Compulsive Hoarding: a Sociological Perspective on a Modern Pathology

Shawn Musgrave, Boston University 2012

Economics and Global Development

smusgrav@bu.edu (520) 820-6615

This paper examines the basic characteristics of compulsive hoarding, as well as proposes certain

characteristics of modern Western society as potential stressors.

 Like every field of study, research in psychiatry and psychology is subject to fits and

flurries of intense focus on a particular subject, be it a novel disorder or cognitive deficit or a

well-established one due for a dusting-off. Compulsive hoarding is one such fad currently

commanding the attention of the psychological research community. It is a prime candidate for

such prominence: tales of compulsive hoarders’ struggle capture the public imagination in a

graphic and bizarre way that many other mental disorders cannot approach. In the U.S., public

interest has been so intense in the past ten years as to be quantified in television ratings,

prompting episodes devoted to compulsive hoarding on such popular talk shows as The Oprah

Winfrey Show and The Dr. Phil Show. The entertainment (or, perhaps more frankly, voyeuristic?)

value is apparently of such magnitude as to warrant the production of an entire television series,

Hoarders, which premiered in fall 2009 on reality television network A&E to the network’s best-

ever premiere at 2.5 million viewers, 1.8 million of which fell into the prime viewing

demographic of adults aged 18 to 49i. The show’s synopsis promises the enticing bliss of “there

but for grace go I”:

Each 60-minute episode of Hoarders is a fascinating look inside the lives of two different
people whose inability to part with their belongings is so out of control that they are on
the verge of a personal crisis. Whether they're facing eviction, the loss of their children,
jail time, or divorce, they are all desperately in need of help. In a fly-on-the-wall style,
we'll capture the drama as experts work to put each on the road to recovery. [….] The
healing won't be easy. For some, throwing away even the tiniest thing -- a sponge, a
button, an empty box -- is so painful that they will not be able to allow the cleaning to be
completed, no matter the consequences. At the end of each episode we'll find out who has
been able to keep their hoarding behavior at bay and who, despite help, is still lost inside
this painful disease.ii

Similar TV specials have also been produced in the U.K. As one headline put it, media attention

has made 2009 “The Year of the Hoarder”iii.

Such intense public fascination has both spurred and been intensified by a recent

outpouring of case studies, patient trials and reexaminations of the theoretical foundations of
hoarding behavior. What follows is a presentation of the general characteristics, basic

epidemiological data, and a brief examination of the evolution of psychiatric consensus on

hoarding behavior, including current debates in its study and interpretation. The sociocultural

implications follow in an examination of possible connections between consumeristic, high-

stakes modern culture and hoarding tendencies.

An introduction to hoarding: symptoms and diagnosis

As its name suggests, the central symptom of compulsive hoarding is an “inability to

resist the urge to acquire possessions and to discard possessions”iv. The consensus among

researchersv further associates the following three features with the disorder:

(1) the accumulation and failure to discard a large number of possessions that appear to
most people to be useless or of limited value,
(2) extensive clutter in living spaces that precludes activities for which the rooms were
designed, and
(3) significant distress or impairment in functioning caused by the hoarding.

DSM-IV does not include a separate diagnostic category for compulsive hoarding behavior,

instead listing the inability to “discard worn-out or worthless objects even when they have no

sentimental value”viamong the symptoms for obsessive compulsive personality disorder (OCPD).

The potential establishment of a separate diagnosis in DSM-V is an issue of considerable

contention, and will be examined below in the section on theoretical frameworks. Given the lack

of delineation of hoarding symptoms in DSM-IV, a recent therapist guidevii oriented specifically

toward intervention procedures for hoarding cases provides a set of working diagnostic criteria,

in hopes of inclusion in DSM-V:

(1) The client accumulates a large number of possessions that clutter the active living areas
of the home (e.g., living room, kitchen, bedroom), workplace, or other personal
surroundings (e.g., vehicle, yard) and are kept in a disorganized fashion. If disorganized
clutter is not present in these areas, it is only because of others’ efforts (e.g., family
members, authorities) to keep these areas uncluttered.
 (2) The client has current or past difficulty resisting the urge to collect, buy, or acquire free
things that contribute to the clutter.
(3) The client is extremely reluctant to part with items, even those with very limited
monetary value or utility.
(4) The accumulation of clutter or difficulty parting with items causes marked distress or
interferes significantly with normal use of the home, workplace, or other personal
surroundings, occupational (or school) functioning, usual family and social activities;
poses significant health or safety risks (e.g., blocked egress, cluttered stairs, fire hazard);
or causes significant conflict with family members, neighbors, or authorities (e.g., work
supervisors, landlord).
(5) The problem has persisted for at least six months and is not the result of a recent move,
repairs to the home, the accumulation of many items resulting from the death of a family
member, or other temporary circumstances.
(6) The clutter and the difficulty parting with items are not better accounted for by another
mental disorder such as OCD (e.g., fears of contaminations, checking rituals), dementia
(e.g., cognitive impairment that interferes with decision-making and organizing), major
depressive disorder (e.g., diminished interest in normal activities, fatigue, indecisiveness
resulting from difficulty concentrating), schizophrenia (e.g., retention of items resulting
from delusions or hallucinations about objects, paranoia regarding personal information),
or bipolar disorder (e.g., impulsive buying sprees, distractibility that interferes with
organizing). The disturbance is not the result of the direct physiological effects of a
substance (e.g., drug abuse, medication) or a general medical condition (e.g., stroke, brain
injury).

