For Hoarders, The Mess Begins In The Mind Researchers now believe that compulsive hoarding is an anxiety disorder that first emerges early in life and gets worse with time. For many, therapy that focuses on decision-making skills and reducing anxiety is much more successful than simply cleaning out the home.
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For Hoarders, The Mess Begins In The Mind

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For Hoarders, The Mess Begins In The Mind

For Hoarders, The Mess Begins In The Mind

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Convincing some parents to vaccinate kids is hard enough. It can feel impossible to convince other people to clear a path through the stacks of clutter that have taken over their homes. NPR's Patti Neighmond reports on an approach that might help.

PATTI NEIGHMOND: We've seen the TV shows and heard the stories about people who can't bring themselves to throw anything away. Researchers now believe these are people who have always been hoarders, that the problem first emerges in childhood and adolescence and gets worse as time passes. That's where psychologist Catherine Ayers comes in. Ayers specializes in anxiety disorders and late-life hoarding at the University of California, San Diego. And she's trying a new therapy with some of her patients.

NEIGHMOND: OK, Cheryl. So let's start off today with a review of your homework, and then we wanted to talk about our strategy of the day, which was using a calendar.

NEIGHMOND: Ayers talks with her 65-year-old patient, Cheryl Sherrell, who's been in therapy for about a month.

NEIGHMOND: Do you have anything to add to the agenda?

NEIGHMOND: Just what - maybe some of the to-do things that I'd put on the calendar.

NEIGHMOND: OK, great. So we're going to talk about how...

NEIGHMOND: To-do list, calendars, prioritizing and planning. Ayres is teaching basic skills that she says classic hoarders often don't have.

NEIGHMOND: So, for example, if there's a leaky faucet, somebody with a hoarding problem may have a tough time calling a number of plumbers and getting estimates, and then picking one and then carrying it forward and actually hiring a person and paying for it and doing all those things.

NEIGHMOND: Next, Ayers helps them apply those new skills to the more troubling problem of hoarding. She helps Sherrell sort through her stuff, asking questions about the use of each item and why Sherrell wants to keep it.

NEIGHMOND: Her distress will decrease between sessions, and somewhat within session. And most importantly, she's learning that she can tolerate the distress and still make decisions, despite being upset.

NEIGHMOND: One of Sherrell's biggest challenges was a white, fake-fur jacket that was way too small, and she says she hadn't worn for maybe 30 years.

NEIGHMOND: And so Dr. Ayers was asking questions about, you know, what is it about this coat that makes you want to keep it? And all of a sudden, the memory of wearing that coat when I was a young mom with kids that were still in my arms, and the emotion came - I just cried. I loved being a mom. I loved having kids home.

NEIGHMOND: But Sherrell found other ways she could preserve her past.

NEIGHMOND: I did realize that I could keep those memories with pictures, and that coat was - I probably would never wear it again, so I did choose to put it in the discard box.

NEIGHMOND: And that's the operative word Sherrell's learning from Dr. Ayers: choice.

NEIGHMOND: One of the things that I kind of knew intuitively but didn't really understand until it was taught to me here, is that I have to be in control. I can't let people come in and just take over. My anxiety just goes off the wall.

NEIGHMOND: Emily Saltz is a geriatric social worker in Boston who agrees control is key. She had a client whose court-appointed guardian had her condo cleaned out.

NEIGHMOND: And now, a year later, I've been called in, and the apartment is absolutely floor-to-ceiling bags, belongings, clutter, junk, bottles, food. And the client herself is actually sleeping in her car on the street somewhere because she can no longer fit into her unit.

NEIGHMOND: And even when patients resist getting into psychological treatment, Saltz says there are still things that clients can do themselves, small things that will help.

NEIGHMOND: Would she agree, for example, to put all the junk in one room - that could be behind a closed door - and keep the rest of the spaces clear? Could we get her to agree to create pathways between the junk so that there wouldn't be a fire hazard? So we would start with that, as opposed to we are getting rid of everything and, you know, we're going to make this place safe again, because it just doesn't work.

NEIGHMOND: Patti Neighmond, NPR News.

INSKEEP: And that's Your Health for this Monday morning.


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