Hoarding—and the issues that come along with it—is nothing new. However, given the success of topical reality shows on cable channels such as TLC and A&E, there seems to be a new light being shone on this psychological condition. There is no cure or magic pill, but for those who want it, there is both help and hope.

In this exclusive interview, we talk with clinical psychologist Keith E. Saylor, Ph.D., Sc.M, president and CEO of NeuroScience, Inc., about the triggers of hoarding, who’s more susceptible and what traits to look for when caring for those in your life. Saylor recently appeared on “TLC Reveals The Hidden Lives of Hoarders in Hoarding: Buried Alive.”

Doug Landau: Hoarding is a huge problem for people from all walks of life. That said, it seems as though there is a trend with homebound and/or elderly folks.

Keith Saylor, Ph.D., Sc.M: It’s basic deduction, really. If you have no way of emptying your home, things accumulate. At the end of the day, hoarding is typically a problem of too much inflow and too little output. Disabled/elderly people would need help sorting through what they have and ensuring that enough goes out so that the pathways in their homes are clear for ingress and egress.

Landau: Are there physical attributes that may predispose someone to be a hoarder?

Saylor: No, people hoard for psychological reasons. The things hoarders keep are often things of no intrinsic, sentimental or other value. Old magazines, clothes that no longer fit, toys, outdated electronics, broken sports equipment and damaged furniture are just some examples.

Landau: What should someone do if they see the symptoms of hoarding starting to manifest?

Saylor: I think it’s important to start before the symptoms. In other words, if someone is disabled, watching very early to make sure the trash is taken out on a timely basis, the recycling is done, mail does not build up, etc., will be a sure sign. Shopping online is an issue as well; too many things coming in and looking for bargains are definitely risk signs for hoarders. This is definitely an area in which family can step in and help before the amount of material acquired online and elsewhere takes up otherwise available, usable space and potentially bankrupts the diagnosed individual. Family should be aware, vigilant and helpful in ensuring that there is no buildup of costly and potentially dangerous materials or mass.

Landau: Anxiety and depression are some of the traits consistent with people who suffer from this condition. How do these characteristics play into the presentation of hoarding?

Saylor: Some of the usual sources of relationships and satisfaction become limited as we get older or if we become disabled. Those sources typically have some sort of connection to anxiety and/or depression. Hence, we start to find satisfaction and happiness in other things—including objects. And those objects—which may look like “garbage” to others but trigger happy memories—may be saved in order not to have to face the reality of their situations. In turn, these people develop psychological attachments to items instead of people and that’s when the hoarding truly begins.

Landau: What about the home’s environment? Are folks affected even
aware of the dangers around them?

Saylor: People do not become hoarders by choice. They are often unaware of the danger just in the immobility and inability to get around in their own homes. Rooms and entire floors become unusable, plumbing becomes unusable, electrical wiring become dangerous, access to heating, air conditioning and other vents gets blocked, and often garbage and waste products build up. It’s not something people think about. They are not saying to themselves, “ I’ve got to stop accumulating stuff and saving it forever.” They are not aware of the dangers that come with hoarding, so they just accumulate. Once this occurs, we start to see rodents, fire hazards and personal safety issues (i.e., tripping, slipping, falling, etc.), which are especially dangerous for those who are already disabled, elderly and/or living alone.

Landau: How should a family deal with a hoarder who is also disabled?

Saylor: Hoarding is probably worst for disabled people just based on the sheer difficultly in getting around. It’s imperative that a caring, trusted family member, friend or neighbor take control by gently, but assertively, removing items to prevent needless harm and injury. Even just saying, “I am going to keep these things at my house or in my basement” is better than ripping it away. There is a tendency to abandon people or throw your hands up, which is maybe understandable if the person is fully capable, but if the person is disabled, that cannot be an outcome. There should be an advocate on some level, even if it is not a family member. Hiring an organizational team, getting some sort of mental health
professional involved or sometimes even medicine can help with the anxiety and depression, but there is no medicine that treats hoarding alone— nothing that’s effective yet, anyway. If there is an underlying disorder prior to the disability, like an obsessive compulsive disorder (OCD) or anxiety or mood disorder, hoarding would likely set in faster and the symptoms would become more severe more
quickly.

Landau: While hoarding is not triggered by physicality, it can cause physical ailments. Do hoarders respond to the onset of physical problems brought on by hoarding? Is there any sort of reward system that works?

Saylor: Unfortunately, the “reward” is the keeping of the items they hoard. Therefore, the reward for not keeping has to be far greater and it is almost impossible to find that. Generally speaking, people who hoard will not come in for treatment— not unless they are highly motivated and realize they want to clear things out. That would be the only instance in which a rewards system would work. They have to want to fix the problem first. It is rare to find a reward or incentive big enough to keep the person from starting to hoard all over again. It is sort of like weight loss. You have to have a “window of acceptability” that the person agrees to and sticks with. Especially for the disabled person whose choices are limited in terms of mobility, even the best of intentions for getting rid of the hoard can get stymied.

Landau: What type of therapy works best?

Saylor: There are all kinds of reasons people keep things, so that is why psychological counseling is often imperative to help the person to understand. The best form of therapy is an “exposure-based” treatment, whereby the affected person really knows what is happening and is given tools to withstand the discomfort of the separation. This all comes from the limbic brain (which controls our emotions). The removal of objects is perceived as a threat to the person who hoards. When piles are moved, the hoarder feels very anxious and uncomfortable. But due to the brain’s capacity for neuroplasticity, you can change the wiring. So the experience (of moving and hopefully removing accumulated material) becomes very different over time and the person can tolerate the discomfort. We try to emphasize not avoiding that discomfort and thereby going right back to the hoarding, because that’s a state of avoidance and all that does is perpetuate the problem.

Landau: Let’s talk about “hoarding rebounders.” The name itself seems pretty obvious…

Saylor: It’s the same as a recovering addict. Vigilance is needed so that nothing exceeds the “window of acceptability.” Plus, even in situations in which the hoarder has disgorged some of the stored items, we see a physical manifestation of the stress in the form of nausea, anxiety, fatigue, etc. These people experience an extreme “low,” much like someone who has lost a loved one. They often want to see the piles every day, and when the accumulated materials are gone, they mourn. It is not unusual to see this response in hoarders, so family and friends need to be supportive and vigilant. If a person with hoarding tendencies sustains an acute injury or disability, then the attention the patient gets may help, in the short run, avoiding more accumulation. However, this attention usually dissipates over time as others cannot sustain that initial level of attention. The loneliness then sets in and often compels some compensatory mechanism, such as buying, keeping and other such habits. The other thing to consider is the effect of medication on a person’s moods and inhibitions. This is especially true of pain medications. Such medications can encourage a lack of care in hygiene, both personal and environmental. These additional factors can contribute to hoarding. Once these medication and dosage issues are taken care of, they may also lead to a reduction in the overall hygiene and hoarding safety problem. If you know a person with hoarding tendencies who is compromising their health and safety, mental health professionals should be contacted at once.