of information about the treatment of hoarding in previous replies on this site. You can also consult chapter 3 of my recently published book, which has a section on the behavioral and pharmacological treatment of hoarding.
L. Koran, M.D. [lorrin.koran@stanford.edu]
Dept. Of Psychiatry, OCD Clinic, Stanford, CA
Not having other OCD or OC Personality symptoms is not actually that unusual. Hoarding is classified as an OCD symptom, but we have seen a number of people who have no other OCD problems and we have not reason to think that treatment for hoarding should be different; if anything, it is a bit more complicated when a person also has other rituals like checking or washing. Treatment should include assistance in evaluating your reasons for acquiring and saving, beliefs and emotions associated with these and systematic efforts to reduce both symptoms and to help you discard and organize your remaining belongings. Good luck.
Gail Steketee, Ph.D. [steketee@bu.edu]
Professor, Associate Dean of Academic Affairs, Boston University School of Social Work
There may be other problems that lead to hoarding but the most common source is OCD. The way to answer the question is really to look at why you keep things. The lack of more typical obsessions and compulsions does not have much implication for treatment of hoarding. The response to hoarding that has the potential to work reasonably well is a cognitive behavioral treatment. It is likely to require a therapist with some special knowledge and willingness to come to your home.
J. Claiborn Ph.D., ABPP [anxietyshrink@comcast.net]
Psychologist
Dear Packrat: Hoarding can be a symptom of OCD or OC Personality Disorder, however if you lack all the other signs of OCPD, then it probably is OCD. Sometimes you may see hoarding behaviors among those who suffer from schizophrenia, however, they may also have concurrent OCD as well. There is no other type of hoarding disorder that stands alone. Who told you that it was so hard to treat? That simply isn't true. If you are truly sick and tired of living an illness lifestyle, and feel very motivated to change (even if you aren't sure how to do it) then your chances or recovery are as good as anyone else's. Ask OCF for a copy of an article I wrote for them a while ago titled "Saving the World," which outlines the nature of hoarding problems, as well as suggestions for treatment. Behavior therapy plus medications can be quite effective. I have seen many "horror houses" cleaned up and brought back to life. Don't get discouraged. Go out there and find someone with expertise in OCD treatment and get yourself a consultation. This will put the issue of diagnosis to rest, and then you can get on with your recovery. Best regards.
Fred Penzel, Ph.D. [penzel@ibm.net]
Western Suffolk Psychological Services, Huntington, NY
Hoarding Question: 21
Do you have any particular advice for compulsive hoarders (i.e., packrats)? The organizing books I have read don't seem to understand the underlying anxiety that accompanies trying to discard of things. How do we deal with that aspect of it? ==> Dena
Both Dr. Jenike and I have dealt with this in our recently published books on OCD. I have also written extensively on the management of hoarding in replies to previous questions. Please scroll through. Anxiety accompanies all OCD symptoms, not just hoarding, and is dealt with via medications and exposure and response prevention treatments. It is never easy to overcome OCD symptoms because facing them temporarily increases anxiety.
L. Koran, M.D. [lorrin.koran@stanford.edu]
Dept. Of Psychiatry, OCD Clinic, Stanford, CA
There is indeed considerable anxiety in trying to discard for those with hoarding problems. Take a look at the chapter on hoarding in Jenike, Baer and Minichiello's 1998 book on OCD: OCD: Practical Management published by Mosby, Chicago. This clarifies this problems and offers some suggestions.
Gail Steketee, Ph.D. [steketee@bu.edu]
Professor, Associate Dean of Academic Affairs, Boston University School of Social Work
There has been a little research on treatment of this type of OCD. Dr. Steketee who regularly contributes to this list is co-author of some work on treatment of this problem. There is a very good chapter in the book by Jenike et al. on hoarding and its treatment by Frost and Steketee. Hoarding is difficult to treat and not well understood but seems to respond to specific behavioral treatment.
J. Claiborn Ph.D., ABPP [anxietyshrink@comcast.net]
Psychologist
Hoarding Question: 22
How do you talk someone with OCD (hoarding) into getting some help? How do you help the family that wont talk about the problem? Should it be allowed to go on or should they just ignore the problem that has been going on for 16 years? ==> Tiffany
Hoarding is a difficult problem to treat in part because the people who do it usually are very reluctant to work on the problem. If asked I would clearly want to work with the family to try to get them involved in working with the hoarder to deal with this problem. When you ask if it should be allowed I am guessing you mean should the hoard be disposed of against the hoarders will. The answer to this is generally no. It will only lead to a lot of anger and distress and not stop the hoarding from occurring.
J. Claiborn Ph.D., ABPP [anxietyshrink@comcast.net]
Psychologist
Trying to talk people into something they don't want to do is pretty much a waste of energy. Usually a problem has to get bad enough or the consequences have to be too painful before someone is willing to change. If the behavior is having an effect on you, the only thing that can be changed is how you respond to it, rather than expecting that someone else will change or somehow "see the light." I have a cartoon that says, "people don't change because they see the light, but because they feel the heat."
Nancee Blum, MSW, LISW [nanceeblum@aol.com]
Social Work Specialist
Dear Tiffany: Unfortunately, you can't help everybody. Not everyone is ready or willing to be helped at a particular time. I suppose you can give them information and let them decide for themselves. Otherwise, there isn't much you can do if they won't even talk about it. Some families deal with problems by ignoring them and hoping they will go away if ignored. It really isn't up to anyone to "allow" a problem to go on or not. It is strictly up to the person with the problem. They are the only one with any control over it. You can't change what you cannot accept. Best regards!
Fred Penzel, Ph.D. [penzel@attglobal.net]
Western Suffolk Psychological Services, Huntington, NY
You're describing extremely difficult situation. You can confront people only up to some point about your belief that they should get treatment, but ultimately it is their responsibility. Particularly if the family itself won't talk about the problem, I'm not sure if you can have any other options, then just avoiding or living with the situation, it is not an easy place to be.
