How much stuff is too much stuff?

Everyone likes to acquire and hold on to things for a variety of reasons. This item is unique. It reminds me of an important event in my life. It's a great deal. I could have a use for it one day.

Most people have a balance among what they obtain, hold on to and let go. However, for some, having too much can lead to significant problems in day-to-day living.

Hoarding disorder affects about 3%–6% of the population.

Common characteristics of hoarding include:

• Excessive acquisition of items with limited objective value or immediate use.
• Difficulties discarding, giving away or recycling accumulated items.
• Problems with organization, attentiveness, memory and decision-making.
• Excessive buildup of clutter in living spaces.
• Avoidance of managing the clutter.

Hoarding disorder isn't the same as being a collector or pack rat. Collectors tend to focus on a specialized area of interest rather than a wide range of different things. They also may collect items that have recognized value. Pack rats may hold on to many sentimental items, but it may not result in problems with their living spaces.

With hoarding disorder, living spaces can no longer be used for their intended purpose due to excessive clutter. For example, a person's kitchen counters and stove become so cluttered that meals cannot be prepared. A bathroom is so filled with miscellaneous office supplies that the toilet or shower cannot be used.

The most hoarded items are information, including books, magazines, mail and scraps of paper; clothing; household items, including coffee mugs, towels and pens; and crafts. In more serious cases, some people excessively accumulate food or pets, which can result in unsanitary living conditions.

People who hoard hold strong beliefs about their possessions, including their uniqueness, future use and not wanting to be wasteful. They also tend to have a strong degree of emotional attachment to their possessions, feel highly responsible for retaining their items, and can become increasingly territorial when there is any threat to discarding or losing their things.

Continued hoarding behavior increases the risk for other health and safety problems, including:

• Narrow pathways between piles of newspapers, books and bags of clothing can be a significant fall risk, especially for the elderly and others with mobility problems.
• Attempts to conceal hoarding from others can result in isolation and feeling more disconnected from others, and increases the risk of depression.
• Financial struggles due to spending money on storage facilities for their possessions rather than covering important expenses, such as food and utilities.

Hoarding behaviors can start during the teenage years. However, the problems with clutter in living spaces and other responsibilities in life gradually develop over time, so impairment usually starts to show up in middle-aged and older adults. Hoarding is equally common in men and women, and often is associated with other mental health problems, such as depression.

Researchers have found that hoarding may be related to:

• Family history
  Hoarding tendencies or the full disorder may tend to run in families. This may be due to shared genetics or by learning patterns of acquiring and retaining items.
• Personality
  Indecisiveness and perfectionism are common traits among those who hoard.
• Stressful life events
  Sustaining significant losses in life, such as the death of a family member or destruction of possessions in a fire or natural disaster, can increase the risk of developing hoarding disorder.

Treatment for hoarding disorder

Treatment can be challenging since the problem usually has been going on for several years in private. Plus, the prospect of decluttering can be distressing for some people due to the high degree of emotional attachment to their items, general avoidance tendencies, and strong beliefs about acquiring and retaining. Sometimes treatment is motivated by external factors, such as the threat of eviction, legal action or frustrated family members. Addressing personal motivators for treatment is essential for engagement.

Cognitive behavioral therapy is the most evidence-based treatment approach for hoarding. It tends to be more intense and takes longer than other anxiety conditions, such as panic, post-traumatic stress or social-anxiety disorders. No medications are indicated for hoarding, although the use of antidepressants may help when a depressive disorder is present. In some cases, family therapy also may help.

Treatment focuses on:

• Gradually changing patterns and learning new skills.
• Encouraging participation with others who are healthy and can offer practical assistance.
• Conducting home visits to apply skills to manage clutter.
• Providing follow-up to prevent relapse.

Among the skills that cognitive behavioral therapy teaches are:

• Identifying and challenging beliefs about acquiring and retaining items.
• Resisting urges to accumulate more items.
• Organizing and making decisions over where to start in their home, including how to make the best use of storage space.
• Increasing tolerance for sorting through possessions, including making decisions over keeping, recycling or throwing them away.
• Preventing clutter from taking over cleaned areas of the home.
• Increasing involvement with more meaningful activities and social supports.

Hoarding disorder is a treatable but challenging condition. Some communities, counties and social service agencies may have additional resources and specialists available.

Craig Sawchuk, Ph.D., L.P., is a clinical psychologist in Primary Care in Rochester and Kasson's Division of Integrated Behavioral Health at Mayo Clinic in Minnesota.