Do you have any advice concerning a man who buys things that are unnecessary for his everyday life? He buys more food, housewares, electronics, and home furnishings than he needs, and then buys storage cabinets and containers to store excess items. This has been going on for a long time and it's causing problems with relatives.

— Kay, Pennsylvania

Kay, the behavior that you are describing fits a pattern referred to as hoarding and usually reflects an anxiety disorder. Hoarding has some common characteristics, including the excessive collecting of objects (or animals), regardless of their value, with an inability to discard them; having living or working spaces so cluttered that it is difficult to find things or the space becomes unusable for its intended purpose; and collecting behavior that interferes with daily functioning and puts a strain on relationships. Historically, hoarding has not been considered a distinct disorder but rather a subtype of obsessive-compulsive disorder (OCD). More recently, however, experts are proposing that hoarding may also be related to generalized anxiety disorder (GAD) and social phobia.

The cause of hoarding is not well understood, but researchers have identified common features associated with hoarding behavior. Hoarding often starts in adolescence and typically gets more severe with age. People are at increased risk if they have had a close family member who hoards. Sometimes significant stressful life events can result in hoarding behavior. There also seems to be an element of perfectionism in that people fear making the “wrong” decision when it comes to discarding things. Merely considering discarding something can cause significant anxiety, and so they avoid thinking about it.

The severity of hoarding behavior is quite variable, but in some cases, hoarding can result in living quarters that become so cluttered they are unsanitary or fire hazards, an inability to do daily activities such as cooking or bathing, increased isolation for the person, and family discord. In the case of the man you describe, it appears that there may be considerable expense involved in his hoarding.

Unfortunately, those who hoard often do not see their behavior as problematic, which makes helping them quite difficult. However, I would advise you to strongly encourage this man to seek help. If you can get him to see a mental health professional who is an expert in the treatment of OCD and hoarding behavior in particular, there are effective treatments available. Therapy would begin with a thorough evaluation to understand the nature of the problem and determine the appropriate diagnosis. This then allows for the development of a specific treatment plan.

As with most mental health disorders, the two primary methods used to treat hoarding are psychotherapy and medications. Evidence suggests that cognitive-behavioral therapy, which is designed to help the patient think and behave differently while simultaneously working to lower associated anxiety, can help hoarding behavior. This type of therapy may include teaching the hoarder how to experience the urge to acquire without acting on it, how to develop decision-making strategies for discarding objects, and challenging perfectionism and other harmful self-beliefs. The types of medications that might be recommended are SSRIs, antidepressants typically prescribed for OCD.

Kay, I am sure it is difficult for those who love this man to watch his behavior unfold. Sadly, it is very likely going to get worse if left untreated. I hope he will understand that you are worried about him and that he will take steps to get help.