While hoarding behavior can be a feature of a number of true medical problems, such as dementia or traumatic brain injury, it could also be a combination of biological and psychological vulnerabilities. Researchers have even recently uncovered genetic factors that contribute to the expression of significant hoarding behavior. "In its more extreme manifestations, a hoarding problem is easy to spot," says Tompkins. Can the loved one sleep in his or her bed? Can she move easily and safely about her home? Can he discard possessions in a reasonable period of time when given guidance or help? But in the early stages, spotting someone with the problem is more difficult. "Generally, people with a significant hoarding problem compulsively acquire from an early age, often bringing home items that appear to be trash. Furthermore, they have great trouble letting go of apparently useless items like old newspapers or spoiled food," explains Tompkins. "In addition, if you and your loved one are arguing a great deal about what to keep and what to discard, or the loved one has denied family members access to the home or parts of the home, the loved one may have a hoarding problem."
If the behaviors above sound like you or someone you care about, don't panic—there are promising treatments for hoarding behavior. Tompkins says that traditional talk therapy does not seem to be particularly helpful for people who hoard, but notes that a particular form of psychotherapy—cognitive-behavior therapy (CBT)—may be helpful. That's because CBT has a number of components that appear to help those with hoarding behavior, including training in skills like sorting, organizing, and letting go of possessions. Current studies suggest that the majority of people who complete CBT show substantial improvement in the level of clutter and how they feel in general. However, the number of people who are actually "cured" at the end of 8 months of treatment is low, says Tompkins. In most cases, although the person’s living situation is less cluttered at the end of treatment, he or she still lives in more clutter than the average person. (See the National Association of Cognitive-Behavioral Therapists website to find a therapist.)
But still, just because you're messy doesn't mean you're a hoarder, or that you're going to become a hoarder. And researchers have pinpointed certain personality traits for people who tend to hoard. "People who hoard tend to be perfectionists and, for that reason, have great trouble making the myriad of decisions necessary to declutter a space efficiently," says Tompkins. "Many with a hoarding problem are very sensitive to any negative emotion, such as anxiety, loss, guilt, or shame, and therefore avoid experiencing these emotions. This is particularly true when it comes to the feelings of loss that accompany discarding an item."
Recent research suggests that more than 50 percent of people with hoarding problems are clinically depressed. However, the depression does not seem to cause the hoarding, although it might make managing a hoarding problem more difficult, adds Tompkins.
If you know someone who is a hoarder, chances are you may have offered to help clean his or her home or offered to help him or her find a therapist. But often, hoarders will refuse this help at first, and sometimes it takes an eviction to make them address the problem. "Although some with the problem do see that the clutter is excessive and that their living conditions are unsafe and uncomfortable, many do not. Many people who hoard resist or avoid treatment or help, and they appear baffled by family members’ reactions to the clutter, and are oblivious to the risks and discomfort that come with living with too many things," says Tompkins. "They tend to minimize the severity of the situation with comments such as, 'My house isn’t that messy,' and show little awareness of the problem, even though they may be smart and rational in other ways. Typically, when these people do accept help, it’s because others have forced it upon them."
If you're not a hoarder but your house still needs some decluttering, focus first on cleaning out your entryway, because it's the first thing you see when you enter your house, and it sets the tone. Use a chest or an old wicker laundry basket to store shoes, set up a decorative "borrow box" to hold all borrowed or rented items like DVDs, library books, or your neighbor's pruners, and read 3 Strategies for a Clutter-Free Home.