Dr. Randy Frost of Boston University and, as previously mentioned a leading researcher in hoarding found that hoarding runs in families.  People who hoard usually have a first-generation relative who is described as a “pack rat” (Frost et al., 2000). Often a person with a diagnosis of Alzheimer’s dementia has hoarding behaviors.  However, it is felt that this is due to an inability to differentiate between necessary items and trash.  Also, if a person sustains a brain injury to parts of the frontal lobes of the cortex he/she will often develop hoarding behaviors (Anderson, S.W., 2004). In addition, research at Johns Hopkins Medical Center has indicated chromosome 14 is linked with compulsive hoarding behaviors in families with OCD (Samuels, J., Shugart, Y.Y., Grados, M.S. et al.).

Regardless of biology with both hoarding and cluttering the outcomes are similar – piles of stuff.  Their houses are full of stuff.  Their garages are full of stuff. Their basements are full of stuff.  There are narrow pathways surrounded by stuff.  With all this stuff it is important to determine if it’s due to disorganization or hoarding behaviors. The National Study Group on Chronic Disorganization (NSGCD) has developed a Clutter-Hoarding Scale as a guideline tool to define the level and clutter in a home.  The five levels relate to the health and safety of the individuals living in such an environment.  Knowing the level of the clutter help in developing a treatment plan.  People at Level I and II are likely to just be disorganized.  They are often creative people with numerous interests and projects. People at Level III through Level V need psychological and/or medical intervention.  A Level II house may evoke the eyesore of Oscar from the “Odd Couple” whereas a Level V dwelling is a virtual no-man’s land of structural damage, infestation of animals, unusable water and sewer, rotting food, and often no power. It is truly a health hazard. Often the only recourse is to condemn the property.

While hoarding affects a small percentage of the population, and disorganized cluttering probably a much larger percentage, stuff accumulates because it can. If one remains in their home for decades it accumulates.  If a corporation moves you even the trash goes along to the next accommodation.  If you’re moving yourself you load up the stuff promising to sort it when you have time.

DEALING WITH ALL THAT STUFF
 
After determining the level of the clutter, it is important to address what hoarders and clutterers think as to the reasons they collect and then explore what purpose it serves. Do they feel safer and more secure when surrounded by stuff? Are they afraid that if they throw out items they will lose that memory?  Do they think they’ll need it in the future? Are they fearful of throwing out the wrong item so they just keep it all?   Often a third party can prove to be the most beneficial in dealing with all the stuff that has accumulated. Along with the appropriate psychological intervention, there are companies, which specialize in moving the elder. They are often members of the National Association of Senior Move Managers (NASMM) who are better equipped to handle the trauma of the elder’s move.  Although slightly more costly than conventional movers they can save families a great deal of ill feelings and grief. Also, members of NASMM are excellent resources for obtaining estate sale agents, trash-haulers, recyclers, and charity organizations.  These companies focus on building a trusting relationship with the elder prior to the move.  They may have training necessary to explore why the person collects versus just throwing out the items or boxing them up.  Much of their initial work involves simply listening to the elders talk about their possessions, a ritual that the adult children or grandchildren may not have the patience for.  The elder is going through a life-review and grieving process.  They’re reliving decades of their lives through their stuff. Often this third party can overcome resistance to getting rid of stuff better than an adult child. In the journal Social Work Today, Gail Steketee, PhD, from the Boston University School of Social Work, focuses on the need to approach the hoarder with respect, sensitivity, and a non-judgmental attitude.  Confrontation is not effective. If at all possible stuff should not be touched without permission first. She stresses the need to understand the underlying issues.  Without the why it is only a matter of when the hoarding will begin again.  In an interview with Dottie Albright of Transitional Moving in Atlanta, Georgia, and a member of NASMM reported in an interview with me that she helps the client focus on safety issues when rightsizing (downsizing). Often an individual will listen to a “professional” rather than their own children regarding possessions. Ms. Albright often reframes the clutter to the client as a collection that has acquired a collection so it is time to rein it in.