Ask the Doctors: Cognitive behavioral therapy may help hoarders

Dear Doctor: I’m a 77-year-old woman, and I’m a hoarder. Well, maybe I’m a hoarder. Or maybe I’m just lazy or even a procrastinator. Regardless, how can I get myself in gear?

Dear Reader: Hoarding behavior has only recently been recognized as a disorder. According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, six criteria must be present for someone to be diagnosed with hoarding disorder:

1) The person must have difficulty parting with an item, regardless of its value;

2) The person feels a need to save the item, and has distress upon discarding it;

3) Such items lead to clutter of the living areas;

4) The hoarding causes decreased socializing, affects work or can lead to dangerous situations in the home;

5) The disorder is not caused by a brain disorder;

6) The disorder is not caused by depression, obsessive-compulsive disorder or schizophrenia.

Under this classification, hoarding disorder affects about 1.5 percent of people. Older people are more prone to hoarding disorder, as are those who are unemployed or single. People with hoarding disorder are also more likely to have depression, anxiety, panic and post-traumatic stress disorder. Hoarders are more likely to be perfectionists than non-hoarders, but are also likely to be procrastinators, avoidant and indecisive. Lastly, studies of identical twins have found a substantial genetic factor for hoarding behavior.

Obviously, I don’t know the degree of your hoarding behavior or even if you fit the criteria of hoarding disorder. Hoarders may have a strong sentimental attachment to the objects they possess or may feel that the object has some value — either for its aesthetics or for its potential use. Many people with hoarding disorder are not aware that their behavior is a problem, so it’s good that you have the insight to see that it may be an issue.

As for what you can do, the first course is to target a specific spot in your house — an area with little clutter is fine. Get a plastic bag. Put everything in that specific spot in the plastic bag. From the items in that bag, make three piles: a keep pile, a discard pile and a recycle/donation pile.

The discard pile should go straight to the trash. The recycle/donation pile should be taken to a local charity or recycling center. The items you want to keep should be itemized by what you intend to do with them.

If you’re saving items for your children, you might want to have them with you during this time, so they can tell you if they actually want the items. If not, then the items should be discarded or recycled.

Because you may experience distress when discarding, try focusing on one portion of your house at a time, and set multiple days for going through your entire house.

Many people with hoarding disorder benefit significantly from cognitive behavioral therapy, in which a therapist helps reduce clutter and prevent future hoarding. Don’t be afraid to get help for hoarding: Quelling this behavior will have a positive impact on your life.

Even if you don’t have hoarding disorder, the above plan can help you, as you phrased it, get “in gear.”

Robert Ashley, M.D., is an internist and assistant professor of medicine at the University of California, Los Angeles.