Dr. Steven Friedman [Steven_Friedman_at_hscb-uh1@netmail.hscbklyn.edu]
Hoarding Question: 23
How do I know if my hoarding is OCD or just embarrassing? Or am I lazy because I can't put things away (out of sight), even insignificant trash and junk mail? ==> Jill
"Laziness" is an unlikely and generally nonuseful explanation for hoarding behavior. I assume that there are some things that you do accomplish and that you do not just stare at the wall all day. Why would you be lazy only regarding some tasks and not others? OCD or some other related problem is a more likely explanation. The fact that you do something that makes you unhappy in other ways (e.g., causes embarrassment) is simply another indication that you have a problem. I hope you will seek an evaluation from a clinician experienced with OCD who may then be able to give you a more definitive answer regarding the nature of your problem.
Alec Pollard, Ph.D. [pollarda@sluvca.slu.edu]
Anxiety Disorders Center, Saint Louis Behavioral Medicine Institute
Sounds like hoarding. This behavior is usually motivated by feeling "I might need it sometime," "I may make a mistake if I throw away the wrong thing," or sentimental attachment to items. It is not laziness. See recent posting about treatment.
L. Koran, M.D. [lorrin.koran@stanford.edu]
Dept. Of Psychiatry, OCD Clinic, Stanford, CA
Dear Jill: Hoarding can be a serious problem - people have created fire hazards, ruined nice homes, and even been evicted because of it. I suggest that you get a professional consultation with someone who is expert in treating OCD, to find out just how serious your problem is. You might even bring along some photos to show whoever it is you go to see. Also - ask the OC Foundation for a copy of an article I wrote a few years ago called "Saving the World." It is all about hoarding, and should give you a fair amount of information so that you can orient yourself. One way to tell if it may be OCD is the level of dysfunction is causing you (how much it is messing up your life), if you just cannot ever decide what things to throw away, and if you get extremely anxious about throwing things out. If it is OCD, then behavioral therapy (Exposure and Response Prevention) and possibly medication (SSRI-type antidepressants) are the best treatments. You can get a lot of help and instructions about how to decide what to throw away, how to reorganize your home, and get help in actually throwing things away. Go get help soon. You don't have to live this way. Best regards.
Fred Penzel, Ph.D. [penzel@attglobal.net]
Western Suffolk Psychological Services, Huntington, NY
Hoarding is actually probably a common problem and most people who have the problem probably have OCD. I don't think what you describe is just being lazy. The only way to know for sure is to get an evaluation from a professional who knows about OCD. The treatment of hoarding problems is something many professionals don't know about and is likely to require a therapist who is willing to come to your home. This foundation has a list of therapists who treat OCD and that might be the best place to start getting help.
J. Claiborn Ph.D., ABPP [anxietyshrink@comcast.net]
Psychologist
I suppose to make the diagnosis, one would need to know why you cannot get rid of trash and junk mail. If you are saving them because you feel they have some future value and it is filling up your house, then you may have hoarding. I will E-mail a chapter on hoarding. Best wishes.
Michael Jenike, MD [jenike@comcast.net]
Usually people who are lazy are not disturbed by their habits. The fact that you are worried about it suggests that you may have OCD or hoarding. I would suggest that you consult a mental health professional for further evaluation and treatment.
Dr. Steven Friedman [Steven_Friedman_at_hscb-uh1@netmail.hscbklyn.edu]
Hoarding is actually probably a common problem and most people who have the problem probably have OCD. I don't think what you describe is just being lazy. The only way to know for sure is to get an evaluation from a professional who knows about OCD. The treatment of hoarding problems is something many professionals don't know about and is likely to require a therapist who is willing to come to your home. The OCF has a list of therapists who treat OCD and that might be the best place to start getting help.
J. Claiborn Ph.D., ABPP [anxietyshrink@comcast.net]
Psychologist
Hoarding Question: 24
My husband collects tools and other things to the point that our house is so full it looks like a warehouse. He keeps buying and buying. We recently were married, and now I think he is OCD/hoarding. Is it O.K. To clean up the house, he gets very frustrated when I do. Also, how do I get him to seek help? He thinks it is normal to live like this, and everyone sees the problem except him. ==> JoAnn
It won't really help him learn anything if you do the cleaning. Consider finding some leverage point so that you can insist that he receive some help and offer to participate so that you can help him learn to manage the problem. You can also set some rules that are reasonable about where he cannot store his things so you and the family can function effectively. It probably won't help to complain and criticize since this has most likely not worked in the past. You do need to take action by helping him identify a person in your area he can consult (OCF can assist with referrals) and arrange to go with him. Meanwhile, there is a chapter in Jenike, Baer and Minichiello's 1998 book on OCD that discusses hoarding problems and interventions. This does take time since your husband likely has several skills he needs to learn to correct his thinking and behavior.
Gail Steketee, Ph.D. [steketee@bu.edu]
Professor, Associate Dean of Academic Affairs, Boston University School of Social Work
JoAnn: Most people who hoard are not very bothered by it - it is their families who want them to get treatment for it. It is fine for you to clean up the house so long as this doesn't cause any marital problems, but don't expect this clean situation to last! Can your husband agree to confine his hoarding to only certain places that you both agree on? Good luck.
Lee Baer [Baer@psych.mgh.harvard.edu]
Dear JoAnn: You might try to start by educating your husband. Ask the OC foundation for a copy of an article I wrote for them a while ago titled "Saving the World." See if you can get him to read it. It may also be that he doesn't have OCD, but has Obsessive Compulsive Personality Disorder. People with OCPD also have been known to hoard things, however, they don't see anything wrong with this, and even get satisfaction from it. In such a case, it is not very likely you will get him to change his views. Even in OCD, when someone is very resistant to the idea of treatment, there are limits to what you can do. You cannot force anyone to change. People can only change themselves. Even when they are motivated it is hard work. Other than educating someone, there is little else you can do with them. Best regards. [WebMaster Note: This publication is in the OCF Bookstore ]
Fred Penzel, Ph.D. [penzel@attglobal.net]
Western Suffolk Psychological Services, Huntington, NY
What you describe could be hoarding which is a form of OCD which is difficult to treat especially because many hoarders don't see it as a problem. Your cleaning up or getting rid of things will never be acceptable to him. Ultimately you may need to decide how much you can take and put pressure on him to get help because it is having an adverse effect on you.
