The Pack Rat

Pack rats are scattered about among us, and their compulsive, pathological hoarding habit of disposophobia — the fear of disposing of or parting with things — has become a genuine health concern.

These "junk junkies" live in a maze of mostly useless stuff — either stashed in numerous stacks here and there, stuffed into drawers, containers and other receptacles, or piled high on shelves and sometimes on beds, from the floor up in every room at home, and often, at work, too.

Why do some people harbor the need to save and accumulate everything in sight, including newspapers, magazines, pets, food, computer files, every gift that they've ever received and whatever else they can get their hands on? And what health risks are they running?

"We don't know for sure what causes people to hoard, but most likely, in large part, it has a genetic basis. It's largely biological," explains Stephen M. Mechanick, chief of psychiatry, Bryn Mawr Hospital and Main Line Health System psychiatry chair.

"There isn't always a correlation if people grew up, for example, in a family that hoarded. It doesn't usually happen that it's learned in this way, but it can be," he says. "So we're still learning about it. Not enough studies have been done on it."

Adds Mechanick: "The condition overlaps with obsessive compulsive disorder and obsessive compulsive personality disorder. There is a compulsive quality that causes people stress to part with things. Of the psychiatric disorders, it's one that hasn't been studied that much because people don't often present themselves for treatment."

While those affected directly don't normally come for treatment on their own — many don't recognize the fact that a problem exists — he says family members and others around them do see a troubling behavior and often arrange for professional help.

For the condition to be called a disorder, there has to be a problem, explains Mechanick — either a subjective distress or a distress for others. For example, how bad is the hoarding, and what problems is it causing the hoarder and others?

"It can affect all ages, but tends to become more prevalent in middle age to later in life," he says.

People with a hoarding condition can become self-absorbed and detached, but they are the least concerned about it usually, he notes. Health and safety risks include a fire hazard from mounds and mounds of collected items, and a danger from eating spoiled food.

Rethinking the Problem

"Disposophobia can be revealed through some underlying reason, such as depression, and can be treated successfully with medications, including some of the typical anti-depressants, and through psychotherapy that tends to be more cognitive than behavioral," explains Mechanick, adding that clinicians focus on getting people to rethink their ways so they can see some of the distortions in their thinking.

"The thinking reinforces the behavior, and the behavior reinforces the thinking," he adds.

Treatment? For starters, patients should be seen weekly and then less so, he suggests.

At Community College of Philadelphia, David Berg of the behavioral-sciences department says that most people are somewhat obsessive and compulsive. It's only when those behaviors go over the top, he says, that they can become a problem.

"Being obsessive and compulsive can mean thinking about things — it can mean planning things out — so thinking and planning are a positive and can be a gift," says Berg.

"But when people cross the line," he continues, "it becomes a problem. Collecting various things, like any kind of mementos, books or memorabilia, such as sports, isn't a problem usually. It's normal and healthy to have those interests.

"When it turns into accumulating vast amounts and numbers of things in boxes, on shelves and on the floor, and it begins to interfere with normal living where there are piles and piles everywhere," he says, "and when people start to isolate themselves and become withdrawn, and when they can't get any work done … it's a major concern."

Of course, when hoarding behavior leads to unhappiness for anyone, attests Berg, it's time to get help.