The Hoarding Syndrome — When Clutter Goes Out Of Control

As the caseworker from Child Protective Services approached Sue Howard’s home last year, she knew something was wrong. Outside the one-story brick house on a quiet, leafy street in Nacogdoches, Texas, a blue dresser stood against one wall. The front porch was crowded with papers, books, an open bag of cat food, toys, a bunch of shoes and several pairs of roller skates. The white steel front door, which had fallen off its hinges, was propped up in the door frame.

Inside the house it was much worse. The entry hall was crammed with a love seat, boxes and so much clothing, the caseworker had to step on it to get to the dark, wood-paneled living room and then the dining area, where piles of papers, books and other objects (including boxes and boxes of past-their-prime Girl Scout Cookies) were stacked on nearly every surface.

he Hoarding Syndrome -- When Clutter Goes Out Of ControlIllustrated by Matt MuhurinThis clinical obsessive compulsive disorder transforms the everyday act of throwing away an object into a deeply, wrenching personal violation.

This was not the life Sue Howard had imagined in 1988, when she married and joined her husband in satisfying but low-paying church work. Her family had grown at a much faster rate than their modest income. The financial struggle became overwhelming.

About nine years ago, Howard, now 42, began to feel trapped by poverty. “I thought, What can I do? I’ll do what my grandma did.” From that moment, Howard refused to discard anything she considered potentially useful.

In 2001, when her husband went to graduate school, Howard began selling books online. She took pride in snapping up bargains for her four children and her business at thrift stores, garage sales and Wal-Mart. But those bargains gradually took over the household, adding to the tension of an already troubled marriage. The scuffed kitchen floor was sometimes sticky, and appliances, including the dishwasher and refrigerator, were often on the fritz. Howard was too embarrassed to allow a stranger in to do repairs and too overwhelmed to clean up a home filled with clutter. Every time the doorbell rang, her stomach knotted in fear.

Between 2002 and 2005, caseworkers visited Howard’s home at least five times in response to anonymous calls. They gave Howard and her husband time to clean up the property, which they always did. But the visit in May 2006 was different. By then, Howard had separated from her husband and was raising Kelsie, 16, Zachary, 15, Clay, 10, and Ben, 8, on her own for almost a year and a half. The clutter was getting worse — and potentially dangerous. The caseworker told Howard to move the children to their father’s apartment.

Dangerous Compulsion
Saving stuff, in moderation, is usually considered normal. But this otherwise healthy impulse can go too far and develop into what some experts consider a clinical obsessive-compulsive disorder. Compulsive hoarding can’t be chalked up to eccentricity or a character flaw. It’s more serious and harder to control than that.
“This is not laziness, criminal negligence or failure to attend to the responsibilities of life,” explains Sanjaya Saxena, MD, director of the Obsessive-Compulsive Disorders Program at the University of California, San Diego. “It is, in fact, a neuropsychiatric disorder that will not get better unless the person is treated.”

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And it can lead to tragic consequences. One of the most famous cases involved the wealthy and reclusive Collyer brothers. In 1947, their bodies were discovered in a crumbling New York City mansion packed with more than 100 tons of junk. Last year, a resident of Shelton, Washington, was smothered when a massive pile of clothes toppled on her. And a few fatal fires have even made headlines. Hoarders tend to fill their homes with flammable material and often block hallways and exits in the process, which can make escaping a fire impossible.

Hoarding can affect people of all ages and backgrounds. As many as three million to six million Americans may be afflicted at some level, and Saxena warns that hoarding often requires extensive treatment. But many deny that they have too much stuff or that the clutter is a problem. And even those who seek treatment can’t always find or afford the currently recommended approach: cognitive-behavioral therapy (sometimes paired with medication) from a specialist.

And it’s a myth that hoarders keep only junk. Like the rest of us, they may save things that are beautiful, useful or have sentimental value, say national experts Gail Steketee, PhD, professor and acting dean at the School of Social Work at Boston University, and Randy O. Frost, PhD, a psychologist at Smith College. The difference is that hoarders often find beauty, utility and meaning where others don’t.

Most people, for example, can recycle an old newspaper without a second thought. But a hoarder who saves old newspapers may see an archive of valuable, potentially life-changing information. From that perspective, discarding a newspaper is wasteful, foolish, perhaps even a personal failure. And so this clinical disorder transforms the everyday act of throwing away an object into a deeply wrenching, personal violation.
Organization is also a nightmare. Steketee and Frost say that compulsive hoarders usually have trouble categorizing items, find it difficult to make decisions, and worry that objects not in sight will be forgotten. They might leave clothes on top of a bureau, for example, instead of putting them in drawers. Over time, a few items piled here and there grow into mountains of dangerous clutter.

How dangerous? The dust, mildew, mold and rodent droppings commonly found in extreme clutter can irritate allergies or lead to headaches or respiratory problems like asthma for hoarders and their families. In some cases, home maintenance suffers, so individuals may endure freezing winters without heat and sweltering summers with no air conditioning. Clutter also places hoarders and their families, especially the elderly, at high risk of injuring themselves in a fall.

Extreme hoarding endangers not only the residents but also neighbors and firefighters, who face greater risk of injury and death when battling clutter-fed flames. It can become a financial threat to communities as well. Making a hoarder’s home safe and habitable can be staggeringly expensive, and hoarders can’t always pick up that tab. One year, the health department of a small town spent approximately 75 percent of the community’s entire budget on cleaning out a hoarder’s home, according to Frost. A mere 18 months later, “the home was back the way it was before.”

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