Additionally, a Hoarding Scale widely implemented in screening research participants includes a

self-check for characteristics such as: “I have trouble throwing things away”; “When I try to

throw things away it upsets me emotionally”; “I save certain things because I am scared I may

need them after I throw them away”; and “I see my belongings as extensions of myself, they are

a part of who I am”viii. Throughout the literature, there is a fundamental distinction between

hoarding and purposive collecting, both in that the collecting individual “maintain[s] collections

of objects that are generally considered interesting and valuable”6 and in the functional

impairment of the hoarding patient. Furthermore, collectors “save in a systematic way […. and]

usually specialize in one or a few classes of objects, which they organize, display and even

catalogue. But [hoarders] tend to stockpile their possessions haphazardly and seldom use them”ix.
Such distinctions between collecting and hoarding suggest a particular cognitive clutter within

the minds of hoarders, as well as the readily-apparent material clutter in their living spaces.

In terms of symptomatic (outward) behavior, then, hoarding essentially involves aberrant

approaches to acquiring and discarding. In terms of acquisition, hoarding has predictably strong

correlations with compulsive buying, and it is often observed that “people who hoard possessions

buy extra food, household supplies and toiletries […. as well as] items that are aesthetically

pleasing, rather than utilitarian (i.e. gifts purchased with no one in mind to give them to)”v.

Additionally, such individuals often acquire free items through simple collection as opposed to

purchase, especially “extra newspapers, promotional giveaways, and discarded items from street

trash or dumpsters”xi. Having collected an item, the hoarding individual rarely discards of it, and

tends to endow objects with “sentimental, instrumental, or intrinsic value in excess of their worth

in most people’s eyes”xi. Among those hoarding individuals who are able to discard some of their

possessions, “the process [of discarding] is so elaborate and time-consuming that the number of

newly acquired items easily exceeds removed ones”, resulting in a steady accumulation of

possessions over time.

An additional characteristic of compulsive hoarding behavior, to the extent that it has

become an additional quasi-diagnostic distinction between collection and hoarding, is a lack of

insight into the detriment of such behavior on the health and well-being of the hoarding

individual and others. Indeed, most of the small proportion of hoarders who seek treatment do so

at the urging of others, rather than as a result of acknowledgment of functional impairmentx.

Even among those most severe of hoarding instances which are reported to community health

authorities, hoarding individuals fail to recognize the danger their behavior poses to their own

and others’ health and safety. An interview study with Massachusetts state health officers reveals

this entrenched tendencyxi. Over a five year period, excessive hoarding was reported to co-
present with substandard household hygiene in a full 88% of complaints. Other measures of

impairment were similarly severe: 86% of cases saw a marked inhibition of movement within

living spaces, 92% of reports included limited furniture access (such as inability to sleep in the

bed due to accumulated clutter, etc.), and 80% of case files described inhibited access to food

preparation and storage facilities. Even when confronted with the health officers’ assessment of

their living conditions, however, only 50% of cited individuals acknowledged the health risk

posed. Compliance statistics in such extreme cases are also incredibly telling: only 32% of cited

hoarders willingly cooperated in removal and sanitation of their properties, while 28%

cooperated reluctantly “but made few attempts to reduce the number of possessions.” The

remaining 40% refused to cooperate at all in the cleaning process and had to be monitored by

community health agencies and family members. Researchers point to such studies, although

flawed by selection bias toward extreme cases (i.e., those that have reached such a threshold of

severity as to warrant a complaint to community health agencies), as indicative of a general lack

of insight on the part of hoarding individuals. Indeed, subsequent case studies report relative

unanimity among hoarders’ resistance to changing their behavior, summed up in the following

general profile: “In spite of admitting the irrationality of their hoarding, [most patients] consider

the ideal solution to be the acquisition of more space; […] none suggested the solution was the

curtailment of their hoarding”xii.

