Too much clutter can be a sign of a mental illness known as hoarding, which can lead to dangerous conditions in a home. © trekandshoot | Dreamstime.com

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As a professional organizer in Baltimore, Amy Bloomer, founder of Let Your Space Bloom LLC, said that accumulation of possessions is a natural part of life.

“There are a lot of people who live with a lot of clutter. Even if you’re very cognizant of editing your stuff, if you’re in a space for a long time, you’re going to accumulate a lot of clutter,” said Bloomer, who works with empty nesters who are preparing to sell their houses.

It can feel overwhelming to own too much. “Clutter is pervasive, physically and mentally,” she said.

But sometimes a person’s accumulation of stuff grows to the point that it signifies a deeper problem. Since Bloomer started her organization company in 2016, she has encountered about a dozen people who meet the definition of a hoarder.

Hoarding disorder, according to the American Psychological association, is “a persistent difficulty getting rid of or parting with possessions.” It’s a widespread problem that affects between 2% and 6% of the population.

What’s behind hoarding?

Television shows such as “Hoarders” and “Hoarding: Buried Alive” increased public awareness of the issue by presenting a vivid picture of hoarding to millions of viewers.

But TV shows — particularly those that emphasize cleanup services rather than therapy — can present a distorted picture of the serious work involved. Cleanup alone is almost never a long-term solution.

It’s unclear where compulsive hoarding comes from; research has shown that it isn’t correlated with material or emotional deprivation earlier in life.

Psychologists have identified a pattern of cognitive and emotional difficulties that underlie hoarding symptoms. These are as follows:

• Indecisiveness and fear of making mistakes. By never choosing to throw anything out and constantly accumulating things “just in case,” the hoarder tries to avoid making wrong decisions or having regrets.
• Difficulty categorizing. A person who has a hard time sorting objects into categories can find it difficult to decide which drawer something belongs in. For a person who has difficulty distinguishing between valuable and worthless items, keeping old supermarket flyers may seem as sensible as keeping last year’s tax return.
• Concerns about memory. A hoarder may have unjustified doubts about the reliability of her memory and therefore avoid putting things away for fear of not being able to find them again. Dresser drawers remain empty while clothes pile up on furniture and the floor. Old newspapers and magazines are saved for fear the information in them will be forgotten if they’re not kept on hand.
• Emotional attachment to objects. A hoarder often comes to see beauty and value in clutter and develops a sentimental attachment to it. This heightens his or her enthusiasm for acquiring things and reluctance to discard them.
• Need for control. The hoarder usually doesn’t want anyone else to make decisions about her possessions, so it can be difficult for the family to help.

Medication and therapy may help

There are no specific anti-hoarding medications. Drugs that are used to treat OCD may help, especially selective serotonin reuptake inhibitor (SSRI) antidepressants or tricyclic antidepressants.

But compulsive hoarders often don’t respond to these medications. Studies show that people with OCD are less likely to respond to SSRIs if hoarding is one of their symptoms.

On the other hand, these drugs may be useful for treating the depression and anxiety that often accompany hoarding.

Traditional cognitive behavioral therapy (CBT) can work, but hasn’t worked well either, often because patients are reluctant to participate.

To find a therapist with experience in the treatment of hoarding, check the treatment provider listing in the hoarding section of the International OCD Foundation website.

An escalating problem

Over the years, compulsive hoarding takes an increasing emotional, financial and sometimes physical toll. The home becomes unsafe. Guests may be forbidden.

“Family members are much more likely to seek help than the hoarder. Hoarders are reluctant to change. And they’re usually upset about their hoarding only if people are putting lots of pressure on them to change,” said Dr. Michael Jenike, professor of psychiatry at Harvard Medical School and founder of the hoarding clinic at Massachusetts General Hospital.

Family interventions don’t always help. The hoarder may resist to hiring a professional cleaner. Extra storage units may simply be filled up.

Relatives or friends may try to strong-arm a hoarder into getting rid of her stuff, but that tactic often ends disastrously, causing lifelong resentments.

“You need someone to negotiate for you,” Jenike said. “In some cases, a person isn’t going to deal with this until the Board of Health gets involved.”

Some villages in the area, including the Village of Takoma Park, have trained volunteer staff who might be able to help hoarders. Call your local village to ask.

Just a pack rat?

If all this talk about hoarding has you wondering where you fit on the continuum of clutter, Bloomer offers this advice for ordinary decluttering:

“Start with small wins. Don’t start with your basement or your garage or your shed — that’s like Pandora’s box. Who knows what could be in there? Start with small spaces, build that confidence and keep going.”

Don’t be afraid to ask for help, whether from friends or an organizing business.

You can pick up Marie Kondo’s bestselling book (The Life-Changing Magic of Tidying Up, 2011) or watch her Netflix reality series “Tidying Up with Marie Kondo.”

Bloomer said Kondo’s popularity has helped others understand her job — how stressful a messy house can be and how liberating a clean, organized house can be.

When you start your decluttering project, don’t expect instant results, Bloomer said.

“You have to be patient and kind to yourself in trying to unravel what has accumulated over large periods of time.”

How to help a hoarder

1. Listen. Let the person tell his/her story. Respect the person’s perspective and attachment to the possessions. Don’t tease or criticize.

2. Go slow. There’s no need to rush changes unless the person’s living situation is unsafe or it is necessary to move to smaller quarters or a nursing facility.

3. Engage. Involve the hoarder is decisions about where to put things and what to throw out.

4. Notice other changes. If there are signs of other cognitive or emotional problems, arrange for a professional evaluation. For example, hiding belongings or spending a lot of time rummaging through stuff can be a sign of dementia.

5. Provide structure and emotional support. During the de-cluttering process, keep the person company and help him/her stay focused on one area at a time.

6. Lift and tote. An older hoarder may need family, friends, professional cleaners or movers to help with handling the clutter.

7. Work with others. More than 75 communities have hoarding task forces that address psychiatric, legal, geriatric and housing concerns. One possible source of information is your local area Agency on Aging.

— Harvard Women’s Health Watch, © President and Fellows of Harvard College. Distributed by Tribune Media Services, LLC.