J. Claiborn Ph.D., ABPP [anxietyshrink@comcast.net]
Psychologist
Hoarding Question: 25
After my first visit to a CBT intern, I was diagnosed with OCD and OCPD. We need to meet again before she's sure about OCPD, but hoarding is her major tip-off. Please explain the difference between OCD and OCPD again. ==> FLC
You do not have to have a "pea brain" to have difficulty understanding these issues. I have days when I get confused. Here's a short version: OCD involves specific obsessions and compulsions that the individual does not like or want. OCPD involves a general personality style (e.g., extremely inflexible, perfectionistic, detail oriented) that may bother others but often is perceived by the individual as being acceptable or even preferable to the way others behave. As you might imagine then, people with OCD are more likely to pursue help. Individuals with OCPD are more likely to be pushed into treatment by family or others if they seek help at all. These are generalizations and there are of course exceptions in individuals cases. A person can have OCD and OCPD, but most people with OCD do not have OCPD. A person can have OCPD without OCD. I hope that helps.
Alec Pollard, Ph.D. [pollarda@sluvca.slu.edu]
Anxiety Disorders Center, Saint Louis Behavioral Medicine Institute
Hoarding is not just particular to OCPD. It can also be a part of OCD. In OCPD, individuals don't see their behavior as a problem. It seems a part of who they are, and they usually can't see themselves changing. They don't usually go for treatment, unless others are strongly pressuring or threatening them, or their behavior has gotten them in some type of trouble. Even then, they see the situation as being a problem that someone else is having with them, not a problem they, themselves are having. They also tend to be quite perfectionistic and controlling. I suggest you get a copy of an article I wrote on hoarding for the OCF newsletter titled "Saving the World." It spells out a lot about compulsive hoarding. You may just have OCD, and your intern (how experienced are they?) may be confusing the fact that you hoard with the notion that you have OCPD. If you don't really see any problem with your hoarding, enjoy saving things, and deep down don't really want to change this behavior, then I would consider OCPD. If it seems foreign to you, you really hate it, but just don't know how to stop, then I would look more toward OCD -- particularly if you are saving things due to doubt, or else due to guilt about throwing away potentially useful things. Best regards.
Fred Penzel, Ph.D. [penzel@attglobal.net]
Western Suffolk Psychological Services, Huntington, NY
OCPD is considered a set of personality traits that are characterized by orderliness, preoccupation with details and schedules, perfectionism that interferes with getting things done, excessive devotion to work and productivity, overconscientiousness or inflexibility about matters of values, miserliness, rigidity. These things are usually viewed by the person as good traits, but others often find them excessive and unpleasant. These traits interfere with the person's ability socializing and enjoying life. Hoarding of possessions is sometimes part of this picture, and if it is, it is usually because the person has strong moralistic beliefs about being wasteful, saves things to avoid this, and thinks others should do so to. However, hoarding often occurs in people without OCPD and in that case the hoarding tends to be more often because of strong attachment to items and beliefs that items somehow represent part of their identity; throwing things away causes anxiety and sometimes crying.
Gail Steketee, Ph.D. [steketee@bu.edu]
Professor, Associate Dean of Academic Affairs, Boston University School of Social Work
OCD is a disorder characterized by obsessions and compulsions. Obsessions are ideas, images, urges etc. that come intrusively into ones mind and produce distress or anxiety. Compulsions are behaviors designed to reduce the anxiety. Hoarding is essentially a set of compulsions and avoidance behaviors. It is a common form of OCD. Although hoarding is mentioned in the diagnostic criteria for OCPD this is not something that really fits of there. Making the diagnosis of OCPD on the basis of hoarding is a mistake. OCPD is diagnosed based on a pattern of behaviors including rigidity, focus on rules to the extent that they loose sight of the purpose of what they are doing. I think your intern may need to do some homework him/her self and learn more about OCD.
J. Claiborn Ph.D., ABPP [anxietyshrink@comcast.net]
Psychologist
Hoarding Question: 26
I started CBT 3 weeks ago to work on my OCD hoarding and cluttering. I was not put on any medications at this time because the intern felt that a SSRI won't help with the hoarding and cluttering. I was told to try CBT first. Should I just wait and see, or should I press the medication issue? ==> JLV
Wait and see. There is pretty good evidence SSRIs are not as effective for hoarding as for other OCD symptoms. If a good and sustained effort at CBT does not produce some benefits (allow at least 6 months to see significant progress), then consider adding medication. CBT should include efforts to stop or reduce acquiring of new items (however you usually do this -- buying, free things, etc.), gradual discarding of hoarded items starting with easier ones and working toward harder items, deliberate organizing of possessions you decide to keep, work on dysfunctional beliefs associated with hoarding (needing to have more than one copy/item, objects representing memory aids, excessive attachment to possessions as representations of one's identity or life experience, beliefs about being wasteful, etc.). Good luck.
Gail Steketee, Ph.D. [steketee@bu.edu]
Professor, Associate Dean of Academic Affairs, Boston University School of Social Work
Hoarding Question: 27
My husband has two big storage units filled with, newspapers, brochures and dozens of undeveloped films. He cannot fulfill a task without being distracted, is constantly collecting items about natural disasters and when he was working as a photojournalist he spent 18 hours a day in his work. Now he is not working and spends his time in details that prevent him from functioning. He is extremely slow, yet, he is happy, gentle, kind and seems to suffer no stress. Please help! ==> Lisis Martin
Sounds like one of his problems is his distractibility and the other is his desire to collect these items, as if they remain important to him. If he is content but you are not, sometimes the only way to get him help is to decide for yourself what you can tolerate and what you cannot. Don't make idle threats, but do let him know what will happen if he does not seek assistance and be sure to find him a good referral person whom you would be willing to see also. Check with OCF for referrals and call first to be sure the person feels able to work on hoarding problems. This is a complex problem that requires time to treat, usually at least a year or more of steady work, once the person decides that removing clutter is a goal they are willing to work on. Good luck.
Gail Steketee, Ph.D. [steketee@bu.edu]
Professor, Associate Dean of Academic Affairs, Boston University School of Social Work
Dear Lisis: Your husband's behavior may fall into one of two categories - either he has a type of OCD know as hoarding, or else he may have a problem known as Obsessive-Compulsive Personality Disorder. If he is suffering no distress at his own behavior, and seems indifferent to it as you say, he may fall into the latter category. OCPD sufferers don't see their behavior as abnormal. Saving things to excess would be quite natural to some OCPD sufferers, and they really couldn't see themselves not doing it. It is just a part of who they are. OCD sufferers find their behavior distressing and want to stop, but just cannot seem to be able to do so on their own. If your husband were willing, you might take him to someone who specializes in OCD for a consultation, to see just what is going on, and what, if anything, can be done. If it is OCPD, don't expect miracles. Sufferers are not usually very willing to go for treatment, as they don't really believe that they have a particular problem. They only tend to change when great pressure is brought to bear on them, or they stand to lose something important. Best regards.
