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Uncovering the Psychopathology of Compulsive Hoarding

For some people, a small pile of things in the corner of an otherwise well-ordered room constitutes serious clutter. For others, only when the narrow pathways make it hard to get through a room does the clutter become a problem.

/ Published September 24, 2010

In a consumer culture dominated by possessions, the clutter in our lives can be a source of comfort and pleasure. For compulsive hoarders, however, the collecting and saving of things can be the cause of great suffering. And a Smith College researcher who studies the hoarding disorder says, “We may own the things in our homes, but they own us as well.”

Sitting in his sunny, sparsely decorated office in Bass Hall in the Smith science quad, psychology professor Randy Frost smiles as he reflects on the special hold the topic of hoarding — and how humans value their possessions — seems to have on the cultural imagination. Three recent reality TV shows, A&E's Hoarders, the Learning Channel's Hoarding: Buried Alive and Animal Planet's Confessions: Animal Hoarding have fueled the fascination with the disorder, which is surprisingly common. In the U.S, somewhere between 6 and 15 million — approximately 2 to 5 percent of the adult population — are believed to be hoarders, he says.

In his work on hoarding, psychology professor Randy Frost found that people have very different ideas about what it means to have a cluttered home. He developed a series of pictures of rooms in various stages of clutter — from completely clutter-free to very severely cluttered — to help get an accurate measure of a clutter problem. Click on images to enlarge photos.

“People who hoard save everything, and it's the good stuff as well as the crummy stuff,” he says. “Hoarders are very interested in the physical world and see it in a different and more complex way than the rest of us do. Most of us look at a bottle cap and see just that. Hoarders look at it and see the shape the color, the unusual details that the rest of us overlook. By noticing this, it gets valued and offers a whole host of potential uses. But it's potential that they never follow up on. It's creativity run amok.”

According to Frost, who is the Harold Edward and Elsa Siipola Israel Professor of Psychology, hoarding is a psychological disorder distinguished by the compulsive accumulation of possessions through compulsive shopping and collecting, and an inability to discard or organize the growing piles of objects.

In their new book Stuff: Compulsive Hoarding and the Meaning of Things, Frost and co-author Gail Steketee, dean of Boston University's School of Social Work, describe the people who compulsively hoard yet are blind to the resulting chaos and clutter. The book also details the key traits and underlying causes of the disorder.

The response to the release of Stuff has been huge. “It has been like a runaway train,” Frost notes. He has fielded interview requests from radio and television stations in the Netherlands, Mexico and Ireland. And the calls keep coming.

“I knew from the start this was something big, but didn't realize how big it would get,” says Frost, who this summer was invited to deliver a keynote address on perfectionism and present a workshop on hoarding at the 27th International Congress of Applied Psychology in Melbourne, Australia.

Until the early 1990s, the scientific literature contained few case studies on the hoarding syndrome and it was thought to be a rare problem. However literature has referenced hoarding for centuries, and In Stuff, Frost and Steketee write about the literary legacy. From Dante's The Divine Comedy — “Hoarding and squandering wasted all their light” — to Charles Dickens' character Krook in Bleak House who was described as “possessed with documents,” hoarding has its own history. One of the most well-known cases in the 20th century inspired a historical novel by E. L. Doctorow, Homer and Langley, based on lives of the two Collyer brothers who lived and died in their mansion in Harlem, New York, victims of their own hoarding.

“The case of the Collyer brothers is something that happens fairly often, in fact more often than you think,” Frost says. “Even today, New York City firemen refer to a hoarded home as a ‘Collyer home.’ Hoarding is recognized as a public health and safety risk.”

In Melbourne, Frost spoke with members of fire brigades that have completed a study in which they found hoarding to be a marker for fatal house fires. In the homes of hoarders, fire spreads to other rooms more quickly because there is so much more fuel and the fire load is greater.

Smith psychology professor Randy Frost, an internationally known expert on compulsive hoarding, says he has no trouble keeping his office in Bass Hall free of clutter.

Little research had been done about the disorder until 1993, when Frost, already an internationally known expert on obsessive-compulsive disorder and the pathology of perfectionism, and Smith senior Rachel Gross published the first systematic study of hoarding in the journal Behaviour Research and Therapy. Much more research followed.

Later, Frost and colleague Steketee began to collaborate on studying the hoarding phenomenon and co-authored Buried in Treasures: Help for Compulsive Acquiring, Saving and Hoarding and the clinicians' workbook Compulsive Hoarding and Acquiring: Therapist Guide.

The disorder is now the focus of two widely recognized ongoing research projects into the treatment and psychopathology of compulsive hoarding, with funding from the National Institute of Mental Health. Frost also is co-editor of the International Obsessive Compulsive Disorder Foundation's Hoarding Center Web site and, locally, has helped establish a three-county task force to study the problem in western Massachusetts.

This semester, Frost teaches a seminar in advanced abnormal psychology; its topic: The Meaning of Possessions. And every semester, Frost's research lab actively involves up to a dozen Smith students in a self-help project to develop treatment strategies for hoarders.

As he reflects on 20 years of research, he knows that much work still lies ahead.

“The research on hoarding is still in its infancy,” Frost says. “We still need to study what's happing in the brain that drives this behavior. And what part of the brain is involved in decision making and forming attachments to possessions? How does the brain sort it out, and what needs to happen to break the attachments? There are research careers ahead for people who want to ask these kinds of questions.”