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Interview with Randy Frost, Part I Compulsive Hoarding Disorder Definition and Causes

By Sere Halverson
Editor’s Note: We recently sat down with Randy Frost to discuss compulsive hoarding disorder – a fascinating and complex problem that affects from 2.5 to 5 percent of the population, many who are elderly.

Randy has a Ph.D. in clinical psychology and is a professor of psychology at Smith College. He is one of the leading authorities on compulsive hoarding disorder. He has co-authored two books, a self-help book entitled Buried in Treasures: Help for Compulsive Acquiring, Saving and Hoarding, and a therapist manual entitled Compulsive Hoarding and Acquiring: Therapist Guide and Workbook. Randy has been featured on The Dr. Oz Show, NPR and ABC News and has been interviewed for articles for numerous publications, including The Wall Street Journal, The New York Times, and Newsweek.

Randy had so much valuable information about the causes and characteristics of hoarding, and how best to try to help a loved one with a hoarding problem, that we’ve divided this interview into several parts that we’ll post throughout the coming weeks. Keep checking back for more.

icarevillage: Randy, will you explain to our readers what compulsive hoarding disorder is?

Randy: Compulsive hoarding is the acquisition of and the failure to discard a large number of possessions. Many of us engage in this type of behavior to some extent. We all collect things, we all have a lot more possessions than we probably need. But there are two important distinctions that point to a disorder rather than the more common behavior of collecting.

First, the accumulation is so vast that it clutters living spaces and makes them unusable. For instance, you can’t sit on the couch because it’s full of stuff, as is the kitchen sink, the kitchen table, the bathtub, and so on.

The other component is the level of distress and impairment the hoarding causes. While the person usually enjoys the act of collecting, the distress occurs when they worry about someone seeing the home, or become anxious about having to get rid of any possessions.

The hoarding causes significant impairment. It affects their ability to handle financial affairs, because when your home is filled with disorganized stuff, it’s easy to lose bills and important papers. The home is often unsafe because exits are blocked. There are fire hazards.

Appliances often stay broken. The person with a hoarding problem is afraid to have anyone into the house for repairs because the home’s condition may be reported to authorities. We’ve seen elderly people who have no working refrigerator, no working stove, sometimes no working hot water – sometimes no water at all, which means no working bathroom.

icarevillage: So we’re talking about much, much more than just a disorganized, messy house. Hoarding can become a serious problem that causes unfit living conditions and puts people in danger. Are the elderly more susceptible to compulsive hoarding?

Randy: We do see a lot of hoarding behavior in the elderly. But interestingly, when we ask older people how long they have been hoarding and how long their home has been like this, most of them tell us it’s been going on all their lives.

So we’re not sure if there is a separate kind of phenomenon of hoarding that begins in old age. Most of the research on the onset of hoarding suggests that the behavior itself starts sometime around age 12 or 13, but doesn’t become a problem for several decades after that.

One of the reasons why hoarding in the elderly may be so much more apparent to us is that while the hoarding behavior may have always been present, when people get older they lose some of their ability to cognitively process things. They lose some of their resources for handling things, they move more slowly, and so forth. So aging increases the severity of the behavior. But we suspect that the hoarding behavior probably was there most of their lives. And we’ve seen people who are as young as 19 with serious hoarding problems, so it’s definitely not limited to the elderly.

icarevillage: Do you know what causes hoarding?

Randy: We think that people who hoard process information in several unusual ways. A person with a hoarding problem pays attention to the unique detail in objects, such as the shape, the color, the texture, and so forth. For example, take a bottle cap. They might focus on these details and give it value rather than focusing on the fact that it’s a bottle cap without a bottle and therefore has no useful function.

Another feature of information processing that differs in the person that hoards has to do with the amount of information they pay attention to with respect to an object. So they will look at an object and focus on all its unusual details and those details will have meaning. When that person tries to make a decision about that object, they’re faced with many more details to consider than most of us are. Therefore, making any kind of decision requires taking a large amount of information and filtering it down and using it to come to a conclusion – and this is very difficult for them. It affects everything they do, from ordering off a menu to choosing what to wear in the morning. These are decisions they sometimes struggle with for long periods of time.

The other characteristic of people who hoard has to do with the way in which they organize their lives. Most of us organize our lives categorically. We get an electricity bill, we put it the category called bills, and when we need to find it we can go to that location. But people who hoard seem for the most part to organize visually and spatially instead. So if you ask them where their last electricity bill is, they’re likely to tell you that it is halfway down in the middle of the pile in this room, because that’s where they saw it last. Their organization occurs by remembering where objects are in space.

Now, a lot of us organize some things this way. My desk is organized like this – I have piles of things and I remember what’s there because I last saw it there. But if I were to do that for all my possessions, that system would break down quickly.

icarevillage: Are people who hoard more intelligent than those who don’t?

Randy: Because they have this more complex way of thinking, we used to think that people who hoard are more intelligent than the rest of us. I’m not sure that’s true, but I do think that people who hoard may have more of a creative streak than the rest of us. This is because they notice and appreciate the unusual details of things, and I think this is a mark of creativity. Unfortunately, this is creativity run amok; it’s too much creativity and they can’t manage their lives because of it.

icarevillage: Is hoarding a genetic disorder?

Randy: There are several studies now that suggest that hoarding runs in families. One of the early studies we did found that over 80 percent of the people we identified with hoarding problems said they had immediate family members with this behavior as well. And that’s been replicated in a number of studies now that suggest there are certain genetic links to hoarding.

icarevillage: Are there differences in the brain of a person who hoards?

Randy: All of these information processing deficits seem to be associated with a particular area in the brain, and indeed some recent research suggests that there are differences in what happens in these areas of the brains of people who hoard. We are seeing some overlap between what we are learning about their processing experiences and what’s actually happening in the brain.

icarevillage: Thank you, Randy. You’ve certainly given our brains a lot to process. Let’s take a break and then talk more about how to recognize the problem and how to best help parents and loved ones who are buried under their own compulsive hoarding.