Well Being: Helping hoarders fight the compulsion

Matt Paxton has cleared clutter from a thousand houses. He has removed dead cats, soiled diapers, and urine-saturated carpets. He has evicted hundreds of rats. He has seen living conditions too horrible to describe.

The former host of the TV show Hoarders and author of The Secret Life of Hoarders, Paxton, 39, knows hoarding. Recently, at the Hyatt at the Bellevue, he talked about this ailment to social workers, home health aides, property managers, professional organizers, and admitted clutterers.

"Hoarding is a mental disorder marked by a desire to acquire a significant amount of stuff," Paxton said. "It is a compulsion, not an obsession."

The Anxiety and Depression Association of America defines hoarding as "persistent difficulty discarding or parting with possessions."

Books, magazines, newspapers, clothing, knickknacks, containers, food, animals - people hoard all sorts of things, including many that others consider worthless.

"For hoarders, perception is reality," Paxton said. "They live in a perfect past and fantasy future. They're avoiding the present because it sucks."

Hoarding occurs in 2 percent to 5 percent of the population - 6 million to 15 million people - and can lead to substantial distress and disability, the American Psychiatric Association reports. Long linked to obsessive-compulsive disorder, hoarding is now regarded as a distinct affliction and is so listed in the APA's Diagnostic and Statistical Manual of Mental Disorders.

Though the proportion of hoarders remains the same, the stigma of hoarding has eased, Paxton says, and more people are admitting and reporting it.

The condition has a genetic component and is seen in those struggling with depression, anxiety, hyperactivity, short attention spans, alcoholism, eating disorders, and dementia.

Hoarding can be triggered by a loved one's death, divorce, job loss, abuse. "When something bad happens, people seek happiness in stuff," Paxton said. "There is always a reason; no one would choose to live like this."

Paxton, now in-house hoarding expert for ServiceMaster, the cleaning and restoration specialists, stressed that hoarders deserve compassion and respect. "They are not lazy, crazy, or sloppy," he said. "They are good people, almost always the smartest person in the room. They're looking for self-worth and happiness; their disability just happens to be visual."

Paxton added: "It's never about the stuff. . . . Much of what they buy are gifts for other people."

Paxton showed various hoarding situations - the pyramid, the reverse pyramid, the Red Sea (parted by a discernible path), rolling hills (no obvious order), the cave (a house so full it's splitting at the seams), and the cockpit, a small space where hoarders feel safe.

"The mess is a blueprint in time," Paxton said. "Each room represents a different mental state in the hoarder's life."

Paxton distinguished between hoarding and collecting. "Collecting is something you do with your family and friends," he said. "With hoarding, the collection is your family. The items become more important than people, experiences, and relationships."

The APA says collectors "have a sense of pride about their possessions and they experience joy in displaying and talking about them. . . . Those who hoard usually experience embarrassment about their possessions and feel uncomfortable when others see them."

Marla Deibler, a licensed psychologist and executive director of the Center for Emotional Health of Greater Philadelphia, with offices in Cherry Hill and Princeton, specializes in anxiety and obsessive-compulsive disorders and related problems such as hoarding.

"There isn't any medication that is helpful for hoarding itself," she said. "Hoarding as far as we know responds only to cognitive behavioral therapy. That's the standard of care."

Digby Baltzell, the late University of Pennsylvania sociologist, ascribed many ills of modern times to "a declining belief in an afterlife." The name of the game is to amass as many possessions as possible. One can credibly argue that American society, based on an economy that depends on more (consumption, profits, growth), is permeated by a hoarding mentality.

"I absolutely agree," Paxton told me. "I see an increase in me, me, me. 'I got to get that thing or I won't be happy.'

"We work for higher salaries so we can buy more stuff. We are addicted to the rush of acquisition, to 'retail therapy.' When we feel good, we buy things; when we feel bad, we shop. We pay money to store stuff we don't need in proliferating storage centers because our attics and basements are full."

In cleaning the houses of hoarders, "the goal is not to get rid of everything," Paxton said, "but to get rid of the junk and make space for things that truly matter and that celebrate who you are."