Fred Penzel, Ph.D. [penzel@attglobal.net]
Western Suffolk Psychological Services, Huntington, NY
I am not sure what sort of help you want. You describe your husband as happy. If that means that you see his behavior as a problem but he doesn't the odds of effective change are small. To change things like OCD (it that is what he has) is difficult and time consuming.
J. Claiborn Ph.D., ABPP [anxietyshrink@comcast.net]
Psychologist
I will forward a chapter from our 1998 book on hoarding; this may be part of his problem. He should probably have an evaluation by an expert to make sure he does not attention deficit disorder or some other problem that gets in the way of his functioning. Best wishes!
Michael Jenike, MD [jenike@comcast.net]
Hoarding Question: 28
My son, age 15, was diagnosed with OCD about 2 years ago. He also has been diagnosed with depression. A few months ago, he had a psychotic episode and was hospitalized briefly. He takes Risperdol and Zoloft. His mood is much improved and some of the obvious OCD symptoms are under control. However, he still has a big problem: he steals (always small stuff that he can well afford). Is this an OCD symptom or something unrelated? What can be done? ==> Lynn
The behavior of stealing is very unusual in OCD but could be a compulsion. I would start by asking him why he does it.
J. Claiborn Ph.D., ABPP [anxietyshrink@comcast.net]
Psychologist
I have worked with several other children who have "stealing" behavior which in process resembles a hoarding behavior (very strong urge- feels like would be impossible to resist). Provided that a child feels remorse for the behavior, and wants to prevent it from happening again, then treating it as a compulsion where boss back strategies and ritual prevention practice are used, should be effective. As with other OCD symptoms, you tackle the problem hierarchically, exposing to the smallest challenge first, then advancing to the next level. For example a child may do an exposure in a 5 and 10 store first, and then advance to an electronics store where the items are more tempting. During these exposures, (usually with assistance) the child is saying to himself on purpose- "take it!" and then practicing resisting the urge. The coach is nearby to make sure that the exposure is a success.
Tamar Chansky, Ph.D. [chanskt@erols.com]
Hoarding Question: 29
I live in a 55 unit complex. One resident hoards massive amounts of newspapers, paper bags, jars/bottles in his bin, any other bin he can and his unit. All other residents are worried about fire. What can be done to insure a win-win situation? ==> Joan Vitolo
This is a very difficult situation and some communities are now beginning to develop task forces of housing authorities, fire, police, social service and other organizations to work on this problem. An important part of the problem is often the lack of motivation on the part of the person who hoards to change their behavior. This can sometimes be enhanced if they can see a clear benefit in reducing the quantity of items of confining it to areas where no hazard exists. Someone will need to talk to the resident in a non-threatening way to find out what they are motivated to do (have more storage space, have more space in their apartment, organize their things so they can find items they need, etc.). Undoubtedly the person will need help in meeting whatever goals are set and how to do this depends on the resources available to help and what help the resident will accept. It seems pretty clear that removing the offending items without the hoarder's cooperation will likely just lead to a repeat performance. Good luck finding alternatives.
Gail Steketee, Ph.D. [steketee@bu.edu]
Professor, Associate Dean of Academic Affairs, Boston University School of Social Work
This form of OCD is very hard to treat in part because the hoarders usually don't want to deal with it as it causes too much anxiety. If you can get the individual involved with someone who understands the treatment of this type of problem then you may see some progress. It may be hard to find anyone who has treated this. There are a few things written about what we know about treating hoarding.
J. Claiborn Ph.D., ABPP [anxietyshrink@comcast.net]
Psychologist
Hoarding Question: 30
I am going crazy living with my husband's undiagnosed OCD. I am not allowed to throw anything out. Our basement is full of "stuff." He has "collections" of empty containers for shaving cream, deodorant, etc. He even saves his skin and nails. I have to hide trash and then put it out on trash day or he will save it in his car. What should I do? ==> Judy
Treatment of hoarding ("pack-ratting") is described in my book, "Obsessive-Compulsive and Related Disorders in Adults" (pages 72-74), and in Dr. Jenike's book, "obsessive compulsive disorder s: Practical Management" (pages 544-551), either of which you can consult. Hoarding can be due to OCD or to other disorders including schizophrenia, and in the elderly, dementia. You can bring educational materials about OCD to the house (available from the OC Foundation) and encourage the person to read about OCD on this OC Foundation's Web site. The family should insist that the affected person be evaluated by a psychiatrist ("because we are concerned about you" or "care about you"). If the person refuses, you can call the public health authorities in your community and they will make an inspection to determine whether a health hazard exists (vermin, etc.,). If they determine that such a hazard exists, they will clean out the house (after giving the person a chance to do so). The family can also seek family counseling from a psychiatrist or psychologist for more detailed ideas on how to manage this problem.
L. Koran, M.D. [lorrin.koran@stanford.edu]
Dept. Of Psychiatry, OCD Clinic, Stanford, CA
It certainly sounds like your husband meets the diagnosis of OCD hoarding. If your husband is not willing to admit that he needs help, you will have to decide what your next step will be. In some cases, giving the person an ultimatum has worked, but the person giving the ultimatum needs to be committed to following through with the consequences (moving out, asking them to move out and dumping all the stuff, or whatever you are willing to do). In one similar case, the wife threatened to end the marriage if he didn't agree to get help and to follow through with the assignments to get rid of stuff (and not accumulate more). We wrote up a contract in which the hoarder agreed to get rid of one box of stuff the first week, two the second week, and three boxes/week thereafter until his stuff fit into the amount of space his wife was willing to let him have in the basement. The agreement further stated that if he didn't get rid of the specified amount in any given week, his wife could get rid of that much without his interference. Good luck!
Nancee Blum, MSW, LISW [nanceeblum@home.net]
Social Work Specialist
Living with someone who has OCD diagnosed or not can be very challenging. The hoarding form of OCD is often a major source of tension at home. You can deal with this in a couple of ways. One is to try to talk to your husband about how this problem is affecting you and trying to get him to realize that it really is a significant problem. You can also look for a support group in your area or even start one for family members of people with OCD. You can get information on the treatment of hoarding and try to get your husband to work with someone who knows about this problem.