Hoarding epidemiology

It is difficult to determine an epidemiological prevalence for disorders such as hoarding,

largely due to the aforementioned resistance on the part of sufferers to come forward for

treatment. However, a recent case study puts the prevalence between 0.4 to 5.0% in the U.S.

based upon community samples, including both subclinical and pathological hoarding
tendenciesvi, xiii. Age of onset varies widely across case study estimates, due largely to

discrepancies in determining what constitutes a clinical manifestation or precursor. Among

hoarders able to pinpoint precisely when their tendencies toward compulsive saving and

acquisition, 60% indicated an age of onset at or before 12 years, with 80% indicating their

hoarding behavior began before age 18xiv. Anecdotally, however, the vast majority of reported

cases involve the elderly, and several studies have found an increased prevalence with age, while

also noting the likelihood that “consequences of a hoarding tendency become more problematic

as individuals age, due to accretion of objects over time, or because of increases in physical and

mental infirmities that interfere with discarding and organizing possessions”13. Such caveats

illustrate the importance of differentiating between age of onset of the behavior and thinking

patterns versus age at presentation for treatment or report to community health officials. As far as

distribution of the disorder, there is a relative consensus that hoarding behavior is inversely

related to socioeconomic status13. There is debate as to gender distribution, with some studies

finding significantly higher prevalence among males13 and others finding no significant

difference between the sexes6. In sum, considerable debate remains as to the epidemiological

prevalence of hoarding symptoms, perpetuated by the dearth of truly epidemiological studies.

Debate over diagnosis: separate or subsumed?

As noted above, there is considerable debate over whether hoarders should receive a

distinct diagnosis or be covered by the umbrella diagnosis of OCPD. One of the first case studies

to address hoarding specifically determined that “hoarding would seem to be best subsumed

diagnostically under obsessive-compulsive disorder”12. Several studies have indeed established a

link between obsessive-compulsive symptoms and hoarding tendencies, estimating that 18-33%

of those diagnosed with OCD also presented with hoarding symptomsxv. Inversely, hoarding
individuals also demonstrate elevated OCD symptoms6, but cases in which hoarding symptoms

exist without OCD comorbidityxvi suggests that their linkage is not absolute. Clinicians note

several key differences between obsessive-compulsive and hoarding tendencies. First, patients

presenting with clinical OCPD most often have insight into the negative impact of their behavior,

whereas the hoarder most often emphatically denies any ill effects and derives considerable

pleasure from acquisitionxvii. This is most evident in the fact that OCD patients seek treatment

much more willingly (and comply much more reliably) than hoarders16. Response to treatment

also differentiates hoarding from obsessive-compulsive behaviors, as cognitive-behavioral

therapy and medication most frequently prescribed for OCD and OCPD have had considerably

lower success rates when implemented in hoarding cases17, although there is contention as to

whether such differences in treatment outcomes are the result of hoarding tendencies or other

factors such as age, gender or comorbid conditionsxviii. Researchers who posit a significant

differential response to treatment find links to the poor correlation of hoarding symptoms and

other OCD tendencies such as checking rituals, as compared to the strong intercorrelation of

such behaviors in clinically-diagnosed OCD patients not presenting with hoardingxix. Based on

the above, there is considerable support among the research community for the establishment of

a distinct diagnosis in DSM-V.

The Collyer case

While the technological innovations and the pervasion of mass media in the past half

century facilitate the current popular fascination with pathological hoarding behavior to an

unprecedented level, interest in abnormal acquisition in both the public imagination and

academic circles is hardly new. Just as Freudian psychoanalysis was reaching the height of its

primacy among psychological research and clinical practice in the 1940s, the bizarre story of the
Collyer brothers xxbrought to the forefront of American curiosity what remains the most extreme

published case of hoarding. Homer and Langley Collyer (b. 1881 and 1885, respectively)

belonged to one of the elite families of Manhattan social circles. Both excelled in study at

Columbia College, and, frequent accounts of eccentricity notwithstanding, upheld the family

name in their respective pursuits. Beginning in 1917, however, the brothers began to cut ties to

the outside world, disconnecting their telephone, gas, electricity, and finally running water

despite considerable family wealth. After Homer suffered a seizure in 1933, which completely

blinded him, both brothers disappeared from the public eye and Langley emerged from their

three-story Fifth Avenue brownstone only to fetch water from a public fountain or to shop for

food. Langley was also often seen after dark foraging the Harlem streets, “gathering items from

curbside trash piles and bringing them home […. including] huge amounts of newspapers,

cardboard boxes, barrels, metal cans, tree branches, scrap metal, and other assorted trash”.

Neighborhood fascination and concern at such eccentric behavior multiplied over the years after

a series of rumor-mongering New York Times exposés touting the hidden riches within the

Collyer family residence, as well as reports that the wealthy brothers had foreclosed on their

mortgage.

