STEVE INSKEEP, host:
A new study focuses on the brains of compulsive hoarders, people who save so many things that their lives become focused exclusively on collecting and keeping. NPR's Michelle Trudeau reports on a brain imaging study that provides evidence about the specific brain circuits involved in compulsive hoarding.
MICHELLE TRUDEAU reporting:
Rick, who requested we not use his last name, is among the estimated one million people in this country who are compulsive hoarders. He says he remembers always being what he calls a packrat.
RICK: And like anyone who's a packrat, I didn't think anymore about it. But then friends were pointing out to me that hundreds and hundreds of pounds of newspapers and magazines scattered around the rooms of the house are getting in the way of walking.
TRUDEAU: Rick collected and saved anything you could find about his two great passions: World War II history and old-time Hollywood. But the papers and magazines and books he hoarded were not organized in any way. Rather a hodgepodge of piles on the couches and tables, stacks covering the floor and surrounding his bed, cardboard boxes everywhere crammed full.
RICK: I would have boxes of articles torn out, checklists...
TRUDEAU: And the newspapers and magazines--why did you keep them? What were you saying to yourself?
RICK: I--well, what I was saying was that I'll read this stuff someday. And I also had a great need to hang on to stuff that whether or not I'll read it, I needed to have it.
TRUDEAU: This driving powerful need to hang on to stuff is typical of patients with compulsive hoarding. Rick describes it as an intense unease at getting rid of even a single piece of paper.
RICK: And had enormous discomfort if I even wanted to throw it away. And I was good at convincing myself I had good reasons for keeping them.
TRUDEAU: What did your home start to look like?
RICK: Well, to me, it was just a little crowded. But, you know, one's friends forgive you just about anything, but when even friends start saying, `This is a little out of hand here,' I began to think about it.
TRUDEAU: This reflective, insightful 55-year-old says he began to wonder about his own unusual collecting compulsions.
RICK: I was along enough in years to know that something wasn't right. And I was willing to explore it.
TRUDEAU: And exploring it brought Rick across town to UCLA where a study of compulsive hoarders was just getting under way. Sanjaya Saxena, a research psychiatrist at UCLA, directed the study and treats patients like Rick with compulsive hoarding.
Dr. SANJAYA SAXENA (Research Psychiatrist, UCLA): The most commonly hoarded and saved items include things like newspapers, where people want to save important articles that they might want to read later, magazines, books, clothes--old clothes that they might want to hang onto, storage containers, boxes, bags. We've had patients who end up sleeping in a little corner of their living room because their entire bedroom is now cluttered.
TRUDEAU: And at its most severe, people will hoard and be unable to throw away even their garbage. Saxena says that for his patients, compulsive hoarding is a fearful and painful anxiety.
Dr. SAXENA: We've had people who've had boxes and bags of trash all throughout their house, you know, several feet high, unable to throw them away because of fear that there might be something important inside.
TRUDEAU: So consumed, such people often are unable to work and can feel so shamed by their hoarding behaviors, that they become socially isolated. Hoarding like this is a form of obsessive-compulsive disorder, says Saxena, a common psychiatric illness where patients are gripped by obsessional thoughts and compulsive behaviors. But only about one out of every 10 people with OCD are severe hoarders. So Saxena wondered if hoarders may have a unique brain signature, distinct from other OCD patients and different from normal, healthy people. To find out, Saxena took brain images of 12 compulsive hoarders, including the patient Rick. The results of the study are published in the current issue of the American Journal of Psychiatry.
Dr. SAXENA: And what we found was that the compulsive hoarders had a qualitatively and quantitatively different pattern of brain activity as compared to not only the normal control individuals, but also other patients with OCD.
TRUDEAU: The brain images showed significantly less activity, 10 percent lower metabolism, in an important area of the brain called the singlet that controls decision-making, motivation, attention.
Dr. SAXENA: And so lower activity in that area fit very well with what we see clinically. It fit with the tremendous indecisiveness and attentional and motivational problems that the hoarders describe in their daily lives.
TRUDEAU: And, Saxena adds, in each patient, the lower the activity in this brain area, the more severe the compulsive hoarding behaviors were.
Dr. SAXENA: The results of our study would suggest that lower activity in this area is a marker for hoarding and saving.
TRUDEAU: Having located the specific brain circuits associated with compulsive hoarding will allow researchers to design medications specifically targeted to help normalize brain activity in these areas. That's a critical next step because currently, neither medicines nor psychotherapy, which are used effectively to treat other OCD symptoms, work well in treating compulsive hoarding. James Leckman, a research psychiatrist at Yale University, studies compulsive behaviors. He believes hoarding activities evolve from our primitive past.
Dr. JAMES LECKMAN (Yale University): There probably were times in our evolutionary history that unless our forefathers and foremothers were careful to sort of collect things that we would need during periods of privation that we just wouldn't have made it to the next generation.
TRUDEAU: So, Leckman adds, hoarding behaviors themselves are normal and functional, to a point.
Dr. LECKMAN: When they dominate an individual's mental landscape and they can't do much else besides focus on these issues and it takes up so much of their time, that's when it becomes a pathological state.
TRUDEAU: Rick's life was dominated by his collecting and saving behaviors. But because he entered the UCLA study, he was able to get help with his compulsive hoarding. He was prescribed an antidepressant called Paxil. And while generally not very effective in treating hoarding behaviors, in Rick's case the medicine worked, evidenced when Rick and a friend began digging out his house.
RICK: We cleaned the whole house for several days and finally I said, `You know, I can't put it off any longer. We've got to get rid of the newspapers.' And out came all the large trash bags and hundreds and hundreds of piles--newspapers and magazines went into these huge bags and out to the trash.
TRUDEAU: He didn't save anything because, as he says, he wanted to shut down the behavior. He was successful.
RICK: I felt remarkably relieved. I was sort of surprised. It was like taking a shower after a particularly grimy day. I just really felt somehow relieved, unburdened of it all.
TRUDEAU: Rick still has some hoarding urges and tendencies. So, for example, he now keeps empty computer and equipment boxes stacked up in the living room just in case he needs to return any of the equipment for repair. But he's aware that this collecting is starting to feel obsessional again, and he's determined that his compulsion to keep is kept under control. Michelle Trudeau, NPR News.
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