J. Claiborn Ph.D., ABPP [anxietyshrink@comcast.net]
Psychologist
Dear Judy: If possible, the best thing you could do would be to insist that he go for a consultation with a psychologist or psychiatrist who is expert in OCD, or else you will not be able to continue living under these conditions with him. You might first give him some reading matter on OCD and compulsive hoarding, to see if you can get him reach some kind of an insight. If he doesn't accept he has a problem, he certainly won't be willing to go for help. You can download an article from my clinic's Web site (http://www.wspsdocs.com) I wrote for OCF a few years ago, titled "Saving the World." It is all about hoarding. With a problem as serious as you are describing, it doesn't sound as if halfway measures will work. He will most likely need behavioral therapy and perhaps, medication to help him out of this predicament. Don't hesitate about this. If you can't help him out, at least you can do something about helping yourself. If he utterly refuses to do anything, go get some counseling for yourself, so that you can figure out your next move. Just remember that you cannot force him to get well if he isn't inclined. Best regards.
Fred Penzel, Ph.D. [penzel@attglobal.net]
Western Suffolk Psychological Services, Huntington, NY
Hoarding Question: 31
As the daughter of a "professional hoarder," I have had the task of helping him "hide" his illness to neighbors, friends and family. I have been able to bring up the subject a few times without him getting mad, however, I know that speaking to him about therapy would ruin everything I've accomplished up to now. I need suggestions on how I can help him help himself without direct interference. No therapy or medications. Are there any techniques out there that are used by therapists that I could or he could use to help the problem? ==> Polly
Part of the problems associated with hoarding is a) it creates an environmental mess and b) it eventually makes it difficult or impossible for the hoarder to find -- and use -- the things he/she has hoarded. Therefore, use organizational techniques for getting the hoarded items off the floor and organized into easy-to-find categorized plastic containers. (Buy these at home improvement stores.) The sorting activity will help the hoarder separate the junk from collectable items (that should be saved). This sorting should be done perhaps a half hour every day. (Don't tackle the project at one time. It'll overwhelm you.) While not initially treating the OCD, it will get the hoarder's living quarters back into a usable area. Additionally, if the hoarder learns to "sort and save," rather than just "collect and dump," he/she can then take the next step and actually throw out the garbage items, which are now in their own unique containers. Every once and awhile, Oprah Winfrey has a TV show or magazine article on how to better organize your home. These are great organizational techniques that everyone -- especially hoarders -- can adapt and use. Having said that, it is imperative that you don't enable (i.e. help the hoarder hide) his OCD. Instead, when the time is right, help that person get the proper medical help they deserve. (Getting your friend to go to this Web site, for example, would be a good first step.)
Al Willen
OCF WebMaster
I think you are asking for an awful lot. You want to know how to help your father with hoarding but you don't want to mention that it is a problem or that therapy might help. Hoarding is a very difficult problem to work with. I am not convinced that by helping him hide it you are really helping him as this seems to reduce the natural consequences which may make hoarding more aversive. The best work on hoarding has been done by Drs. Frost and Steketee. You could try to locate one of their articles or book chapters on the subject to get details of some of the methods they suggest.
J. Claiborn Ph.D., ABPP [anxietyshrink@comcast.net]
Psychologist
Hoarding Question: 32
Would you please define intrusive thought for a compulsive hoarder? ==> Judy
Often these would include fears of needing something in the future or missing something, or obsessional doubts about whether or not something may be important in the future.
Jon Abramowitz, Ph.D. [abramowitz.jonathan@mayo.edu]
Clinical Psychologist, Mayo Clinic
The diagnosis of OCD requires either obsessions or compulsions but not both. Most people with OCD have both but occasionally people seem to have only obsessions or only compulsions. Most experts would agree that people who appear to only have obsessions have other behaviors that serve the purpose of compulsions or neutralizations. hoarders may not appear to have obsessions. This is partly because they successfully avoid setting them off by engaging in the hoarding. However if you ask a compulsive hoarder to get rid of something they hoard or not acquire something you will find that they begin to express concerns that sound like obsessions about not having an object, not being able to remember something or not being able to find something they might need and perhaps not being responsible in disposing of something or wasting something.
J. Claiborn Ph.D., ABPP [anxietyshrink@comcast.net]
Psychologist
Hoarding Question: 33
When I search on "hoarding," most of the questions involve adults living in situations of homes being crowded with newspapers, garbage, etc. There is also little information, in general, about hoarding in some of the OCD books I have. My 9 year old son hoards (or, at the very least, can't bring himself to throw certain items away, though he must realize I do). Can you speak about hoarding compulsions in children? He also seems to have harm obsessions and perhaps mental compulsions. He currently takes Luvox, Anafranil, Clonidine and has recently begun CBT. ==> Ginny
Ginny, I cannot speak to hoarding in children, but in adults, the medications have generally not worked as well for hoarding symptoms as they have for other OCD symptoms and it sounds like he does have some of these. CBT is likely to be useful, and you might suggest to his therapist to look at some recent articles/chapters by Dr. Randy Frost and colleagues, 2 of which are given below. These may be available through the OC Foundation: Frost, R.O., and Steketee, G. (1999). Issues in the treatment of compulsive hoarding. Cognitive and Behavioral Practice, 6, 397-407. Frost, R.O., and Steketee, G. (1998). Hoarding: Clinical aspects and treatment strategies. In M. Jenike, L. Baer, and W. Minichiello (Eds.), Obsessive-compulsive disorders: Practical management (pp. 533-554). (Third Edition). St. Louis: Mosby Year Book Medical.
Gail Steketee, Ph.D. [steketee@bu.edu]
Professor, Associate Dean of Academic Affairs, Boston University School of Social Work
There is relatively little written about hoarding in OCD in the first place. I am not aware of any literature on it in children although I have certainly know of children who have this form of OCD. OCD in general seems to be very similar in children and adults so what we know about treating a particular form in one group probably applies to both. In general medication does not seem to be a big help for people with hoarding problems. This may be because hoarding is what I see as a "successful" compulsion meaning that it successfully reduces anxiety and thus is unlikely to stop simply because the anxiety is reduced by medication. CBT for hoarding has been described by Frost and Steketee in book chapters and articles. Your child's therapist may want to read up on it and help you develop a plan to deal with the problem. It should involve your son making the decisions about disposing of things and doing it himself.
