A common response is that such a condition could never happen to one of us or someone we love. But that’s not true. Significant hoarding is surprisingly common, affecting as many as one in every 20 Americans, according to recent studies. What you need to know about hoarding...

Why Do People Hoard?

An inability to discard possessions even when they make living space unusable is the hallmark of hoarding. Most hoarders also acquire in excess—for example, they can’t stop shopping or can’t resist anything that’s free.

Many hoarders have trouble concentrating and are easily distracted from sorting and discarding tasks. They generally find it hard to put things in categories (that’s why electric bills end up in a pile with junk mail and old newspapers) and often are chronically indecisive.

Hoarding symptoms are thought to initially occur in childhood and gradually worsen. A traumatic event (such as the loss of a spouse or a violent crime) can exacerbate the disorder.

Important new finding: A 2010 study of 18 adults (age 60 and older) diagnosed with compulsive hoarding found that while onset was reported in midlife, signs of the problem actually surfaced in childhood or adolescence and worsened with each decade. Depression and anxiety disorders were common among the study participants.

Latest development: Though evidence suggests that hoarding may be a subtype of obsessive-compulsive disorder (OCD), mental health experts are now recommend­ing that a separate diag­nostic category for the problem be included in the fifth edition of the standard handbook on psychiatric disorders, Diagnostic and Statistical Manual of Mental Disorders, expected to be published in 2012.

Hoarding is not just a mental health issue. It also is hard on one’s family and takes a heavy toll on one’s physical health. Debris and dust aggravate lung conditions such as asthma, allergies and emphysema. Objects piled everywhere can cause falls... and accumulations of paper and blocked exits are a serious fire hazard.

The Meaning of Possessions

Hoarders hold on to their possessions for the same reasons we all do—but form intense emotional bonds to a wider variety of objects. Collectors, on the other hand, keep their possessions well-organized and proudly displayed.

Common reasons for hoarding...

• Just in case. A powerful sense of responsibility makes hoarders feel intense guilt and anxiety about discarding anything that they or someone else could possibly use.

• Fear of forgetting. There’s a world of facts in those heaps of newspapers, junk mailings and bank statements that hoarders feel they may someday need. Hoarders prefer to place objects in the open rather than put them away for fear they’ll forget they possess the items or where they placed them.

• Sentimental value. Objects represent memories of loved ones, special events and bygone days. To a hoarder, letting go of a possession means losing something irreplaceable—even part of his/her identity.

Strategies to Try

It may seem that the solution to hoarding is as simple as learning how to organize and systematically throw things out, but the condition usually requires professional treatment.

The most effective treatment—cognitive behavioral therapy (CBT) —works by helping hoarders change how they think about their possessions along with what they do with them. If you think that you may be a hoarder, try these CBT techniques yourself...

• Think before acquiring. The impulse is so strong for compulsive hoarders to acquire (buy or take something for free) that they forget that their living quarters are already overflowing.

Solution: Make a list of questions to ask yourself whenever the urge to acquire strikes: "Do I have the room for this? How many do I already have? Where will I keep it? Will it really be useful or pleasurable to have? Will buying it help or hurt my hoarding problem?"

• Challenge the pain of parting. Hoarders often believe that they’ll agonize later if they discard any of their treasures.

Solution: Experiment to see if the fear is realistic—throw something away, then write down the way you actually feel. How painful is it, really? How long does the pain last?

• Go slowly. Declutter one small area at a time. For example, free your bed for normal use before attacking piles in the living room. A small success can fuel your determination to keep going.

• Stay motivated. Each day, remind yourself why you’re doing the hard work of decluttering. What values are important to you? How do you want to live? What would it take to get there? Does hoarding help or hurt? Write down your responses to these questions, and refer back to them often.

When to Get Professional Help

If hoarding interferes with your life despite your best efforts, seek professional help.

Important: Therapists trained to work with hoarders are hard to find. Many think that their role is to help people discard and declutter. But their role really is to help people who hoard to view their possessions differently. To find a qualified therapist, self-help group or family support, consult the International OCD Foundation, www.ocfoundation.org, 617-973-5801.

Bottom Line/Health interviewed Randy O. Frost, PhD, professor of psychology at Smith College in Northampton, Massachusetts. He is the author of numerous peer-reviewed journal articles and several books about hoarding, including Buried in Treasures: Help for Compulsive Acquiring, Saving and Hoarding (Oxford University) and, most recently, Stuff: Compulsive Hoarding and the Meaning of Things (Houghton Mifflin Harcourt).