Collectors gather many of the same types of objects together - a box filled with seaside shells, a jar of mismatched buttons, or an album of rare coins. Many of us squirrel away treasured mementoes, while the "packrats" among us hold on to trash or useless, outdated things for longer than we need them. But for people with hoarding disorder the line between treasure and trash becomes hazy. A flurry of new research is revealing new insight into this poorly understood compulsive behaviour. Ultimately, it could be the very decision of "What is treasure and what is trash?" that lies at the heart of the behaviour.

Lifting the lid on a hidden compulsion

When Oprah Winfrey aired an episode of her show focusing on the hidden life of hoarders, viewers were aghast at what they saw: people being literally buried alive by their possessions. Men and women with hoarding behaviours live in homes that are beyond cluttered. One room overflows into the next, and every nook, cranny, and crevice becomes stuffed with stuff: avalanches of newspapers, documents, and junk mail, free giveaways and objects bought at garage sales, piles of clothes never worn. More and more things are bought or brought into the home, and very little if anything is ever thrown away.

All of this stuff can create real danger. Aside from the obvious fire hazards, parts of the home crucial to daily living - the bed, the bath, the kitchen - become blocked by the flood of stuff. As a result, people living in the home can't do the things they need to do to stay healthy, like get a good night's sleep, bathe properly, or cook nutritious meals.

People living amidst the mess may isolate themselves from friends and family. Surveys of self-identified hoarders reveal that they're more likely to be overweight or obese and to have chronic or serious medical problems. Many have been threatened with eviction or had children or elder relatives removed from their homes because of the unsafe conditions of their homes. How does someone get to this point where the things they own, own them?

Is it OCD?

Obsessive-compulsive disorder (OCD) is a condition in which a person obsesses about a particular worry, such as recurring doubts or fear of contamination or loss. The person also has compulsions (or urges) to do something that will relieve the uneasiness caused by the obsession. Although it is considered a related disorder to OCD, hoarding disorder is distinct from OCD with different symptoms and different treatment options. Some people may be hoarders without having other obsessive tendencies. Not everyone who is diagnosed with OCD is a hoarder. And though some people with OCD do display hoarding behaviours, their behaviour tends to be different from that of a typical hoarder. For example, they're more likely to collect bizarre items or feel the need to perform compulsions related to the items they hoard, like checking to make sure items are still there or going through certain rituals before discarding any item.

If it's not OCD, what is it?

The Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) classifies Hoarding Disorder as an obsessive-compulsive disorder (OCD) related condition. Hoarding disorder is characterized by persistent difficulty discarding possessions regardless of their actual value. People with hoarding disorder find it difficult parting with possessions because they believe the need to save items for future use, or the items may have significance or emotions attached to them. The accumulated possessions congest and clutter living areas, which can no longer be used for what they were intended for. The hoarding may distress the affected person, but it can be further distressing to other people such as family.

Hoarding also has a strong genetic component. You're more likely to compulsively hoard if a close family member does. In addition, stress and brain chemistry can be possible causes of hoarding disorder.

Lightening the load of compulsive hoarding

If you recognize the symptoms and characteristics in yourself or someone you love, there are steps you can take. Treatment options exist that can help to alleviate symptoms and guide a person toward a more normal, healthy life. The effectiveness of treatment will depend on whether hoarding is a unique syndrome or a symptom of OCD. Search for therapists in your community, especially those who practice cognitive-behavioural therapy.

Remember that personal hygiene and nutrition are crucial. Try to keep your kitchen, bathroom, and bedroom as clutter-free as possible so that you have daily, easy access to the tools you need to stay as healthy as possible. If your kitchen is unreachable, seek out community meal support programs until you can get help clearing it out for use. Above all else, try to focus on your goal of living a healthier and more enjoyable life.

Search for support in your area.

Amy Toffelmire