J. Claiborn Ph.D., ABPP [anxietyshrink@comcast.net]
Psychologist
Hi Ginny: I'm sure your CB therapist will guide you through this, but the treatments for hoarding involve in part, having the child sort items- clothes, toys, papers, etc. into categories. For example, take out a drawer of "stuff" and sort into three categories: 1. Use now, 2. Give away, and 3. Hold 6 months. Make sure that the child puts things in each category (so not everything goes in "use now"), almost like he's dealing cards evenly to different players. Another dimension of the work is bossing back "Mr. Storage Guy" who says that he won't be OK without holding on to items, and setting up exposures where he intentionally throws things out or leaves them behind. Finally, to stop the hoarding before it starts, there's often a "check your pockets at the door" intervention so that various junk never makes it into your house. Every child is different, though probably some variation on one of these themes will be indicated. Best of luck.
Tamar Chansky, Ph.D. [chanskt@erols.com]
Children's Center for OCD and Anxiety
Hello. I will send you a chapter on hoarding from our OCD book. It is treated with behavior therapy. Medication is not helpful for hoarding in my experience; although it will help depression that is commonly associated with hoarding for some reason. Also, there is a hoarding list on the Internet. You could contact Paula at disi@igc.apc.org and see if you can join the group: This list is very good because Dr. Claiborn monitors the list and answers questions. He knows a lot about hoarding and this is helpful to many people. Also, communicating with other hoarders is really helpful. Best wishes!
Michael Jenike, MD [jenike@comcast.net]
Hoarding Question: 34
Are there health dangers for an elderly person living in a very filthy house? When should a relative intervene to protect the health of an elderly person? ==> Lisa
It's hard to give a definitive answer without knowing what is causing the "filth" -- if there are rats, cockroaches, etc., that could certainly be a health threat. Another concern is whether it is filthy because there is so much clutter that the person may trip or fall and break something. Sometimes I have had calls from family members who tell me the person's refrigerator is full of rotting food, or the furnace isn't working and the person won't let repair people into the house, etc. What are the circumstances that make it difficult for the person to clean the house?
Nancee Blum, MSW, LISW [NanceeBlum@aol.com]
Social Work Specialist
Certainly there are health risks associated in living in filth. This type of situation can arise as a result of hoarding which is usually associated with OCD but may also occur as part of other disorders. The decision about intervention is difficult. First of all it is unlikely to be effective unless the hoarder is actually taken out of their home and put into circumstances where accumulation of new hoards is not possible. Second the intervention is almost inevitably going to cause great distress for the hoarder and not be appreciated or accepted. In the final analysis you have to make a decision about the risks and benefits and act accordingly knowing that the hoarding individual may never forgive you.
J. Claiborn Ph.D., ABPP [anxietyshrink@comcast.net]
Psychologist
Hoarding Question: 35
My husband at age 50 has been diagnosed with OCD hoarding. We are at the start of his treatment. He is trying therapy and medications. As the spouse of someone with this, how should I be supportive yet understand that his behavior has taken our family down with him. (We have a garage and basement filled with his collection. He really gets upset if I throw anything away!) ==> Kate
I can't comment on the specifics of Hoarding or medical treatment options, but I can tell you that it is one of the hardest types of OCD to treat. I suggest you pick up Dr. Herb Gravitz's book called "OCD: New Help For The Family" which is available in the OCF Bookstore. Also, get and read anything and everything by Dr. Gail Steketee and Dr. Randy Frost.They are the world experts on OCD Hoarding.
Al Willen
OCF WebMaster
Kate: This is a common problem with relatives of OCD sufferers -- and a difficult situation for sure. I think that you should ask his therapist what you should and should not do in trying to help. I frequently meet with spouses of patients to coach them in helping their loved one fight OCD.
Jon Abramowitz, Ph.D. [abramowitz.jonathan@mayo.edu]
Clinical Psychologist, Mayo Clinic
Hoarding is characterized by excessive saving and an extreme difficulty in throwing items away. Almost any kind of item imaginable can be saved. Often the sufferer feels he/she needs to go through items thoroughly before discarding them, or that items may have some purpose or practical value and so shouldn't be wasted by throwing them away. Another component of hoarding can also be compulsive shopping. Behavioral therapy involves confronting these beliefs and challenging the saving compulsion by throwing things away. This is often a slow process and the sufferer usually has numerous reasons why items should be brought home and saved. It's likely he's already aware of how his symptoms impact the family. Ultimately, as much as you would like to help, confronting his OCD symptoms is something he will need to face on his own. You certainly have a right to set some limits on the use of space in your home, but if you throw the items he has saved away, it will likely just result in tension between you and not be beneficial to his OCD treatment in the long run. You can support him in his efforts to attend therapy. You may want to think about attending a support group yourself for partners of those with OCD. Occasionally a partner can serve as a coach to help with the behavior therapy tasks. This may or may not be helpful in your situation as it can generate anger and resentment if the help is not welcome and your husband wants to tackle the hoarding at his own pace.
Deb Osgood-Hynes, Psy.D. [os-hynes@OCD.mclean.org]
Director of Behavioral Services and Behavior Therapist; MGH OCD Institute
Hi Kate: I would not recommend throwing away things for your husband. Since the goal of treatment is to teach hoarders how to discard items on their own, your throwing his things away could interfere with his building the skills he needs to keep from reaccumulating. Also, it's likely to increase your marital discord since he gets angry. You can be most supportive by helping him break down the discarding process into manageable steps. Hopefully, his therapist will generate a de-hoarding plan with him, and you can help by supporting the plan. Good luck.
