Hoarders: Behind closed doors

Gail’s house has no heat. The support beams, damaged in a fire several years earlier, are threatening to give way. But until Gail cleans up the mountains of clutter she has collected over the years, repair crews can’t get into the house.

Warren accumulates stuff too – tools, refrigeration units, even the old van in which his father died. His wife, Leanne, is worried about how Warren’s hoarding is affecting their 3-year-old son. She has given him an ultimatum: Clean up or get out. Unfortunately the problem isn’t that easy to solve, because it turns out Leanne is a hoarder too.

Watching an episode of “Hoarders” on A&E is a little like watching a train wreck: It’s appalling but you can’t stop looking. And ultimately you have to wonder if it isn’t exploitive to bring TV cameras into these people’s homes and display their dysfunction for everyone to see, even if the purpose of the show is supposed to be educational.

Hoarding is thought to affect somewhere between 2 million and 3 million Americans. While this sounds like – and is – an enormous number of people, it’s still only about 1 percent of the population. Since many hoarders operate under the radar, so to speak, it’s hard to get a handle on the true extent of this behavior.

It’s not even clear whether hoarding should be classified as a mental disorder. It is being considered for inclusion in the next edition of the Diagnostic and Statistical Manual of Mental Disorders, but a task force hasn’t decided yet whether to list it in the manual itself or in the appendix. The DSM-V’s working definition of hoarding disorder:

A. Persistent difficulty discarding or parting with personal possessions, even those of apparently useless or limited value, due to strong urges to save items, distress, and/or indecision associated with discarding.

B. The symptoms result in the accumulation of a large number of possessions that fill up and clutter the active living areas of the home, workplace or other personal surroundings (e.g. office, vehicle, yard) and prevent normal use of the space. If all living areas are uncluttered, it is only because of others’ efforts (e.g. family members, authorities) to keep these areas free of possessions.

C. The symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning (including maintaining a safe environment for self and others).

If you’ve never seen the effects of hoarding, an episode of “Hoarders” is jolting. Some of the things that can be learned from this series:

- The clutter and the accumulation of items can be extreme. At some level, many of us probably fear our own personal clutter – the stack of unread magazines, the children’s toys and clothing we no longer use or need – will eventually take over the house. Genuine hoarding, however, goes far beyond the typical clutter of the average household. Hoarders often stop using a kitchen or dining room or bedroom because it’s simply too full of stuff. When we meet Gail, for instance, she’s living out of a bedroom and heating all her meals in a microwave oven in an upstairs hall.

- Health and safety can be at risk, and it’s not unusual for living conditions to become downright squalid. A hoarder’s cupboards might be filled with moldy food. In some episodes of “Hoarders,” mice have been found under the silted layers of accumulation. Necessary repairs often don’t get done because the house is inaccessible to repair crews. A surprising number of the individuals featured on the show were living without heat or running water, in some cases for months. In the worst-case scenario, a house can sustain structural damage that’s too extensive to fix.

- Hoarding can escalate into a crisis when people are threatened with eviction or the loss of their children to child protective services, or if the hoarder becomes sick or injured and needs to be rescued from among their mountains of clutter.

- Hoarding affects entire families. Spouses of hoarders feel frustrated and powerless. Children of hoarders can’t invite their friends over. Efforts to help are often met with resistance or resentment, which can further break down family relationships.

- Although hoarding tends to be associated with older people, perhaps because they’ve had a longer lifetime to collect things, it also affects younger people. The syndrome is thought to have a genetic component. (Actress Lindsay Lohan revealed a couple of weeks ago that she “has a lot of stuff” and needs to clean out her home, although it’s not clear if this means she truly is a hoarder or if she’s just disorganized.)

- The emotional attachment that hoarders have to their possessions is very real and not necessarily rational. Gail got increasingly testy when her family and a professional cleanup crew tried to pry away some of her accumulated belongings. Warren was unable to part with his father’s old van, and at the end of the episode, the van was still sitting in the back yard.

There’s a lot, however, that this show simply doesn’t tell you. Are the individual stories typical of hoarders, or do they represent the extreme end of the spectrum? How these people got this way is never really explored, although there are hints that among many of them, the hoarding escalated after a loss or death in the family.

Nor is there much exploration of hoarding itself. Even the experts can’t completely agree on how to classify the psychopathology. Is it a variant of obsessive-compulsive disorder, or is compulsive hoarding syndome an entirely separate entity? Research suggests there is indeed a difference between compulsive hoarding and hoarding associated with OCD, with implications for how each should be treated. Elements of social phobia, anxiety disorder and ADHD might be intertwined as well. And exactly where animal hoarding fits into the overall spectrum is not clear.

Where “Hoarders” perhaps commits the greatest disservice, however, is in its portrayal of intervention. A convoy of trucks rolls up to the hoarder’s doorstep and the race is on to clear out the home in two days, three days or whatever deadline has been set by the family’s circumstances. As the cleanup progresses, viewers get to see the couch chewed up by mice, the discarded food packages, the dirty and soggy detritus being carted out to the trucks. We get to witness the tears and anxiety as the hoarder attempts to part with his or her possessions, with a few family squabbles thrown in for good measure. By the end of the episode, the house is restored to reasonable order and the family is receiving aftercare and/or ongoing therapy.

To be fair, the show’s producers bring in therapists and professional organizers to help work with their subjects. They’re up front about the fact that not every intervention is successful. But viewers would do well to ask themselves: Is it really fair to deliberately put hoarders into a situation guaranteed to be stressful, anxiety-producing and probably embarrassing, all for the sake of a TV show?

More to the point, is a one-time, aggressive intervention truly effective? It might help temporarily, but most experts agree hoarding is usually a chronic condition. Once the hoarder’s home has been cleaned, he or she often will start accumulating things again. A combination of cognitive therapy and drug therapy shows some promise, but the psychiatric community still has a long way to go in finding effective ways to treat compulsive hoarding and helping prevent relapses. Among animal hoarders, the relapse rate is thought to be nearly 100 percent without intervention, nor is there any standard treatment yet for animal hoarding.

To the extent that “Hoarders” brings the issue of hoarding out into the open, the show is providing a benefit. It’s beneficial too for people who’ve struggled with this disorder, or watched someone in their family struggle with it, to know that some help is available. We can’t forget, however, that the stories on “Hoarders” are about real people with a real disorder. Long after the TV cameras have disappeared, these people will more than likely continue to struggle with their hoarding and some of them will probably relapse. Although the drama of intervention might make for a compelling TV show, in reality there are few easy or long-lasting solutions to the issue of hoarding.

Photo courtesy of Wikimedia Commons