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Book Review: Stuff: Compulsive Hoarding and the Meaning of Things by Randy O. Frost and Gail Steketee

Book Review: Stuff: Compulsive Hoarding and the Meaning of Things by Randy O. Frost & Gail SteketeeSummary:
It may be difficult to describe a hoard, but you know one when you see one. Maybe you have a neighbor who keeps their shades drawn but when you enter their home you see piles and piles of stuff that either they keep for a project they’ll do one day or because every scrap of it contains important information (according to them). Maybe you’ve only encountered hoarding through reality tv shows focused around the forced clean-up of homes that immediately appear unlivable to you but yet that the person on the show insists is full of treasures. Or maybe you grew up in a home where the hoard slowly encroached on your own room

Between 2 and 5 percent of the population suffers from Hoarding Disorder. Frost and Steketee were the first to begin scientifically studying it. Here, couched in tales of real interactions with and homes of clients (who granted their permission to be featured in an anonymized fashion) Frost and Steketee present both what we know and what we don’t know about hoarding, as well as best practices for helping someone with the disorder.

Review:
As an outside observer of a hoard, it can often be difficult to imagine what leads a person to believe trash is treasure. But of course it’s more complicated than someone just being unable to recognize trash. After all…one man’s trash is another man’s treasure. The authors attack this head-on by first giving a true definition to what counts as hoarding and then talking about various causes and possible presentations of the disorder. So what counts as hoarding?

It hardly matters how much stuff anyone owns as long as it doesn’t interfere with his or her health or happiness or that of others….Hoarding is not defined by the number of possessions, but by how the acquisition and management of those possessions affects their owner. (page 58)

So basically, it counts as hoarding if the collection of items interferes with the person’s health or happiness or the health or happiness of others nearby. The complicated gray area of course is that the sufferer may not realize that the hoard is interfering with their happiness and health. That is the point of conflict for many loved ones of people who hoard.

After establishing and defining what hoarding disorder is and is not, the authors continue on to analyze the behavior and mind of someone suffering from hoarding. Fascinatingly, hoarding shares commonalities with many other mental illnesses, seeming to a certain extent to defy categorization, although the DSM 5 currently lists it among “Obsessive Compulsive and Related Disorders.” Are you shocked? Did you think that OCD always means cleanliness? The fact is that is often not what OCD means. It’s a misunderstanding spurred on by popular culture. OCD is an obsession. It can be with cleaning and germs but it can also be with anything. It also often features repetitive behaviors. If you think about it, you can see what hoarding has in common with this. People who hoard become obsessed with the idea of not losing something important, of collecting everything relevant to a certain idea, of not wasting things. They also can come to establish repetitive behaviors such as maybe always buying a newspaper from a certain store on the way home from work. Another similarity with OCD is that hoarders often are perfectionists. Part of why their homes become cluttered is they are obsessed with only doing a perfect job of cleaning up or of fixing something or using some item for a project, and they become paralyzed with the fear that they can’t do it good enough, so they never start.

The authors also talk about how hoarding has commonalities with Impulse-Control Disorders, such as gambling and compulsive buying. Many people who hoard also struggle with both of these ICDs, and it’s easy to see the relationship here. Similarly, many hoarders show symptoms of ADD. They often do much better cleaning up if there is simply someone there to help them maintain focus, rather than being easily distracted.

Hoarding is also often a result of trauma. People suffer a trauma and essentially attempt to build a protective space around themselves by hoarding.

Compared to people who do not suffer from hoarding problems, clutterers report a greater variety of traumatic events (an average of six versus three), as well as a greater frequency (an average of fourteen versus five) of such events. The type of trauma most often experienced by hoarders include having had something taken by threat or force, being forced into sexual activity, and being physically assaulted. (page 87)

Interestingly, there’s a comparatively low incidence of PTSD among hoarders, in spite of such a high incidence of trauma. (A 2006 study found only 6% of hoarders had PTSD, page 91). It is possible that hoarding prevents the development of PTSD. Many hoarders also report a childhood devoid of warmth and support, so even if they were not traumatized, it is still likely that they had a cold, distant childhood. In contrast to PTSD, the majority of hoarders (nearly 60%) meet the criteria for major depression, and it is posited that this depression could be in response to the hoarding itself.

People draw conclusions about their worth and competence based on their inability to control their living space, and not being able to entertain people in their homes isolates them and limits their social lives. (loc 532)

The authors then talk about what may be going on in the heads of people who hoard. People don’t do things completely irrationally. There are reasons for it. There are multiple possibilities for hoarding of what may be going on. No single aspect has been determined yet.  However, in general, hoarders suffer from a different type of threat signal. They fear something being removed, rather than the presence of something. It has also been posited that they have the opposite of claustrophobia. They feel safer in small, tight spaces, so they artificially create them. Hoarders also frequently struggle with identity. Rather than knowing who they are, they often are defined by the question “Who am I?” and collect items to try to show who they are. In addition to the aforementioned perfectionism, hoarders also seem to view items differently from the rest of us. They are generally very optimistic about future usefulness and can be quite creative as to reusing things. It has been posited that hoarding may be creativity run amok. However, many hoarders also gamble compulsively and the relationship between a hoarder’s positive thinking and a gambler’s is interesting.