Lisa Jo Bertman-Pate, Ph.D. [lpate@tulane.edu]
Clinical Psychologist
Hoarding Question: 36
My elderly mother's house was condemned (hoarding and vermin infestation) on February 2002. She refuses medical treatment or other help. Although we tried to help her, she is now not speaking to us, tells people we have stolen "everything" (which not true). Her health is bad. She is nearly blind from cataracts, but she is very articulate, intelligent and manipulative. How can we get her into treatment and/or keep her from returning to an unhealthy living situation? Also, our 15-year-old son's room reminds me of my mother's house (piles of junk and a pathway.) Could he have OCD hoarding? ==> Linda
Hoarding problems are often entangled with family struggles and your description of the problem is not unusual. There is little you can do that your mother will agree to and you may end up having to pursue a legal solution. On her own it is most likely that her home would return to its previous state reasonably quickly. Given that the conditions got so bad that her house was condemned it may be possible to get some sort of guardianship which would empower you to control her living situation. It might be necessary to place her in some other arrangement as living at home is unlikely to work at all especially since she is accusing you of stealing her stuff and sounds like she has little or no insight into the problem. Hoarding is a difficult problem to treat in part because unlike other compulsions hoarding often serves to successfully manage anxiety. Your son's situation may also represent a form of hoarding OCD but it is impossible to diagnose without much more information.
J. Claiborn Ph.D., ABPP [anxietyshrink@comcast.net]
Psychologist
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L. Koran, M.D. [lorrin.koran@stanford.edu]
Dept. Of Psychiatry, OCD Clinic, Stanford, CA
Hoarding Question: 37
I have heard it said that the extreme collection of live animals, such as the cliche about the "little old lady with her 50 cats," is a form of Hoarding OCD. Can anyone address this idea? A relative of mine does this. ==> Cyndi
I have worked with many people with hoarding symptoms and many of them (especially women) seem to have multiple cats. I don't know of any research on the topic, though.
Jon Abramowitz, Ph.D. [abramowitz.jonathan@mayo.edu]
Clinical Psychologist, Mayo Clinic
The accumulation of large numbers of cats or less commonly dogs may represent a form of hoarding which in turn is usually part of OCD. Hoarding can occur in other disorders and even when it occurs in the context of OCD it seems somewhat different from other forms of OCD. If your relative seems to fit the cliche of "the little old lady with 50 cats" there is a good chance she has OCD. Hoarding in general is a difficult form of the disorder to treat often because the person with the problem is very unmotivated to do anything.
J. Claiborn Ph.D., ABPP [anxietyshrink@comcast.net]
Psychologist
Go to the Hoarding of Animals Research Consortium (HARC) Web site at http://www.tufts.edu/vet/cfa/hoarding.html for more information about this problem. At this point there is not much evidence that it is linked to OCD except that those who hoard animals also tend to hoard objects as well.
Gail Steketee, Ph.D. [steketee@bu.edu]
Professor, Associate Dean of Academic Affairs, Boston University School of Social Work
Yes, it is considered a form of hoarding, which is indeed a variant or type of OCD. It can be difficult to treat. Good luck.
Bruce Mansbridge, Ph.D. [mansbridge@austinOCD.com]
Director, The Austin Center for the Treatment of OCD
Dear Cyndi: There can be quite a variety of reasons why people hoard things, OCD being only one of them. It is likely that a percentage of people who hoard animals do have true OCD, but it would take a good clinical evaluation to determine if this were so for a particular individual. In any case, I think that people who collect great numbers of animals can often risk the health of the animals and themselves, and in such cases certainly need help. Best regards.
Fred Penzel, Ph.D. [penzel@attglobal.net]
Western Suffolk Psychological Services, Huntington, NY
Hoarding Question: 38
When I was 12, I went through a period of OCD hoarding symptoms. I kept everything from plastic forks to rotting food and on several occasions raided the garbage in the middle of the night. I was not formally diagnosed, but I got better on the advice my parents received that I needed more "structure." Now I am 26 and have not suffered from OCD since (apart from the little "games" I always played which never interfered). What is the likelihood of the symptoms reoccurring? Could my hoarding have been a symptom of another problem or disorder? ==> Alison
Alison, if you haven't had any OCD symptoms since the age of 12, the most likely explanation is that your symptoms at 12 were just normally occurring symptoms not part of any "disorder." I'd say they're unlikely to re-occur since OCD usually starts between childhood and about 18-25 years old.
Jon Abramowitz, Ph.D. [abramowitz.jonathan@mayo.edu]
Clinical Psychologist, Mayo Clinic
OCD is a disorder which often fluctuates in ways that are impossible to predict. The odds are your hoarding was OCD and that for unknown reasons it has become much less of a problem. It is impossible to give the odds of it returning but it is a possibility. It is also possible that OCD would return in an alternative form.
J. Claiborn Ph.D., ABPP [anxietyshrink@comcast.net]
Psychologist
Good question. Remember that the people who walk through our doors are people whose symptoms eventually got worse or at least never got better, so we really don't know how often symptoms get better on their own and never return. Also, it is normal for children to have OCD-like symptoms or games, such as having to say their prayers in just the right order, collecting (hoarding), not stepping on cracks, etc. Your childhood symptoms of hoarding do seem more extreme than my collection of bottle caps, so I'm not saying your behavior was within normal limits. Either it was "normal" or a form of OCD that hasn't returned but might. I don't know of another disorder or condition that might explain it. Good luck.
Bruce Mansbridge, Ph.D. [mansbridge@austinOCD.com]
Director, The Austin Center for the Treatment of OCD
Dear Alison: It sounds as if you either outgrew your symptoms in some way, or else you are in an extended remission. There is really no way to tell at this point, and there are no tests or guides to give us answers. Why OCD may go away in some people is unknown at this time. It is unlikely your hoarding was a symptom of another disorder, as it is mostly only seen outside of OCD in thought disorders (Schizophrenia), retardation, and those who are senile. Best regards.
Fred Penzel, Ph.D. [penzel@attglobal.net]
Western Suffolk Psychological Services, Huntington, NY
Hoarding Question: 39
My daughter is 40 years old and has an IQ of about 49. She keeps everything bought or given to her. There is only a small pathway to her bedroom; barley enough room to pass. It is a fire hazard as well as unhealthy. I cannot get her to get rid of even one coloring book. If I cleaned the room myself, what kind of problems might I cause? ==> Bobbie
She would probably get really angry, and it might seriously damage your relationship with her. Of course, not doing anything runs the risk of damaging the relationship too. It would be best if she could agree to doing something "to create more usable space" or "to make a bigger pathway." Avoid suggesting that she or you get rid of her precious stuff, at least at first. If you have access to a behavior therapist, get him or her involved. You should also work on the other part of the equation, namely, not acquiring so much stuff, which might be easier. SSRI medication can also help, but don't expect that to have a huge effect. Good luck.
