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Johns Hopkins Health Alert

Compulsive Hoarding -- Clutter Out of Control

Johns Hopkins Health Alerts | Depression and Anxiety | Compulsive Hoarding

When saving and collecting take over your life, it may signal compulsive hoarding.

Many people are closet clutterers. But what if you've taken saving and collecting to such an extreme that it’s difficult to move around your home or you’re embarrassed to invite people in because of all the clutter? In that case, you may have crossed the line from a bad habit into a mental disorder known as compulsive hoarding.

Compulsive hoarding affects an estimated one million Americans. Compulsive hoarding is typically considered a form of obsessive-compulsive disorder (OCD), because between 18% and 42% of OCD patients have a compulsion to hoard and save things. But compulsive hoarding can also affect people who do not have OCD.

Compulsive hoarding often starts during childhood or the teen years, but doesn't usually become severe until adulthood. Compulsive hoarding may be driven by an irrational fear of losing items that you believe you'll need later or eventually find a use for (a magazine article, a garment that may someday fit again, a broken lamp that you’re meaning to get fixed). Or compulsive hoarding may be linked to a strong emotional attachment to an inordinately large number of your possessions -- a feeling that they are special, have sentimental value, or are even a part of your identity or family.

Sometimes hoarding is more about fear of discarding than about collecting and saving. The thought of having to throw something out may make you anxious or upset, so you keep it instead. Many hoarders are perfectionists who fear making the wrong decision about what to keep and what to toss, so they just keep everything.

Hoarding is considered to be a compulsive problem when it meets three criteria:

1. You keep a large number of possessions that others view as junk.

2. Rooms in your home are so laden with possessions that you can no longer use them for their intended purpose.

3. You feel significant distress over the clutter, and it is impairing your ability to behave normally. You won’t allow friends, family, or repairmen to enter your home because you’re embarrassed by the clutter. You may even feel depressed, anxious, and hemmed in by all those possessions you've accumulated.

Compulsive hoarding can be a difficult behavior to stop. Unfortunately, the problem doesn't always respond to the same treatments as OCD, which is why many researchers now believe that compulsive hoarding may be a separate disorder.

A brain-imaging study conducted at the University of California–Los Angeles with OCD patients bears this out: Researchers found different patterns of brain activity among hoarders compared with non-hoarders with OCD and study participants without OCD. Hoarders had less activity in the part of the brain that is linked to motivation, self-control, and the ability to choose between conflicting options. The study also found less brain activity among hoarders in areas of the brain that typically register a response to antidepressant treatments. This may explain why hoarders do not always respond to selective serotonin reuptake inhibitors (SSRIs), such as citalopram (Celexa), sertraline (Zoloft), and fluoxetine (Prozac), the standard medications prescribed for OCD.

For more Alerts and Special Reports, please visit the Depression and Anxiety Topic page.

Johns Hopkins Health Alerts | Depression and Anxiety | Compulsive Hoarding

Posted in Depression and Anxiety on September 21, 2007
Reviewed June 2008

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