. . . when does enough become too much?
And why is it so hard for compulsive savers to know the difference?

Hoarding involves the accumulation and inability to throw away unneeded possessions, to the point that a home may become so filled with stuff that furniture and rooms can no longer be used for their intended purposes.

Dr. Randy Frost, a pioneer researcher in the study of clinical hoarding and Dr. Sanjaya Saxena, a neurobiologist who is pinpointing where in the brain the problem seems to originate contribute. Author Denise Linn, addresses non-clinical forms of hoarding with tips on how to recognize -- and get rid of -- clutter.

Dr. Fred Goodwin begins with an essay about his own recent experience in coming to terms with getting rid of clutter. While his story is not an example of clinical hoarding, he notes that it bears a resemblance to some of the stories we'll hear later in the program. He needed someone else's help in assessing and getting rid of what he didn't need -- old magazines, out of date text books, etc -- and he had to overcome thoughts of how the material really might be useful someday ("What if I might someday want to write a history of psychiatry? etc."). For awhile, he compromised by stashing the clutter in his garage, but when his township's yearly "take it away free" day rolled around, he finally threw it out for good. Looking around the now empty garage he felt a sense of accomplishment and relief. "Now the car could fit!"

While clinical hoarding falls in the more severe end of the spectrum of "saving" behavior, Dr. Goodwin notes that studying this condition throws light on more common patterns too.


Next, someone who's experienced problems with compulsive saving and cluttering since she was a child.

Speaking on the understanding that she would be identified only by her first name, Frances, age 70, says her clutter provides her with a feeling of security and abundance, contrasting with the great anxiety she feels when she thinks about throwing something out. Only recently did she recognize it as a possible symptom of obsessive-compulsive disorder, which led her to get help. Frances says friends and family can help by not criticizing someone with this problem, or taking matters into their own hands. She's found that an internet list-serve for compulsive hoarders and clutterers has been very helpful to her, giving her much needed understanding and help in dealing with her problem.

Resources and support for hoarders and clutterers include

• Understanding OC Hoarding, a hoarding and clutter fact sheet from the Anxiety and Stress Disorders Institute of Maryland,
• a web site run by the New York City Hoarding Task Force, hosted by the Cornell University Weill Medical College which includes information from their recent conference on hoarding and
• The Obsessive-Compulsive Foundation:
  http://www.ocfoundation.org/hoarding/ (courtesy Lara)

For more information about hoarding as a symptom of Obsessive-Compulsive Disorder, or to inquire about support groups in your area or visit the Obsessive Compulsive Foundation of Boston or write to Obsessive-Compulsive Foundation, 676 State Street, New Haven, CT 06511; phone: 203-401-2070 and email: info@ocfoundation.org



Dr. Randy Frost is a leading researcher in the field of hoarding. Together with Dr. Gail Steketee, Dr. Frost contributed a chapter to a recent text book about Obsessive-Compulsive Disorder on hoarding and how to treat it ("Chapter 23") that many compulsive savers regard as their "bible." Dr. Frost is professor of psychology at Smith College in Northampton, Massachusetts.

Dr. Frost defines hoarding as the acquisition and saving of unneeded items to the point that it causes significant distress, and says that sometimes hoarding can even preclude the use of furniture and spaces. For instance, a bed will be so filled up with things there's no room for someone to sleep on it. Or the hoarder will be unable to use the kitchen because the stove is covered with things and even the oven is full of things being saved.

Hoarding is most often associated with Obsessive-Compulsive Disorder, which is an anxiety disorder. The anxiety is kept at bay as long as the compulsive saver avoids even thinking about throwing things out. Hoarding behavior is on a continuum, with symptoms ranging from mild to severe.


Getting in the way of being able to organize and throw things out are these neurological features -----

• problems in sustaining attention
• problems in categorizing possessions
• a needed reliance on visual cues to trigger memory ("out of sight, out of mind")
• difficulties in making decisions

Interestingly, Dr. Frost says that the anxiety people experience in discarding items is often short-lived, citing one woman who wept about a book but was fully recovered from her grief about five minutes later. Treatment, he says, can help a hoarder learn to tolerate this kind of anxiety.


Genetic?
A woman who has this problem is concerned that she may pass it on to her daughter, and Dr. Frost says that people who hoard often have a close relative who also has saving problems, but it's unclear whether this is the result of genetics of modeling.

Dr. Frost notes support groups can be effective in helping their members overcome this problem, and says that groups that move from house to house seem to be among the most effective.