Finally, on March 21, 1947, Manhattan police received an anonymous report of a dead

body at the Collyer residence. Time reported the sagaxxi in a feature article the next month (see

photo appendix for accompanying photographs of the excavation):

It took a long time to investigate the call. The police chopped away the Collyers' bolted
front door, and were confronted by a solid mass of newspapers, cartons, old iron, broken
furniture. Finally a patrolman went up a ladder, opened a shutter, swept his flashlight into
a cave-like burrow. Homer was sitting on the floor. He was naked except for a thin and
tattered bathrobe, his long white hair hung down to his shoulders, and his hand rested
near a shriveled apple. He had been dead for some hours.
After that, the police tried to find Langley. At first they thought he was probably hiding
in the house. The building was packed almost solid from top to bottom with incredible
 masses of junk, pierced by winding tunnels. As they cleared passageways the police
found five pianos, a library containing thousands of books on law and engineering,
ancient toys, old bicycles with rotting tires, obscene photographs, dressmaker's dummies,
heaps of coal, and ton after ton of newspapers—the fruit of three decades of hoarding.
But nobody found Langley.

It would take another two weeks and shifting through over 100 tons of debris to uncover

Langley’s body, which was found crushed beneath one of his own rubbish booby traps rigged in

paranoia at robbers and prying reporters. Onlookers came from surrounding states to watch the

spectacle of the Collyer house of curiosities unfold, its secrets and oddities brought into the street

by the truckload. All told, New York housing authorities removed over 180 tons of miscellanea

from the Collyer house.20

Contemporary approaches: common experiences and cognitive-behavioral models

The waning of psychoanalysis has brought about a considerable shift in approach to such

cases as the Collyers and other hoarders. In lieu of regression, Freudian anal triads and fetal

states as explanatory bases, current frameworks seek commonalities among hoarding individuals

—in experience, cognitive processes, and more recently genetics—to build a profile of the

disorder and its sufferers. Recent studies have demonstrated the urgency of developing such a

profile. In addition to public health concerns associated with hoarding (discussed in detail

below), the family stressxxii as well as economic costs of hoarding—in lost work productivity,

eviction from housing and medical costs paid by public fundingxxiii—heighten the detriment of

hoarding behavior and make the study of such pathology imperative for the good of patients,

family and the community at large.

As far as common experience among hoarders, several interview studies have revealed a

correlation between a “general chaotic upbringing”13, ranging from such childhood adversities as

maternal deprivation to parental alcohol dependence to sexual abuse. One study found that 69%
of hoarding respondents had experienced at least one traumatic life event, compared to 51% of

non-hoardersxxiv. The same study also found a “robust and specific” relation between lifetime

traumatic events and hoarding severity. Many researchers and clinicians thus interpret hoarding

as “a behavior aimed at manifestation of a drive to perfectly control the environment”6. Given

hoarding’s additional correlation with lower income brackets, hoarding is thus seen in many

cases as a logical reaction to material deprivation. However, one must look only as far as the

case of the wealthy Collyer brothers for proof that poverty is not the sole (or even major)

contributor to hoarding tendency. Indeed, such has largely been the result of attempts to mine

experiential or circumstantial commonalities from the personal histories of hoarders, in that

universal generalizations are few and counterexamples glaring. While useful in constructing a

more detailed picture of the hoarding individual, common experience cannot fully account for

hoarding compulsion.

Common cognitive patterns go much further in developing a profile of the prototypical

hoarding case. The leading and most often cited framework for understanding hoarding behavior

follows a cognitive-behavioral model, in which hoarding is conceptualized as “a multifaceted

problem, stemming from: (1) information processing deficits; (2) problems in forming emotional

attachments; (3) behavioral avoidance”. Such models have been bolstered by a considerable

literature of case studies, patient interviews and controlled examinations of the thought and

decision-making patterns of pathological hoarders.

Foremost among information processing deficits common to hoarding individuals is

difficulty in object categorization. In addition to simple focus issues and high prevalence of

attention-deficit disorders among hoarders,xxv which may impede attempts at organization, an

underinclusive categorization scheme (i.e., an inability to reduce to basic characteristics) has also

been proposed as central to the condition. In decision-making and categorization experiments,

“hoarders took significantly more time, created more piles, and reported more anxiety than

nonpsychiatric controls”15 when asked to organize a collection of miscellaneous objects. Further

experiments reveal that the problem intensifies when hoarders are faced with categorizing highly

personal objects, and that hoarders report higher anxiety than control groups when asked to sort

their own possessionsxxvi. Clinicians’ home session experience25 has further confirmed this

underinclusive characteristic:

Hoarders' attempts to organize and discard their possessions on their own appear to be
characterized by [a process termed ‘churning’]. Possessions are simply picked up,
examined, and moved to a new pile. It appeared to us that churning involved a search to
find something the individual knew how to categorize---a clear-cut exemplar--something
that could be categorized easily. The clear exemplar can be put away, but everything else,
since it is not clear where any of it should go, stays in the pile. In such attempts the
possessions have been examined and moved, and a few items put away, but little progress
is made since most of the possessions go back into the pile.