Bruce Mansbridge, Ph.D. [mansbridge@austinOCD.com]
Director, The Austin Center for the Treatment of OCD
Hi Bobbie: It's difficult to predict what problems you might have if you cleaned the room yourself, but I think you are right to be thinking of this as problematic and the last resort. I think it is always better to do something like this, for a child or especially for an adult, in collaboration with the person. Maybe you can come up with some more strategies for communicating your concerns directly to your daughter and enlisting her participation in remedying the problem. And maybe you can do it in a gradual fashion. Pick a couple things, with your daughters agreement, that you will get rid of on a weekly basis or something until things are sufficiently de-cluttered. Another idea might be, if necessary, to agree to put some items in "storage" for your daughter, if you have some room. This might prove a useful "transition" for her, that may ease her anxiety about throwing things out altogether. And if she wants something out of storage, let her know that something needs to replace it in storage and agree also on a finite amount that can be stored too, etc. Best wishes.
Thomas H. Styron, Ph.D. [Thomas.Styron@yale.edu]
For adults with normal intelligence, cleaning of their homes by others without their consent rarely works to control hoarding because they continue to collect new items and clutter as before and are often angry about the intervention as well. I don't have experience with people who have more limited cognitive abilities but it seems unlikely that the outcome would be much different. Is there any way to enlist her cooperation by yourself or someone else showing an interest in her possessions, gaining her trust that they won't be discarded and then helping her begin by organizing them and putting boxes of them in storage places (basement/attic) and ultimately helping her give some to others who could benefit from them. You may need to be creative about helping her develop new motivations to remove them and give them to good causes without feeling deprived herself of the comfort or pleasure they provide her.
Gail Steketee, Ph.D. [steketee@bu.edu]
Professor, Associate Dean of Academic Affairs, Boston University School of Social Work
Hoarding Question: 40
Hi. My roommate, who has been a friend of mine for several years, is exhibiting signs of being a hoarder (piles of newspapers, saving all mail, not being able to sleep in her bed because of having too much random stuff on it). I actually had to move out because it got so bad. Her family isn't on the other side of the country, and her boyfriend doesn't mind her mess, as long as she keeps it at her apartment. She is in complete denial about the problem. Is there any way for me to help her? ==> Molly
Motivation is the key, and it's hard to motivate another person. I assume you've been honest with her about why you moved out. Continue to be honest with her, but don't make demands, and don't expect her to make any changes. Good luck.
Bruce Mansbridge, Ph.D. [mansbridge@austinOCD.com]
Director, The Austin Center for the Treatment of OCD
You might try finding some of the Web sites about compulsive hoarding to print out some information you can show her. The OCF will have specific information in the near future on this Web site about this problem, but this has not been assembled yet. It is true that denying the problem is very common. Some professional organizers provide treatment if the problem is not too severe and if you can convince her of the need to get her stuff organized so she can find things.
Gail Steketee, Ph.D. [steketee@bu.edu]
Professor, Associate Dean of Academic Affairs, Boston University School of Social Work
It is not clear there is a lot you can do to help this individual. One of the problems in working with OCD and related problems is that the person with OCD needs to put a lot of effort into the process. The most common reason for therapy to fail is probably because people refuse to do the work. They may be primarily motivated by fear and the desire to reduce or avoid it. The hoarding form of OCD is often difficult to treat in part because it is effective as a compulsion in avoiding anxiety and the person with OCD leaving minimal reason to try to change.
J. Claiborn Ph.D., ABPP [anxietyshrink@comcast.net]
Psychologist
Hoarding Question: 41
Hi. I am a fire inspector and I am concerned with people who save things (piles of paper, old clothes, rotting food, boxes, etc.). Recently, I went to an apartment which looks like a dump; it's a big fire hazard. We have to make the tenants clean the place. Could you tell me what is the difference between an obsessive compulsive disorder and the Diogenes Syndrome? I've read up on this unusual illness and it looks similar to me. Thank you. ==> Louise
You are dealing with compulsive hoarding and it is unclear at this point whether this is best classified as an OCD problem or with other conditions since it has elements of impulse control problems (compulsive buying and acquiring), attention deficit problems for some people and accompanying difficulty with processing information (inability to categorize objects, decision-making difficulty, organization impairment), excessive attachment to things, difficulty discarding due to attachment and to anxiety about making an important mistake or regrettable decision. These lead to clutter, sometimes massive amounts of clutter that becomes a serious fire hazard and makes even walking in the home difficult or impossible. Diogenes Syndrome is not an official mental health diagnosis but has been described as a condition in which squalor is characteristic, often associated with hoarding and with mental health problems. However, many people who hoard do not appear to meet this criteria of squalor. It seems to us that empathic efforts to understand why people save is helpful, but at the same time firm insistence on setting rules and limits so it does not become a public health problem for neighbors or co-dwellers is critical. Best wishes in your work.
Gail Steketee, Ph.D. [steketee@bu.edu]
Professor, Associate Dean of Academic Affairs, Boston University School of Social Work
Hoarding is a reasonably common symptom of OCD and not uncommonly leads to living conditions which would make any fire inspector call for dramatic interventions. People who have the hoarding form of OCD may or may not have other typical OCD symptoms. They will typically express anxiety associated with any attempts to divest them of their hoard. hoarders will express a rationale for keeping things or hoarding objects such as the objects having a value or future use, having responsibility for the proper disposition of objects one in their possession, sentimental value, unique characteristics or some adverse outcome if it is disposed of. It is the anxiety reducing effect of the compulsive hoarding and excess acquisition that defines hoarding in OCD. Hoarding is sometimes observed in people with other disorders such as schizophrenia and dementia. Hoarding has not been well studied and only in recent years have a small number of researchers begun to look at it carefully. Much of this work has been done in the context of OCD. The Diogenes Syndrome is not clearly define nor well studied. Some sources argue that it should not be diagnosed in the presence of a psychiatric diagnosis thus somehow people are supposed to live in the squalor and self neglect but not have any mental disorder. This is not credible to me. It is more likely that the term is applied somewhat indiscriminately to people who hoard and also suffer from one or more undiagnosed mental disorders including possibly OCD in many cases and I would also suspect depression.
J. Claiborn Ph.D., ABPP [anxietyshrink@comcast.net]
Psychologist
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