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Compulsive hoarding--a lot more than just being messy

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A mess like this, which was built up by compulsive hoarding, can usually only be tackled with the help of intensive therapy or medications. Professional organizers may clear out the boxes, but psychological urges to collect papers or appliances will result in the quick return of clutter. (Courtesy of Melissa Korn/CNS)

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Katy H., a compulsive hoarder from Manhattan, sleeps on a mattress on the floor, surrounded by five-foot high piles of boxes, bags and papers. No more than two square feet of carpet are clear in the studio apartment's entire main room. (Courtesy of Melissa Korn/CNS)

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Compulsive hoarders, who make up at least 1 percent of the general population, find the act of throwing things away very traumatic. Katy H. collects newspapers, old appliances, shoes and clothing even though she knows it's not always logical. (Courtesy of Melissa Korn/CNS)

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Psychologists say that hoarders often collect boxes and bags with the intention of sorting through their belongings and cleaning up their homes. But because that is such an intimidating task, the containers themselves may begin to pile up and add to the clutter. (Courtesy of Melissa Korn/CNS)

Katy started collecting paper in high school, cutting blank space off homework and storing the sheets in her bottom desk drawer. She intended to write on the leftovers or make bookmarks, but it just piled up.

That was more than 40 years ago. Today, Katy, who requested that her real name not be used, lives alone on Manhattan’s Upper East Side surrounded by paper. Old copies of newspapers crinkle underfoot and have even crept up to cover her futon mattress, adding inches of extra cushioning for a good night’s sleep, she says.

Katy, a bookkeeper, also lives with 5-foot mounds of clothes, furniture and broken appliances blocking the windows. Loaves of moldy Arnold Whole Wheat bread rot in her crammed kitchen.

You might think she could clean up with an organizer’s help. A quick search on Craigslist or Google pulls up dozens of listings with names like “Clutter Cowgirl” and “The Clutter Cutter.” Professionals could sweep in, boxes in tow, categorize her sweaters and chuck her trash.

But it’s not so simple for Katy, a compulsive hoarder. People who suffer from this hard-to-treat psychological disorder are unable to discard items because of an exaggerated fear of needing them again, concerns over being wasteful or a sentimental attachment to the items. Some hoarders accumulate so much that they nearly bury themselves in their own homes.

“Hoarding is a serious mental health problem, and serious mental health problems require serious treatment,” said Dr. David Tolin, director of the Anxiety Disorders Center in Hartford, Conn. “There is some role for professional organizers, but we need to recognize that that does not solve the whole problem.”

Hoarding, which affects at least 1 percent of the population, was recognized as a subtype of obsessive compulsive disorder (OCD) in the late 1980s. Characterized by difficulty parting with objects as well as clutter to the point of “functional impairment,” hoarding is often associated with attention deficit hyperactivity disorder, generalized anxiety disorder, major depressive disorder and obsessive compulsive personality disorder, Tolin said.

But because many hoarders show few other signs of OCD, Tolin and some other researchers believe hoarding may soon become a disorder in its own right.

Hoarding has no cure, requiring lifelong work to fight the urge to collect. Therapists often use cognitive and behavior modification therapies, discussing what happens when patients discard objects, teaching them how to file papers instead of throwing them into piles and planning outings to stores without actually buying anything.

Although medication has been relatively ineffective for hoarders, a recent study at the Obsessive-Compulsive Disorders Program at the University of California, San Diego School of Medicine found that the antidepressant paroxetine, known commonly as Paxil, shows some promise for compulsive hoarders with OCD.

Those results are not comforting to people like John Dunn of Windsor, Conn., who has no OCD symptoms other than hoarding.

Dunn, 63, said his clutter expanded slowly outward from the dining room and worsened after his parents died. The oval table had towers of files climbing a foot tall. Papers piled 3 or 4 feet high soon lined the room’s perimeter. Next, his magazines, books and myriad instruction manuals invaded the living room, kitchen, bedrooms and even master bathroom.

Then about four years ago, he misplaced a six-figure check from the sale of his parents’ house. Morning-till-night digs through the files and furniture left him empty-handed and red-faced. He eventually had to request a new check.

The experience led him to seek help from Beth Johnson, a local organizer who runs workshops, support groups and online and in-person session for hoarders. Although not a trained psychologist, she uses similar techniques to those used by Tolin and other experts in the field, down to having discussions about how not to acquire new things.

Starting with what Dunn called his bathroom’s “shower closet,” filled with boxes, he and Johnson worked through the house for months. Johnson encouraged him take before-and-after pictures to focus on his progress and to donate items so he could discard things without feeling wasteful. In September 2005, Dunn and his wife used the dining room table for the first time in more than a decade.

“It’s a little easier to talk about it now,” Dunn said, estimating that his house is 85 percent emptier than it was 15 years ago. “It’s not over, though. It’s very hard to maintain.”

Now self-employed and working in real estate, he collects “For Sale by Owner” signs and stores them in his upstairs office, the one room he still hasn’t tackled.

Dunn, like many compulsive hoarders, said his marriage was strained for years because of the mess. Hoarders tend to be solitary, and the ones who do marry “have reached some treaty about living space,” said Randy Frost, a professor at Smith College and Tolin’s co-author on a new book about hoarding, “Buried in Treasures.”

Leslie, from West Hollywood, Calif., who also asked that her real name not be used, said lifelong hoarding forced her into a lonely adulthood because she was ashamed to bring friends and family home.

“I’m a real people person. I would cultivate new friendships but would really not let them in my house," said Leslie, 43, who has since cleaned most of her apartment with the help of therapy and the medications Abilify, Adderal and Wellbutrin. "I just felt so crappy about myself.”

Leslie said she had been accustomed to stumbling over boxes and shimmying past the vanity blocking her doorway. But when she was forced to play host, “I saw it through other people’s eyes, and I was just horrified,” she said.

Leslie said her social life had still not recovered to its pre-hoarding, 1980s level. Even though her apartment is suitable for visitors, she said, she is reluctant to have guests.

Although her home once looked like she was “getting ready for a garage sale,” full of clothes and memorabilia, Leslie says she is actually a perfectionist.

“There’s so much anxiety over what goes into every decision,” Leslie said. If she cannot find the right home for an object, she doesn’t put it away at all.

E-mail: msk2135@columbia.edu