One interviewed patient had “tried various methods to organize, including taping important

papers to the wall. Unfortunately, these systems failed because ‘important things’ were covered

with ‘more important things,’ resulting in a pile of items of varying importance”. From these

results, then, researchers associate hoarding with “an underinclusive cognitive style with respect

to categorization. That is, each possession must be set apart to reflect its special importance”27.

From multiple perspectives, difficulty in categorizing and organizing possessions appears to be a

near universal component of the hoarder’s cognitive blueprint.

The second information processing deficit widely found in hoarding individuals is

associated with memory, mainly in perceived deficiencies on the part of the patient. While

experiments have found no significant difference in memory function between hoarders and

controls, the hoarders’ confidence in their memory was significantly lower than their

counterpartsxxvii. For instance, patients who accumulate newspapers and magazines often fear

forgetting the information they contain, and so hoard written material as a substitute for their
perceived ‘poor memory’.25 In a similar way, many hoarding patients resist filing away

possessions in storage facilities for fear of forgetting any belongings not in plain sight.28

Researchers have suggested a link between the two information processing deficits. Non-

hoarders tend to focus only on those possessions deemed most important by their unconscious

organizing principles. Since hoarders have difficulty differentiating between ‘important’ and

‘unimportant’ objects, the task of remembering their larger number of ‘important’ ones becomes

exponentially more difficult and daunting25. This paranoia might be the foundation for lack of

confidence in memory faculties.

A strong tendency to develop deep emotional attachment to possessions is another

prevalent cognitive characteristic among hoarders. Interviews with self-identified hoarders

contain common threads such as elevated feelings of loss when throwing things away, and a

higher tendency to report that “they loved some belongings the way they loved some people”

than reported by non-hoarders6. Emotional attachment to possessions can become so strong as to

trigger physical discomfort at their disposal; as one hoarder reported, “I get a headache or sick to

my stomach if I have to throw something away”8. Understandably, then, such adverse side

effects of organizational experiments likely contribute to the reluctance of hoarders to seek and

comply with treatment. Even more fundamentally, the most intense of hoarders can even come to

view their possessions as extensions of themselves, and so protect their possessions as they

would their own well-beingxxviii. Especially for hoarders who may have had the aforementioned

“chaotic” upbringing, protecting miscellaneous objects may be a means to protecting the self

from perceived danger. This has been confirmed by interviews in which hoarders intimate, “I

don’t understand why, but when I have to throw something away, even something like dead

flowers, I feel my old abandonment fears and I also feel lonely”8. It would seem, then, that the

hoarder’s emotional attachment to his or her possessions can be so strong as to trigger emotional
or even physical pain at its severance; the Hoarding Scale discussed above in the section on

diagnosis reflects such attachments in its questionnaire.

Connected to the emotional attachment to possessions is the hoarder’s tendency toward

behavioral avoidance. Given the possibility of pain and a sense of loss at discarding a possession,

the hoarder may decide to save indiscriminately so as to avoid negative consequences

altogether29. There is also a strong correlation of avoidance with the anxiety of categorization

discussed above, as the hoarder can forestall distress by refusing to designate certain objects

worthy of saving or discarding15. Above all, hoarding has been proposed as a mechanism of

averting mistakes. Many hoarders present a preoccupation with the potential usefulness of their

possessions, reflected in the following clinical observation29:

Hoarders seen to have a heightened sense of responsibility for being prepared to meet a
future need. Each possession is seen as having functional utility under certain
circumstances. Although those circumstances may not pertain at present, they may in the
future. It is as though they have a solution, but no problem on which to use it. If the
solution is discarded and the problem occurs, 'harm' has been done. It is this 'harm' that
the compulsive hoarder seeks to avoid. The exact nature and severity of this 'harm' is
diffuse and unspecified.

Facing distress at categorization, strong emotional deterrents from discarding, and the possibility

of mistakenly throwing away an item that might be needed in the future, the hoarder sidesteps all

choices about possessions and simply accumulates, to the detriment of both individual and

community well-being.

The advent of advanced genetic research methods has of late begun to influence hoarding

research, and there has been considerable effort to determine whether pedigree has any causal

influence over the expression of hoarding tendencies. Prominent clinicians are divided on the

issue, with few willing to categorically assign hoarding a deterministic genetic component.

While the more cautious describe hoarding tendencies as “a certain set of inherited

characteristics”xxix but maintain the importance of environmental and experiential factors, some
researchers are more categorical, going so far as to suggest a “recessive inheritance pattern”xxx.

