The Secret Lives of Hoarders: True Stories of Tackling Extreme Clutter by Matt Paxton, Phaedra Hise

genetically predisposed may be triggered by a traumatic event. That same event can also trigger hoarding behavior, and the two disorders can develop simultaneously.
    Ironically, I’ve noticed that hoarders who are depressed usually don’t fight a cleanup. They just lack the initiative to make the push and get it done themselves, and they generally accept help. However, under these circumstances, it is even more important to understand that the cleanup on its own will not solve the problem. Unless the underlying issues are resolved, the hoarding will come back. Depression isn’t just an annoyance; it can lead to a seriously life-threatening situation.
▶ Social Phobia
    Ben, the “pizza man” who also hoarded vintage airplane parts, was shy and uncomfortable around people. He avoided group settings because they made him anxious. Ben seemed to have an issue that Dr. Chabaud says is sometimes linked with hoarding—social phobia.
    Hoarders who have a social disorder connect more with the world of objects than with people. Their possessions become their friends. Those possessions won’t threaten them with pressing questions or awkward social moments. Hoarders can control their relationship with these items more than they can control relationships with friends or family members.
    This disorder, Dr. Chabaud says, isn’t necessarily a symptom of hoarding, or a cause. Like depression, social phobia can show up in hoarders, but it’s not clear which disorder came first, or if one triggered the other.
    One of the keys to success on a hoarder cleanup is to get the hoarder back into the world and involved in outside activities and a social life. For that reason, any social disorder needs to be treated as part of a hoarder’s recovery therapy.
▶ Dementia
    Rick, the retired professor with a house full of paper, was showing signs of dementia when the cleanup began. He was very forgetful, often standing in the living room hunched over in confusion and asking the same question over and over. Sometimes he didn’t recognize an item he had in his hand, or remember why he was holding it. His sister commented that the problem had been worsening over the past year.
    He had focused on information hoarding during a lifetime as a professor, but his forgetfulness had exacerbated the problem. He would pick up something, intending to use it or throw it away, and then forget why he was holding it. Confused, he would just set it down again on a growing pile.
    A study published in the American Journal of Geriatric Psychiatry found that 23 percent of patients with dementia also showed hoarding behavior. As the population ages, dementia—and hoarding—will increasingly become severe problems, which need to be addressed in tandem. When a hoarder isn’t even able to have a coherent conversation about the issue, interventions are essential if the hoarder is living in conditions that are physically dangerous or unhealthy.

WHY GET INVOLVED?
    Aside from the emotional toll that hoarding takes, it can make conditions physically unsafe for the hoarder. Piles can fall over and germs can cause illness. A cluttered house can hide serious structural damage. An elderly hoarder can have trouble getting around, and if there are medical issues, it’s sometimes impossible for emergency medical teams to even get into the house to respond.
    As we have discussed, hoarding is—and often disguises—a severe mental problem, as hoarders tend to be isolated, cutting themselves off, socially and emotionally, even when they crave human interaction. If a hoarder also has a related mental disorder, that often goes untreated.
    Hoarding affects more than just a hoarder. Children growing up in a hoarder house don’t learn to set limits on their possessions and sometimes on their behavior. I’ve seen those bad habits spill over into work attitudes and financial management, so that a child of a hoarder struggles