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This year, at least one person was trapped under an avalanche of their own clutter. Now, research suggests that people like this—compulsive hoarders—have distinct brain abnormalities. This ScienCentral News video has more.
The Chaos of Clutter
The door to apartment 2F looked like any other. But what lay inside was a shocking sight: Mounds of garbage and trash so tall and so plentiful that there was almost no way to open the front door.
"There was a huge table there piled high with stuff and there was a tiny little path. In some places you had to sneak by it sideways," says Ron Alford, who runs Disaster Masters, Incorporated, a company dedicated to helping extreme pack rats clean house. "Stuff was just stacked up and the cockroaches were walking up behind it and making a mess on the wall."
After an 85-year-old man broke his leg tripping over the clutter, his family called Alford, who with a crew of six men and women waded through an apartment packed full of old roller skates, radio parts and airplane model material.
Nearly three days later, the carpets and floors began to see daylight. Alford has a special word he coined to describe such hoarding behavior: disposophobia. "When you trip and fall on your own stuff, when you're ashamed or afraid to have your friends, relatives or neighbors come into your house and sit down, that's how we draw the line," he says. "Your life has become abysmal because the stuff is overruling your life."
Sanjaya Saxena, a UCLA psychiatrist who's studied compulsive hoarders for nearly six years, wouldn't exactly describe their condition as a phobia: "We're studying people who have hoarding problems that are really due to anxiety and obsessions and compulsions…folks who are unable to throw away even garbage from their kitchens or junk mail or anything so stuff is piled up, several feet up."
As reported in Discover Magazine, Saxena took a scientific approach to understanding the minds of such hoarders. He devised a study comparing the brain scans of those with no disorders, those with Obsessive-Compulsive Disorder (OCD) (characterized by a compulsion to act on anxieties) and those with Obsessive-Compulsive Hoarding. He and his team were able to glean some interesting findings. "In the brain of compulsive hoarders was a unique, distinct pattern. They did not have the typical areas of elevated activity we saw in all the other OCD patients, instead they actually had low activity in certain parts of the brain that were involved in visual-spatial orientation, and in other parts of the brain involved in tension, motivation and decision-making."
Those free of hoarding behavior have an area in the brain called the cingulate gyrus—a structure that runs front to back, down the center of the brain—that fires up areas involved in decision-making and motivation. But in the brains of compulsive hoarders the cingulate gyrus registered low activity. "What we think is going on," says Saxena, "is that low activity along the midline in these areas of the brain seem to be responsible for not only the overt hoarding and saving and acquiring behaviors, but probably also are responsible for some of these other features that we see in compulsive hoarders—the disorganization, the trouble with attention, the motivation, the difficulty with making decisions."
Before, medications used to treat OCD had no effect on hoarders, whose disorder doctors believed belonged to a subset of OCD. Knowing that their brains differ from the brains of patients with OCD—and how—means that doctors might now be able to jump-start a process in the brain of patients with compulsive hoarding, says Saxena: "We're now in the process of trying out new medication…because we know that in other disorders they actually effect those brain areas that were abnormal in the patients with compulsive hoarding."
No case of compulsive hoarding is more famous than that of the Collyer brothers, Langley and Homer, once residents of a fashionable Harlem neighborhood. One sickly and blind, both reclusive and distrustful, their brownstone was rigged with booby traps, trip wires and ropes meant to bring some of the home's 136 tons of rubbish toppling down on would be robbers. On March 21, 1947, police received a tip that there was a dead man in the brownstone. Officers combed the lugubrious inside but it took several hours of maneuvering through piles of garbage to find Homer Collyer, dead of starvation, swathed in a checked robe. Langley remained missing. Not until eighteen days later did a city worker in the house lift a box. Beneath it peaked a foot— nibbled on by rats— that belonged to the long dead Langley. He had unwittingly set off his own booby trap, burying himself under a crush of the things he so loved to collect.
From what Alford says he's seen,chemical approaches that treat hoarders like the Collyers are often ineffective. He says that after trying medication some of his clients "look at all the stuff. They get more depressed than when they already left because they get this little bump of enthusiasm or hope and then they hit reality and they just sort of spiral down." Instead, he believes that their problems are better solved with behavior-based therapy.
But that comes with its own difficulties. Because of the social stigma attached to the disorder, compulsive hoarders are notoriously unwilling to reveal their problem, Saxena says. Still, he stresses that there's hope in the psychiatric community that compulsive hoarding can be successfully treated. Getting professional medical attention, he believes, is the best option that hoarders have: "That's the only thing that is going to control the behavior in the long run."
Without a structured approach to treating compulsive hoarding, those who suffer from it will continue to be referred to fire departments or health departments, where they're generally given ultimatums to clear out their homes or face eviction. "While that might solve a short-term health hazard or fire hazard, it's not going to stop the behavior," Saxena warns. "They'll come back a year later and these folks have filled up their house again."
And while that will keep Alford in business, it will also keep compulsive hoarders amongst piles of debris that could one day prove deadly. This research was published in the June 2004 issue of the American Journal of Psychiatry and was funded by the National Institute of Mental Health.
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