Recent case studies have added to the debate, with the boldest estimate placing heritability of

hoarding symptoms at 71%xxxi and more cautious case studies proposing that “hoarding

aggregates in families; first-degree relatives […] were significantly more likely to have

symptoms than the relatives of non-probands”xxxii. Two recent case studies have agreed on a 50%

heritability, based upon a findings from hoarding family history studies16 and twin studiesxxxiii.

Genetic testing has found suggestive linkage on chromosome 14xxxiv, although the majority of

researchers maintain a diathesis-stressor model34.

Sociocultural implications

With the exception of the rare researcher who wholly apportions blame for hoarding

tendencies to genetic predestination, most theoreticians shaping the current approach to hoarding

essentially sidestep causality. They analyze in detail the cognitive deficits and aberrant thought

patterns of their hoarding patients, without attempting an explanation as to the source of such

cognitive processes. Those case studies that stab at causality in hoarders’ common experiences

stop short, noting the curious lack of any universal experiential link and calling for more

comprehensive epidemiological studies, all the while missing a fundamental common

denominator: modern culture.

It is a glaring oversight indeed, given the particular nature of and restrictions on hoarding

behavior. Widespread hoarding is, by material necessity, restricted to the developed world. The

hoarding literature essentially accepts this conclusion on faith—one treatment guide opens with a

reference to the explosion of “the number of personal possessions owned by ordinary people […]

throughout much of the developed world [….and in] modern civilizations”6. However, the
restriction of hoarding to developed societies merits an examination, so as not to confuse a

necessary condition (i.e., general prosperity within a given society) as a causal mechanism.

Hoarders most frequently acquire either by buying goods (most often compulsively, as described

above) or by collecting various possessions from the street and nearby garbage facilities. A

relatively wealthy society is required for either case to become widespread, especially for such

tendencies to present in higher proportion among the lower socioeconomic tiers, as has been

shown to be true among hoarders13. In societies that are less-developed economically, the poorer

citizens do not have the means to compulsively acquire consumer goods; their incomes simply

cannot support such a compulsion, the vast majority of household income going toward

necessities such as food and rent. Nor is borrowing on credit an option, given the scant access the

poor have to the already scarce financial infrastructure of less-developed countries. In developed

economies, where the general level of wealth is considerably higher, even the less-affluent have

disposable income (or else have relatively easy access to credit through robust formal banking

systems) to facilitate hoarding and excessive consumption.

The second variety of hoarder—the compulsive collector, as opposed to purchaser—can

likewise only emerge on a widespread scale in countries in the developed world. Again, this is

purely a matter of practicality: only in developed countries is there widespread availability of

such (relatively wasteful) non-durable, disposable goods as compulsive collectors feverishly add

to their troves. For instance, newspapers and printed material, anecdotally placed among the

most common of hoarded items, cannot be hoarded in countries lacking abundant publishing

resources. An item in short supply cannot be stockpiled in this way, as explicit value—by virtue

of scarcity—makes it unlikely that goods will be disposed of into the eager hands of hoarders

nearly as readily as they would be in a developed economy. As such rapidly-developing nations

as China and India have seen over the past decades, a rapid increase in waste accumulation
invariably accompanies development and urbanizationxxxv. An item must be had before it can be

thrown away, and a country must be at a certain economic level before its general citizenry can

consume and dispose for pleasure. Additionally, one of the oft-touted development strategies

prominent since the 1970s (and at least partially responsible for the emergence of China and

India as economic powers) is export-oriented industrializationxxxvi, by which a developing

country targets export industries in which it can foster a comparative advantage. Due to

technological barriers, developing countries tend to focus on the production of non-durable

goods (e.g., plastic miscellanea, clothing and textiles, or automobile parts), for which they have

an advantage in cheap and abundant unskilled labor. Thus, for many countries a step toward

development is the strengthening of the non-durable goods sector, which was previously absent

or insignificant, its wares unavailable to the general public. As it is these non-durable goods that

fuel compulsive hoarding, it follows that as a practical generalization and given the profile of the

typical hoarder’s preferences, a society must be economically-developed in order to count a

significant number of hoarders among its citizens.

Should we, then, expect an increase in (i.e., the emergence of) compulsive hoarding

behavior to likewise accompany economic development, as invariably as an increase in waste

production has been reported? If the current framework for understanding hoarding behavior is

correct, there is no reason to assume so. After all, the cognitive-behavioral framework highlights

the aberrant thought patterns characteristic of hoarders, and there is nothing in the existence of

material wealth in itself to produce such thought patterns. The way in which information is

processed (and especially the formation of emotional attachment and anxiety over decision-

making, both central in hoarding frameworks) by nature falls into the domain of the mind, and is

thus determined by cultural context. For instance, an object’s importance to an individual

necessarily falls in line with the general regard for material possessions within that individual’s
culture, because it is the culture that teaches the individual the relational importance of objects to

the self. Such attitudes are not ingrained in human DNA, but rather are learned and shaped by

participation in cultural and historical context. It is thus presumptuous to expect hoarders to

come out of the social woodwork from a mere rise in GDP. It is likely that, in addition to the

precondition of economic development, there are certain cultural foundations to hoarding

behavior.

