Hoarders tend to be emotional; they attach sentimental value to most of their belongings, even used paper coffee cups or outdated calendars. “They’re thinking about all their stuff the way you think about the contents of your jewelry box,” says Nicholas Maltby, a psychologist who works with compulsive hoarders at the Institute of Living in Hartford. Hoarders are often intelligent and well educated, and they typically think in complex ways. “They may have more creative minds than the rest of us in that they can think of more uses for a possession than we can,” says Frost.

Most fundamentally, scientists say, hoarders possess a profound inability to make decisions. Frost describes combing through the possessions of one patient and coming across an article from a travel magazine. The patient could not decide whether to throw away the article or, if she kept it, whether to file it under “travel” or one of the various countries it discussed. So she made several copies and put one in each category.


Indecisiveness extends to other areas of hoarders’ lives. They cannot decide what they should be doing, so on any given day they may start a dozen different projects. “They bounce from one thing to another,” says Sanjaya Saxena, a professor of psychiatry at the University of California at Los Angeles. They also have trouble deciding how much to say. “They are overtalkers. They have to give you every possible detail, rather than a simple answer to a question.”

Compulsive hoarding, unlike obsessive-compulsive disorder, does not respond to treatment with antidepressant drugs, and unlike sufferers of obsessive-compulsive disorder, hoarders actually enjoy being surrounded by all their stuff. “Hoarding seems to be more like compulsive gambling or compulsive shopping because it’s pleasurable to the person,” Maltby says. Moreover, positron-emission tomography brain scans indicate that hoarding and obsessive-compulsive disorder may be quite distinct. In a study published in the June American Journal of Psychiatry, Saxena reported that hoarders have lower activity in the cingulate gyrus—a structure that runs through the middle of the brain, front to back—particularly in areas known to be involved in decision making and focusing attention. People with obsessive-compulsive disorder who are not hoarders do not exhibit this characteristic at all; their brains, in contrast, show elevated activity in areas that generate concerns about danger, contamination, and order.

Saxena’s findings are corroborated by a recent study from the University of Iowa, involving a group of people who had suffered lesions in various parts of their brains as a result of strokes or other neurological diseases. Thirteen patients had never shown a tendency to hoard until they suffered lesions in the mesial frontal region—which encompasses the anterior cingulate gyrus—at which point they fell victim to what the scientists described as a “massive and disruptive accumulation of useless objects.”

The findings suggest that doctors may want to look outside the realm of obsessive-compulsive disorder for drug treatments for hoarding, Saxena says. He plans to experiment with stimulants typically given to people with attention deficit disorder. “We’ll try Ritalin and also drugs that seem to improve cognitive functioning in people with Alzheimer’s,” he says. “The goal would be to improve attention and concentration and find out whether that helps hoarders.”

In the meantime, Frost and Gail Steketee of Boston University are working to develop an effective cognitive-behavioral treatment. Three different behaviors must be addressed, Frost says: the organization of stuff, the acquisition of new stuff, and most important, the timely discarding of stuff. The researchers are developing a

A poll of 10 community service agencies that serve older adults in Manhattan found that approximately 10 percent of their clients are afflicted with hoarding behavior. In recent years the Housing Court of New York has seen a dramatic increase in the number of suits filed by landlords against hoarder tenants.

treatment model that calls for six months of therapy in which patients articulate their mental struggle as they try to discard some of their possessions.

Maltby agrees that hands-on therapy—helping hoarders analyze their thoughts as they sift through their stuff—is crucial. “The problem isn’t solved by cleaning. It’s not solved by coming in and throwing out the hoarders’ stuff. They can collect it again. You have to solve the problem at the decision-making level.”