- The Washington Times - Saturday, January 7, 2006

Working hard to keep the clutter in check, particularly after the influx of holiday gifts? Even made a new year’s resolution to organize the closets, the kitchen drawers and the office?

Many of us fight to keep clutter under control, but there are those whose clutter goes beyond messy countertops and overflowing closets. Theirs is a psychological disorder that can lead to waist-high piles of newspapers and books or the sheltering of hundreds of cats.

They’re called hoarders.

“Hoarding means collecting and being unable to discard excessive quantities of goods and objects that are of limited or no value,” says Dr. Thomas Wise, chairman of the psychiatry department at Inova Fairfax Hospital.

This can lead to homes so packed with stuff that there is no place to sit or lie down, Dr. Wise says. This is referred to as “loss of functional space.”

Ellen Epstein, a professional organizer in Chevy Chase, has seen this firsthand.

“I once had a client who had waist-high piles of cookbooks and newspapers everywhere,” Mrs. Epstein says. “Every square inch was occupied.”

Mrs. Epstein started helping this client by getting rid of some of the stuff.

“I looked at [the client], and she was crying. She said, ‘It’s been eight years since I last saw my rug,’” Mrs. Epstein says.

It’s not clear what causes this type of hoarding, Dr. Wise says. It is a psychological disorder, but he adds that researchers are unsure where hoarding belongs in terms of psychological conditions.

“It could be a variant of obsessive-compulsive disorder, or it could be some form of impulse disorder, like gambling,” Dr. Wise says.

It also is more common in people with different forms of brain damage, and it can appear as a symptom of depression in patients who are too paralyzed to do anything about the disorganization around them, he says.

Often the first person — sometimes hired by a family member — to enter this type of hypercluttered environment is a professional organizer, says Terry Prince, executive director of the National Study Group on Chronic Disorganization, a nonprofit offshoot of the National Association of Professional Organizers.

Ms. Prince and others in her profession found it difficult to categorize the type and amount of clutter they saw in clients’ homes and to determine whether they should suggest that the client get additional help, such as medical intervention.

“We needed to be able to communicate about it, be on the same page,” Ms. Prince says. “So, we came up with a clutter-hoarding scale. It ranges from Level 1 to Level 5. At Levels 4 and 5, other intervention is needed.”

Level 4 includes such things as excessive spider webs, flea infestation, rotting food on counters, the housing of more than four animals, no clean dishes or utensils in the kitchen, and mold and mildew on walls and floors. (The whole scale can be viewed at www.nsgcd.org/pdfs/ fs006.pdf.)

Level 1 on the same scale includes light evidence of rodents and some, but not excessive, clutter.

“The scale really helps us distinguish when we need more than just us,” Ms. Prince says.

Fugen Neziroglu, clinical director at the Bio-Behavioral Institute in Great Neck, N.Y., sees patients who suffer from compulsive hoarding. She says that in many cases, hoarding can become a health hazard, such as when newspapers are stacked next to combustible and highly flammable materials (also part of Level 4 on the hoarding scale) or dozens of pets are kept in the home.

“Which is why hoarding is the most common reason for eviction,” says Ms. Neziroglu, who has a doctorate in psychology and is the co-author of “Overcoming Compulsive Hoarding.”

So, what’s the treatment for this condition?

Ms. Neziroglu says that medication often doesn’t work but a combination of behavioral therapy and practical decluttering assistance can be effective.

“You have to challenge the patient about the need of keeping certain items,” Ms. Neziroglu says. “You have to ask things like, ‘What other ways could you actually get this information?’ if they’re saving old newspapers and magazines. And now with the Internet, it’s usually pretty easy to find any information you want.”

Mrs. Epstein uses the same technique when helping people — even those who are not compulsive hoarders — declutter.

“A common thing the client will say is, ‘But I might need this sometime,’” Mrs. Epstein says. “And you have to say, for example, if it’s a 1980s travel story from Florence about a restaurant and there are another 100 travel sections in the same pile, ‘Are you going to find it when you need it? And will the restaurant even be around?’ You’ll find it much more quickly on the Internet. … It makes no sense for me to clean, sort and create folders in a case like that.”

Professional organizers and doctors alike agree that it’s important to get family members or close friends involved in the process of decluttering a hoarder’s home.

Sometimes, however, even those who are closest don’t know there’s a problem.

“[Hoarders] look perfectly fine at work, but no one ever gets to visit their home,” Ms. Neziroglu says.

In some cases, hoarding grandparents don’t and can’t invite their children and grandchildren to visit.

“The grandparents feel very badly — their grandkids haven’t ever set foot in their home,” she says.

So, how common is compulsive hoarding?

“No actual prevalence rate has been determined,” Ms. Neziroglu says, “but we estimate that about 1 [percent] to 3 percent of the population hoard.”

The disorder can appear at any age but seems more prevalent in older age groups simply because older people have the ability to hoard or accumulate, Dr. Wise says. They have more space and resources.

How many of us are simply cluttered and disorganized?

No one really knows that number, either, but Ms. Prince and Mrs. Epstein say business is booming.

Perhaps surprisingly, non-hoarders also can use the clutter-hoarding scale, but in a slightly different way, Ms. Prince says.

“The scale could actually help you get a really perfectionist family member off your back,” Ms. Prince says. “You could just say, ‘Look, I’m a Level 1.’”

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