A review of the current research fails to find any study of international hoarding

prevalence, even one limited to developed countries. Further inspection reveals a complete lack

to date of case studies carried out in non-Western countries, the vast majority focusing on the

U.S. and U.K., followed by singularities such as a German study on compulsive buying and

hoarding prevalencexxxvii and the groundbreaking study by Greenberg on four Israeli hoarding

patients in the 1980s12, the first to focus exclusively on hoarding as a distinct pathology. It would

certainly be hasty to assume from the lack of non-Western studies that hoarding cannot be

widespread outside of a Western society. However, there are certain aspects of modern, Western

culture that make it particularly suspect in cultivating hoarding tendencies, as well as make

further study of culture’s influence on debilitating compulsions of paramount importance.

Greenfeldxxxviii examines the development of modern Western culture, tracing its roots

back to the development of nationalism in sixteenth century England. The three fundamental

features of nationalism (i.e., secular/humanist worldview, egalitarian social structure and

foundation in popular sovereignty—even if in name only) continue to characterize modern

culture. Most important to the causality of hoarding, they act in concert to produce an anomic

culture. Durkheim’sxxxix anomic “state of deregulation,” was both catalyst and result of the

development of modern nationalist culture. As Durkheim recognized, pervasive anomie is the

hallmark of historic periods of upheaval and cultural transformation; Durkheim specifically

highlights the role of anomie in shaping “modern societies when aristocratic prejudices began to

lose their old ascendancy.” The emergence of upward mobility and its replacement of rigid

feudal social structure spawned a similar period of anomie in sixteenth century England, as the

pervasive worldview with its religious and moral justifications for the status quo were suddenly

thrown into fundamental doubt. Thus, anomie spurred cultural change and the establishment of a

new dominant paradigm: nationalism. With its redefinition of the mass of society as “both

sovereign—the embodiment of supreme authority—and as a community of interchangeable

individuals, each with a generalized capacity to occupy any social position”38, nationalism’s

precepts eliminated inconsistencies between experience of social mobility and cultural norms

that assumed a determinate, inheritable class system. As Greenfeld examines, however, the

emergence of nationalism did not purge the pervasive anomic feeling that had heralded its

ascendance; in fact, it solidified anomie as a fixture of the resultant nationalist culture, endowing

modern culture with the same “normlessness.” The open class structure of nationalism invites the

individual, now on an even footing with all others due to an egalitarian bent, to shape his or her

own destiny and to form an identity based on personal preferences and ambition, as opposed to

receiving a determined identity based on social class. Modern culture does not provide iron-clad

guidelines for shaping such an identity, in essence replacing an inflexible but predictable system

of determinate identity endowment with an endless process of identity chasing, in which modern

individuals must cast their own mould.

The intense pressure of fashioning one’s own identity puts exaggerated importance on the

decisions of the individual. Under a rigid social structure, one needs only to examine decisions in

light of one’s class-endowed identity and execute the appropriate response. An open structure

exponentially increases the gravity of each decision, because each choice is an additional

component of an identity under perpetual construction, reflective not only of self-interest but of
self-defined morals and worldview. For the majority of participants in modern culture, the

perception of such anomie and the burden of crafting an identity out of thin air produces “a sense

of disorientation, of uncertainty as to one’s place in society”38 in occasional bouts of self-doubt

or identity crises, but few perceptible effects in terms of functional impairment. For others, such

as hoarders, the demand of defining oneself results in paralysis when faced with a decision. As

discussed earlier, hoarders report significantly higher anxiety when asked to make decisions

regarding their possessions, for fear of making a mistake in incorrectly categorizing an object or

discarding it prematurely. The stress of deciding being too great, the hoarder avoids passing any

judgment at all.

In the context of anomic modern, one can also view hoarding as a means to constructing

an identity. Recall the Hoarding Scale6 questionnaire, which includes the following self-

characterization: “I see my belongings as extensions of myself, they are a part of who I am.” A

hoarder’s possessions allow a tangible means of self-definition, in that he or she finds grounding

in an identity as the possessor, the owner of this and that and that. Also prevalent among

hoarders is a definition of self-importance as the guardian of their possessions; the hoarder does

not only own his or her belongings, but protects them from damage, misuse or waste25. Thus,

hoarding fills the gaping operative logic vacuum that is modern culture, giving the hoarder an

absolute directive (“collect”) and a guiding purpose (“protect”). Unable to satisfactorily outfit the

self with a firm foundational identity relative to other individuals within the cultural sphere, the

hoarder instead carves an identity relative to material possessions.

