Hoarders: Is it “All in their Head?”

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Hoarding, which is defined as the compulsive urge to acquire and retain a large number of possessions that appear to be useless or of limited value, is estimated to effect two million people in the United States alone. New research reported on at NBC News suggests a brain malfunction may be responsible, at least in part, for the disorder.

My Stuff, Your Stuff

David Tolin, adjunct associate professor of psychiatry at the Yale University School of Medicine and director of the Anxiety Disorders Center at The Institute of Living in Hartford, Connecticut, noticed during his extensive experience working with hoarders that people who tend to hoard become abnormally nervous when asked to discard objectively rather useless possessions. He questioned whether this high level of anxiety has a biochemical basis. His research team completed brain scans on 43 hoarders, 31 patients with obsessive-compulsive disorder and 33 control subjects with no evidence of either OCD or hoarding to see if there were significant biochemical differences in brain functioning between these groups when asked to discard clutter from their homes.

Tolin’s group had each research subject bring into his laboratory all the papers from their countertop, which he put in a box labelled, “my stuff.” He then had the researchers themselves bring in their own personal junk mail, which he put into another box labelled “your stuff.”

While each subject’s brain responses was scanned, a researcher went through each item in both boxes, asking the subject if the item could be shredded. Subjects were told no items would be thrown out without their consent. Hoarders had significantly different brain patterns during this exercise than did OCD patients or “normal” controls.

Significant differences in the insula and the anterior cingulated cortex of the hoarders’ brains were noted. There was significantly lower activity in these areas when the researchers were going through other people’s items as opposed to when they were going through the hoarder’s personal items. During these occasions, brain activity in the insula and anterior cingulated cortex skyrocketed.

Tolin speculates that increased activity in these brain areas is unpleasant for the hoarders, who respond by avoiding decision-making activities altogether. Similarly, hoarders may not notice clutter in their homes as their brain shows low activity in these brain areas when they aren’t asked to throw items out. Tolin is unsure if his hoarders’ brain patterns are genetic or environmental. Cognitive-behavioral treatment, as well as pharmacotherapy with drugs like Paxil, however, is targeted toward changing these brain patterns, no matter their origin.

In cognitive-behavioral therapy, the hoarder is systematically desensitized to decision-making with regard to throwing away his junk. He is shown an item, is asked to make a decision about whether to keep it or throw it away, and his thinking patterns are shared with the therapist. Maladaptive thinking patterns are eliminated and replaced with more adaptive ways of thinking as a way of teaching the hoarder to manage his high levels of anxiety.

According to Science Daily, Sanjaya Saxena, M.D., Director of the Obsessive-Compulsive Disorders (OCD) Program at the University of California, San Diego (UCSD) School of Medicine, has conducted his own research, which supports the neurological hypothesis about hoarders. He found that Selective Serotonin Re-uptake Inhibitors, such as Paxil, might be effective in the treatment of hoarding. His small study found that 32 patients with compulsive hoarding syndrome responded favorably to SSRI medications. Results are promising and warrant further investigation.