Pack rat or compulsive hoarder? When medical help is needed

A retired professional in his late 70s was threatened with eviction last fall because his apartment in South King County was a nightmare — filled almost to the ceiling with paper, boxes, clothes, out-of-date canned food, small broken appliances, garbage and trinkets.

Just getting inside meant crawling over 5 feet of debris. Getting out required sort of sliding to the front door.

"He was a very unassuming gentleman, a very pleasant man, but not cognizant of what was going on around him and the threat that it posed to his safety," said Martin Nordby, code-compliance officer with the city of Federal Way.

"That's very common with our hoarders. They don't see the problem."

Lots of people save or collect things. Just stroll through Hobby Hall at the Puyallup Fair some time.

But compulsive hoarders — an estimated 1 million Americans — accumulate so much stuff piled so high that it hinders daily life and jeopardizes their safety.

Eventually, there may be only a narrow path through the home with even the stove, bathtub and bed buried.

Experts believe this often-hidden anxiety disorder is extremely common.

And the syndrome is so disabling that several federally funded studies are under way to discover causes and treatments. Though still unfinished, the work has attracted attention that's led to better help and advice for families and others who wonder how to intervene.

That's the hopeful news.

But compulsive hoarding still is tremendously difficult to treat and can be discouraging and disheartening for the relatives, neighbors and landlords caught between concern for the hoarder's welfare and anger over the disarray, which may include odors and pest infestations.

"Families get very upset by it because usually it doesn't fit their standards of living," said Karen Kent, a licensed mental-health therapist and regional expert on hoarding.

But "by law in our state we have the right to live, even in squalor as long as we have our mental faculties," Kent said.

Part of what makes the situation so tough for people who try to help is that most hoarders — whether from illness, lack of knowledge or shame — don't want help.

"They want to be left alone," said Kent, who supervises a regional team that's part of Evergreen Healthcare in Kirkland and intervenes with older adults in crisis who have mental-health problems.

Other professionals who work with hoarders include public-health investigators, social workers and city-code enforcers.

A common misperception is that hoarding affects only older people. But the syndrome is established by early adulthood — when the collecting looks the same, but with fewer items — and can run in families.

What drives hoarding?

One of the most common causes of hoarding is obsessive-compulsive personality disorder — whose sufferers exhibit traits such as trouble finishing projects, difficulty throwing things away, exaggerated conscientiousness, perfectionism and poor decision making, according to Kent.

Other causes can be obsessive-compulsive disorder — a like-sounding, but different problem — that involves persistent thoughts, impulses or images that cause anxiety and lead to hoarding.

Hoarding also may be caused by attention-deficit disorder, psychosis, depression or dementia.

New brain-scan studies have shown abnormalities in hoarders' brains in the area involved with decision making and the ability to concentrate.

"They have a lot of trouble with focusing attention and remaining focused on the task. They tend to bounce around," said Dr. Sanjaya Saxena, whose team conducted the brain studies and who directs the obsessive-compulsive disorder research program at the University of California, Los Angeles.

Hoarders also lose the ability to prioritize the importance of objects — that's why it's common to find bills and checks mixed in with trash.

Researcher Randy Frost has found that certain beliefs about possessions encourage hoarding, for example: "This object has potential value, so it must be saved," or "It provides emotional comfort," or "It protects memories."

"We all do this. This is the way we interact with our possessions," said Frost, a psychology professor at Smith College in Massachusetts.

"The problem with the hoarder is they do it to such an extent it fouls their environment."

What IS all that stuff?

The most frequently hoarded items contain information — books, newspapers, magazines, sweepstakes offerings, junk mail.

"They think they're going to read them. They have creative plans about what they're going to do with them," said Karen Roehl, a local clutter coach and professional organizer who has helped many hoarders over the past five years.

But just about anything gets saved. Kent has known hoarders who collect their own feces or chewed bits of meat wrapped in foil. And who hasn't heard of the house overflowing with filthy, poorly cared-for animals?

Hoarders often are able to mask or at least contain their problem to one room as long as they live with other people who set and maintain housekeeping standards. School, work or family responsibilities also can cut into collecting time.

But when a spouse or parent dies, the hoarder, now alone and older, loses control.

The problem comes to light when a landlord or neighbor complains to authorities or a relative realizes the accumulation is not normal.

Steps in providing help

The first task is deciding whether the hoarding is a significant public-health issue or a matter of aesthetics — say a neighbor who's furious because a person has junk in the front yard.

If it's a public-health issue, causing a rat infestation, for example, in the city of Seattle, Public Health starts trying to correct the problem by sending letters demanding the property be cleaned up.

If all else fails, criminal charges can be filed.

But legal solutions often don't work well. The property may be condemned and cleaned up. But the person often starts hoarding again.

The most successful approach is firm, but nonconfrontational. And don't expect the true hoarder to be capable of cleaning up by themselves or getting rid of everything, even with assistance, said Kent, the hoarding expert.

It's best to get a diagnosis of the cause, according to mental-health experts. A person with obsessive compulsive-disorder would be treated differently than a person with depression or dementia.

The best-known treatment uses medication — say antidepressants or antipsychotics — in combination with cognitive behavioral therapy which works to change the thoughts people have toward their personal belongings.

"Families can't really treat it, they can just be empathetic and offer to help the hoarder clean up," said Kent.

If the hoarder does not want to go to treatment, the family can't force the issue, she said. But they can decide to not take it personally.

Cleanup usually provokes intense anxiety. Anyone helping the hoarder — even a professional cleanup crew — should be gentle, always caring and encourage the person to deep breathe and relax.

Kent advised one client to get anti-anxiety drugs from her doctor when the woman couldn't sleep at night because of panic over the prospect of throwing things out.

The South King County man was forced to confront his own hoarding when the apartment manager threatened eviction and called the city's code-compliance office.

"They were worried not only about his safety, but the safety of others," said Nordby. "If there had been a fire, it could've burned in there for a long, long time. Not to mention this kind of stuff is a great haven for rodents."

Nordby phoned the man's relatives, who didn't seem surprised. "They kind of knew this was a problem," he recalled.

The hoarding seemed to be exacerbated by the man's waste-not-want-not values formed during the Great Depression. Still, not everyone who lived through the Depression is a hoarder.

The relatives came to help clean up, but at first the man retrieved many of the items that had been destined for discard. Finally after several months, he transferred part of the accumulation to storage units.

Nordby would like to see a lot more stuff thrown out but thinks the situation is acceptable if monitored. That's why he'll stop by the man's apartment every now and then to exert that needed gentle pressure.

Marsha King: 206-464-2232 or mking@seattletimes.com