To be fair, even the categorically anomic modern culture is not entirely devoid of

directives. Nationalism’s secular worldview and individualism produced an approbation of

material ambition and consumerism that was previously unthinkable for the mass of society.

Secularism lights a particular fire under the individual to strive for economic gains, whereas
religious conceptions of an afterlife can encourage complacency and contentedness with one’s

socioeconomic position. While certainly desire for economic gain did not emerge with

nationalism, its dissemination of such ambition to all classes (a function of egalitarianism) is

certainly distinct. The desire to ‘get-ahead’ undermines any rigid social construct, and so the

spiritual benefits of asceticism and moral fortitude of the destitute are often preached among the

lower classes of such structures. But the religious opiate is only effective to a point, until such a

critical mass of anomic perception has been reached that social upheaval is inevitable. A secular,

open social structure makes material ambition morally-benign and even a mark of moral

superiority. To this end, then, perpetual accumulation—practiced in its most extreme by

hoarding individuals—is the logical reaction, as belongings are the sole exterior marker of the

ambitious. Perhaps simple unconscious maxims such as “more is better” and “waste not, want

not,” the lifeblood of Western consumerist culture enshrined in capitalist economics, expand in

importance to fill the dearth of other guidelines for modern life.

Conclusions: how best to proceed?

Intense research into hoarding behavior is still in its infancy. While public fascination can

help to spread awareness and encourage investigations into conditions previously kept closeted,

it is important to keep in focus the very real damage hoarding inflicts not only on the hoarder as

an individual, but also on his or her family and community, both in terms of public health and in

economic costs for damaged property and cleanup of condemned buildings. Seen in this way,

then, the nature of compulsive hoarding—its classification as a distinct malady or as

symptomatic of an umbrella condition such as OCPD, its causal influences and varied

manifestations—is not merely an academic exercise. Even the most gifted clinician cannot

effectively restore health without a comprehensive understanding of the affliction at hand, and
treatments founded on incomplete understanding run the risk of causing more damage than cure.

Several treatment innovations6 have begun to yield favorable results, but clinicians remain vexed

by compulsive hoarding’s chronicity, and continued investigation remains to build an accurate

disease model. There is reason to remain optimistic, however. Research into hoarding’s inner

workings already has an advantage over investigations into other conditions, in that the literature

thus far exhibits little of the bias toward a deterministic genetic interpretation. There are no

warring factions in the hoarding field (thus far), and clinicians and researchers often collaborate

to integrate the most current developments into treatment programs. However, multi-frontier

studies that examine the influence of cultural mores (or lack thereof) as well as individual

experience on the formation of identity and thought patterns must become a priority, in keeping

with emerging understandings of the mind-culture interface. Objectivity must rule above all:

both mind and brain must continue to occupy the attention of research, the power of each

respected and plumbed.

 Musgrave 22

Photo Appendix

Collyer Brothers: All photos taken from http://www.corbisimages.com , © Bettman/CORBIS

Original caption: Police smashed through a skylight in

the four-story brownstone home of the hermit Collyer
brothers as they began their search for the missing
Langley Collyer, who disappeared shortly before the
body of his older brother, Homer, was found in the
debris-littered mansion on March 21st. Starting from the
upper floors of the junk-filled house, police can be seen
standing atop junk piled so high that men were unable to
stand erect in the high ceilinged rooms. Note chandelier
hanging from ceiling.

Original caption: Patrolman John

McLaughlin checks through
the mess of junk found inside
the Collyer mansion at 128th
Street and Fifth Avenue, as the
police continued their search
for Langley Collyer, who with
his brother Homer, have lived
in the ramshackle brownstone
house as hermits for the last 40
years. Homer was found dead
of heart disease last Friday.
Whereabouts of Langley are
unknown and police feel that
he may be in the house.
 Musgrave 23

Original caption: A Building Department worker crawls

through the first floor if the junk littered Fifth

Avenue mansion of the hermit Collyer brothers.

On the theory that Langley Collyer, who

disappeared after the death of older, blind
brother Homer a few days ago, may still be in
 Musgrave 24

the building, police are clearing the house in

search of him. Homer was found dead in the
building March 21st.
Musgrave 25
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TV ratings from the website www.tvbythenumbers.com for August 18, 2009.
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Synopsis found on the website for the television show, www.aetv.com/hoarders.
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Jeffreys, Don. “Pathological hoarding.” Australian Family Physician 37:4 (2008): 237-241.
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