March 26, 2008 -- We are all pack rats to some degree. We hoard, collect and buy more stuff than we have room to store.
But what if something in our brains made us incapable of throwing things out? Janie Allocca and Lorraine Brennan both live with a psychological disorder called compulsive hoarding -- an urge to hold on to even the most mundane objects, even when they take over their lives.
In a 2007 interview with ABC News, Brennan said that she had been hoarding for nearly 20 years. She lived in a two-story house in Massachusetts with her father, son and fiancé. Most rooms in the house were cluttered, and some were even unusable. The bedroom-office that she shared with her fiancé was overrun with stuff they'd tried unsuccessfully to get rid of at a yard sale. Lorraine's purse was bursting with junk mail and receipts.
Brennan's hoarding was not only ruining her life but affecting her entire family. Her son couldn't bring friends home from school. Brennan and her fiancé had been engaged for eight years, but he couldn't commit to marrying her because of the clutter.
'There's No Place to Sit Down'
Many hoarders are also compulsive shoppers. Allocca had accumulated so much stuff that she used her own house as a storage facility and lived with her mother.
"I remember collecting, and keeping, and hoarding things since I can remember," Allocca told ABC News in 2007. "And now I am just living around the piles and piles I need to get rid of."
"I have so much stuff that my house is totally unlivable," she continued. "There's no place to sit down. I can't get to the kitchen. I can't have anyone over for tea even though I have everything for tea. My collecting is taking up the space where I normally would live."
There's a fine line between simple clutter and extreme hoarding. Most hoarders, observers say, are physically incapable of throwing things out. They can't live in, or use, rooms like the kitchen for their intended use. They also experience extreme distress over their condition.
The Brain of a Hoarder
Hoarding is considered a subset of obsessive-compulsive disorder, but that may soon change. New research is finding that hoarding may be a special disorder completely separate from OCD.
Dr. David Tolin, director of the Anxiety Disorders Center at the Institute of Living in Hartford, Conn., has devoted his career to studying what goes on inside the mind of a hoarder.
"At the moment, compulsive hoarding hasn't been fully defined by the psychiatric and psychological communities," he said. "One of the things that we wanted to do was to understand some of the brain mechanisms behind compulsive hoarding."
Allocca was part of a study Tolin conducted to see which parts of a hoarder's brain become active when they are faced with making decisions. She was hooked up to a brain-scan machine and asked to look at pieces of her mail and decide whether she wants them to be thrown out. She then had to watch the mail get shredded.
At this point, two parts of a hoarder's brain become active. The brain's orbitofrontal cortex is involved in decision making and causes a hoarder to process this experience as a punishing one. At the same time, the hippocampus of a hoarder actively searches for memories about the object. The hoarder tries to remember the object: What it is and why they saved it in the first place. By contrast, people without hoarding problems just don't think about the object that much.
'A Painful and Effortful Process'
"What we find is that the brain is acting very, very differently when a person hoards," Tolin said. "When the person is trying to make a decision about what to throw away, it seems that the person who is hoarding is processing this activity as if it is deeply punishing."
"The person who hoards is going through a very, very effortful search of their memory to try to think of as many things as they can about this item before they make the decision," Tolin said. "What this all amounts to then is a painful and effortful process of decision making, that you and I might take for granted."
There is no cure for hoarding, and there is no medication to treat the condition. Right now, cognitive behavioral therapy is the only way to help hoarders make decisions and deal with their emotions.
In Beth Johnson's Clutter Workshop in Hartford, hoarders and clutterers practice throwing out possessions to which they have grown attached. Johnson also takes her clients on nonshopping -- or nonacquiring -- trips to teach them not to buy things they don't need.
"I try to help them see the larger picture and how this item won't fit into their life," Johnson said. "If you have a jam-packed house, if you're adding to it on a weekly or daily basis, you're basically defeating yourself."
Randy Frost, a professor of psychology at Smith College in Massachusetts, focuses on helping hoarders make their homes clutter-free.
"One of the things we know about hoarding is that the beliefs people have about their possessions are so powerful, that it's very difficult for them to get out of this behavior," said Frost, who also wrote the book "Buried in Treasures," co-written with Tolin. "If the person throws something away and experiences distress, and does it again and again, eventually, they won't have that extreme emotional response, throwing something away."
Frost held a one-on-one session with Brennan to see if he could help her. After a few hours, she was able to throw away receipts and a few pieces of junk but, as with most hoarders, there was still a long road ahead.
One major motivator for Brennan was the possibility of losing her fiancé if she didn't clean up her home. When asked if she thought he would really leave, Lorraine said, "I don't want to find out. I don't want to end my relationship. I want to do better. I want to make it work. I don't want to live like this anymore. I really don't."
'No Magic Pill'
Today, Alloca said the biggest change is that she can actually "see" the mess. "I can acknowledge and accept that I have this problem," she said, but she cites things such as stress, emotional upheavals, bad habits and avoidance of dealing with old memories as still hampering her progress.
Alloca said clutter workshops and support groups did help, although "there is no magic pill, no one way that works for everyone."
"I did handle my flooded basement better than I ever thought I would," noted Alloca, whose house is still cluttered with stuff on the first floor. But she now rents the top floor to her nephew. "It's a challenge and slowly but surely I'm advancing."
At the Institute of Living, Tolin recently completed an Internet-based study on the harmful impact of hoarding. They were surprised to find the results were worse than other forms of anxiety and depressive disorders. In the most severe hoarding cases, there is a substantial economic burden, where those hoarders actually take themselves out of the work force.
Tolin said additional research on compulsive hoarding may show the disorder is more widespread than originally thought, "possibly as much as five percent of the population or 15 million people."
For more information on compulsive hoarding syndrome, click here