Regarding behavioral therapy for hoarding.
Dr. Frost recommends that helpers or "coaches" do NOT take it on themselves to throw things out.

Dr. Frost also recommends that in a de-cluttering or "excavation" session, one should target a particular area and/or type of possession, for instance "books on the kitchen chairs." Assign the things to a very limited number of categories, for instance "books to throw away, books to sell, and books to put on the shelves."

Coaches can help to sort and categorize, but the person with the hoarding problem should themselves make the decisions to discard.

You can reach Dr. Frost through his web site, e-mail him at rfrost@smith.edu

The Infinite Mind's Devorah Klahr visits the home of Jeff, a creative director at a major advertising firm. He's had problems with compulsive saving all his life, he says, and his parents also had problems throwing things out.

Recently Jeff came across a "to-do" list from 1980. At the top of the list "Get rid of half my possession by the end of the year." More than 20 years later, Jeff is ready to tackle the task -- with a little help from a friend. He asks his friend Jane to help him tackle his apartment. While he's at work, she rolls up her sleeves and gets to work, throwing out dusty magazines, paperwork from jobs he finished decades ago, etc. and consigning other possessions to boxes for charity or for Jeff to review.

When he comes home, Jeff says he is fighting a war between two parts of himself. There's the part that want to keep it -- "all of it!" -- as a reminder of past triumphs he wants to enjoy. And then there's the part that wants to let go and move on. Looking around his de-cluttered apartment, he says it will take an adjustment, but he'll get used to it. "It's like a hair cut," says Jeff. His friend adds "Except we don't want it to grow back!"

Dr. Sanjaya Saxena, Director of the Obsessive-Compulsive Disorder Research Program at the University of California at Los Angeles, points out that hoarding behavior is found in people with anorexia which is a disordered characterized by problems with a need to control. It also is found in some cases of schizophrenia, Alzheimer's disease and dementia, and among some people with mental retardation, but still, that it is most often associated with Obsessive-Compulsive Disorder.


OCD has several different 'clusters' of symptoms, each of which seem to have different genetic components, different responses to drugs, and that demand individual treatment protocols. Dr. Saxena is conducting a study that is using neuro-imagery to understand the structural and functional characteristics of the obsessive-compulsive brain.

The study is still underway, but preliminary data suggests that people with OCD who hoard are more likely to have mild atrophy or an unusual shape to their frontal lobes, which is the part of the brain associated with executive functions and decision-making.


Hoarding's Uniqueness Within the OCD Diagnosis

In hoarding, the same medications that are used to treat other manifestations of OCD are found to be far less effective or not effective at all in treating hoarding.

Pharmacologically, Dr. Saxena says that for hoarding behavior, he often uses a COMBINATION of
1) a stimulant (such as Ritalin or Adderall) to sharpen attention
2) an anti-depressant - an SSRI like Zoloft or Prozac

In conclusion, Dr. Saxena points out that the public needs to understand that hoarding is a common problem, and is treatable, through a combination of medication and therapy. Dr. Saxena can be contacted through his web page at UCLA, or visit the Neuropsychiatric Institute on the UCLA web site.

While clinical hoarding represents one end of a spectrum of saving behaviors, most people have to deal -- sometimes more often than they might like -- with garden-variety, everyday cluttering.

Author and feng shui expert Denise Linn, who has helped thousands of readers and clients to clear up their homes -- and their lives. Denise Linn is the author of Feng Shui for the Soul and Sacred Space. Linn has more than 20 years experience in helping people to optimize the flow of positive energy through their homes and businesses using the Chinese art of feng shui. According to contemporary adaptations of this ancient art, clutter can very much impede the flow of positive energy and get in the way of almost every area of our lives. If you're having problems with your finances, for instance, Ms. Linn suggests going through all your financial paperwork and getting rid of what's out of date and un-needed.

She recommends as an exercise that anyone can do, to put on some music, relax, and close your eyes. Then mentally walk through your home and think about each object.

• Imagine picking up an object in your home, and note your reactions
  
• If your energy goes up, then keep it.
• If your energy goes down, think about throwing it away
• or put it in another spot and see if you have a better reaction
• Now imagine picking up another object, and again note your reactions
• Continue

The Infinite Mind public radio show features interview excerpts about many mental health disorders and illnesses. A directory to all the earlier interviews can be found on the website. This is only an excerpt from a much longer interview as heard originally on the radio show.
The Infinite Mind
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