“Seeing the scratch tickets over the counter at the convenience store leads me to think, One of those tickets is surely a winner, maybe a million-dollar winner. How can I walk away when the opportunity is there?” Our hoarders have said similar things about items they’ve wanted to acquire. (loc 202)

Distress avoidance is also often a common feature. Distress avoidance is when a person seeks to avoid a situation that they think will cause them distress. They then build up that situation in their heads to be more of a stressor than it actually would be. Continual avoidance of these types of situations also weakens a person’s ability to deal with them (due to lack of practice), so it’s a bit of a self-fulfilling prophecy.

Animal hoarding is its own special subcategory, and it seems that in addition to all of the other possible hoarding issues, animal hoarders may suffer from a form of an attachment disorder where their bonds with other humans are frayed and easily broken and replaced by bonds with animals.

So, essentially, hoarders are often people who are perfectionists who tend to perform rituals and struggle with impulse control. They may compulsively shop and/or gamble in addition to hoarding. They often had cold, distant childhoods and/or suffered a trauma (or traumas). They tend to come at life from a basis of fear and feel safer in tight, closed spaces, and their fear is heightened by removal of things, rather than appearance of new things. At some point, they started avoiding distress, and this distress avoidance became a self-fulfilling cycle. They also frequently struggle with knowing who they are internally, rather looking outward to possessions for identity signals.  In addition to these compulsions and fears, hoarders also often see things differently or in more detail than non-hoarders, and they also struggle to focus or concentrate, making cleaning up even more difficult for them.

The authors conclude by discussing both how to treat hoarding and effects on family members and loved ones (as well as on communities). The authors stress repeatedly that forced clean-ups are the absolute worst possible solution or treatment option. A forced clean-up just fulfills the person’s fear that people are out to get them, and simply makes them cling on to their possessions even more aggressively. It also can make them more depressed. Since their identity is wrapped up in their possessions, getting rid of them by force can cause emotional trauma akin to someone chopping off your hair by force. I was stunned to learn that there have been cases of people who hoard committing suicide after a forced clean-up. The authors strongly advocate for the much slower, but with more long-term positive results, method of going through the hoard with the person slowly and basically teaching them new ways to think about both their possessions and their identity. They also state that it’s easier to treat compulsive buying and gambling than hoarding, so when possible treat that first to prevent the arrival of new items into the hoard. It is a long, difficult treatment plan to go through a hoard slowly, and sometimes it may be necessary to remove the person from the home for safety but then to return with them repeatedly to work on cleaning out the hoard.

The fact that forced clean-ups are the worst possible solution for the sufferer and the fact that hoards get worse over time leads me to believe that early interventions are absolutely critical to render the most help to those suffering from hoarding. But this is a complex thing. Since many cases of hoarding start due to a cold home environment or from trauma, it may be difficult to get parents behind addressing the situation early. Many people who hoard interviewed in the book talk about their hoarding beginning to get out of control by late in their freshman year of college. Perhaps this is something colleges should be keeping an eye out and offering help for. Additionally, shame is often mentioned as a factor in keeping the problem hidden. Perhaps PSAs and other public service campaigns could both lessen the stigma and offer help to people early on in the development of a hoard.

So much of hoarding is stigmatized. To a certain extent this is understandable. It often isn’t seen by the public until it has reached a public health crisis level or in situations where animal hoarders are keeping their hoards in deplorable conditions. Often loved ones of those who hoard feel trapped and frustrated by the hoarding. They feel as if the loved one loves their stuff more than them. These are complex issues and professional help is required to address them. I honestly don’t think this is a situation that is easily handled one family at a time. A family member must be well-informed and patient and empathetic enough to wait through the long treatment process. Often that family member is the child of the hoarder and therefore a minor with no power, which makes the issue even more complex. This is definitely a situation in which public health education campaigns on things like early warning signs of hoarding tendencies and ways to seek help could be extremely helpful long-term. I do believe the authors could have taken things one step further at the end of the book to this connection to public health, rather than mostly focusing on individual therapy. They do mention less consumerism would be helpful, but that simply is not much of an observation. It is a small complaint, but I do feel that this interdisciplinary leap is important.

Overall, this was a fascinating, enlightening book. The authors have conducted extensive scientific research for years, and they do an awesome job of writing this information at the consumer level, as well as humanizing it by bringing in real cases with clients who they render in a three-dimensional fashion. I know I for one will never be able to stomach watching forced clean-ups on the tv show “Hoarders” again. Recommended to really everyone. Anyone could potentially know someone who struggles with hoarding, whether now or in the future, and the book is very readable.

4 out of 5 stars

Source: Library

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Illness(es) featured: Hoarding Disorder

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  1. February 25, 2016 at 8:39 pm

    Thanks for sharing about this book in such detail! It sounds like a great book and I learned a lot just reading your review.

    • February 26, 2016 at 11:32 am

      Haha, thanks! It honestly was possibly too much detail. I kept trying to condense it down into bite-sized pieces but there was just so much information I wanted to not leave out, especially given the general public perception of hoarding. I’m glad you enjoyed the review!

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