Just what causes someone to begin hoarding, whether it's cats or magazines or empty boxes? Clinical psychologist David Tolin, a noted expert and researcher on hoarding, will speak on the subject at a free Park Center Community Forum on April 25 at downtown branch of the Allen County Public Library. Tolin is also the presenter at a workshop for mental-health professionals on April 26.
Tolin says, for years, mental-health professionals classified hoarding as a form of obsessive compulsive disorder.
“While some people who hoard have OCD symptoms, hoarding is increasingly recognized as a separate disorder,” says Tolin, director of the Institute of Living – Anxiety Disorders Center at Hartford Hospital in Hartford, Conn. Tolin is also one of the therapists who helped launch A&E's weekly show, “The Hoarders.”
After observing failed treatment for hoarding using traditional OCD medications and therapy, Tolin and other researchers began looking deeper at the brains of people who hoard in hopes of finding the cause and better treatment options.
“If we look at the brain, the (hoarding) person's brain is functioning differently,” he explains. In hoarders, the part of the brain involved with complex decision-making, the anterior cingulate cortex, is over-activated when the individual is faced with sorting, organizing or prioritizing personal possessions. Yet, that part of the brain is abnormally inactive when the person is asked about the general environment around them.
“Hoarders seem to be oblivious of what's going on around them,” Tolin says.
Brain scans in hoarders also show a region called the insula lights up when they think about their possessions and gathering more of something. Brain research on addictive behaviors shows the emotionally-charged insula motivates someone to act on their cravings.
Though hoarding and collecting can be difficult to distinguish in childhood, Tolin says, “If you ask adults who hoard, the majority point to childhood or early adolescence” as the time when the behavior first started. But collecting things, even a lot of one kind, is still within range of normal behavior if the person finds enjoyment, pride, purpose or connection with others through collecting.
Hoarders, on the other hand, hang onto things “but don't have a very good plan for using them,” he says.
The “collection” eventually has adverse effects on the individual, limiting his or her ability — and often that of family members — to live and function in a healthy, normal environment. Newspapers, old mail and magazines overtake the kitchen so the stove and sink cannot be used, for example.
“Hoarding does seem to be genetically influenced,” Tolin says, noting researchers at Baltimore's Johns Hopkins University found first-degree relatives of hoarders are also more likely to have difficulty with complex decision-making. “It may be that when we talk about genetic vulnerability (for hoarding), you may inherit a brain that does not process complex decision making.”
Estimates of prevalence of the disorder are one in 20 people; contrast that with the much more talked-about and researched mental illness of schizophrenia, which affects one in 100 people according to the National Institute of Mental Health.
Is their hope for hoarders? Though Tolin says yes, he admits no evidence-based medication is currently available. The most effective treatment is cognitive behavior therapy (CBT), which focuses on helping the person learn and practice new behavior patterns. Along with CBT, some individuals respond to certain medications, such as those used to treat anxiety disorders.
For friends and loved ones of hoarders, Tolin advises, “Stop having arguments about the clutter. You are never going to win them.” And don't start throwing things away.
Family members want quick improvements, but he cautions, “You can't be quick and effective. You have to pick one or the other.” Sustainable changes take a long time. Hoarding really isn't curable, though greater awareness of it is generating more pharmaceutical and therapeutic research.
One study out of the University of Iowa, for example, looked at the brains of stroke patients after noting that some stroke patients, who had never been hoarders, developed post-stroke hoarding behaviors. They found the stroke patients who started hoarding had lesions in their brains in those same areas that move into abnormally high gear in hoarders who have not had strokes.
People who hoard, and their loved ones, can take heart in the fact, “The disorder can be managed and managed reasonably well,” Tolin says.
After an initial period of intense treatment, supportive therapy can keep symptoms under control. “The majority of people get into a state of remission so they don't show symptoms.”
Understanding hoardingWhat: “Buried in Treasures: Understanding Compulsive Hoarding,” a free community forum sponsored by Park Center featuring clinical psychologist, author and hoarding researcher David Tolin, director of Hartford Hospital's Institute of Living - Anxiety Disorders Center in Hartford, Conn.
When: 6:30-8:30 p.m., April 25
Where: Allen County Public Library, Main Branch Auditorium, 900 Library Plaza
Cost and registration: The event is free but pre-registration is requested; email Carol Vinnedge at firstname.lastname@example.org or call 482-9125, Ext. 2220.