Hoarding has traditionally been considered a subset of Obsessive Compulsive Disorder. It shows some clear differences from typical OCD, however, and will likely warrant its own diagnostic category in the upcoming DSM-5.
One of the most difficult aspects of compulsive hoarding is that (unlike OCD) the behaviors are not usually felt as problematic by the person doing the hoarding. Their possessions are to them valuable collections of items which should not be discarded, rather than the junk and rubbish seen by others. Their possessions make them feel safe and secure. Throwing things away is very painful; it can feel like stripping off their own skin, piece by piece. Eventually, however, the hard work must be done, as their hoarding can cause health and safety issues which reach the level of abuse toward children and others living with them. Without change, people can become more and more isolated and may eventually die alone in the midst of their “stuff.”
In my view, compulsive hoarding is a tenacious negative coping strategy for dealing with stress and anxiety, often learned in the patient’s childhood home, with heritable/biological components. The biggest hurdle to improvement is helping the person become safe and secure enough to begin the hard work of discarding possessions and leaving behind dysfunctional shopping and spending habits. Nothing will change (for the better) without commitment and effort on the part of the hoarder. Improvement may require psychotherapy and medication to treat the depression and anxiety which are commonly associated with hoarding. It also requires a tremendous amount of patience and persistence by friends and family. Those closest to the person should realize that the problem may never be completely “fixed,” that without vigilance and continued commitment on the part of the hoarder, their things will begin to accumulate again. It is a real balancing act on the part of therapists and family to help the person acknowledge that they must change while at the same time lowering the amount of stress and anxiety that they must get through.
Improvement is possible, however, and families can dramatically improve their quality of life as the afflicted person is able to let go of their collected possessions.
Below are links to sites which may be helpful to hoarders and their families:
A discussion of online support options
Books on hoarding and treatment
A British site with helpful info
A quick overview of hoarding