everybody accumulates stuff, and many of us have cluttered closets and drawers. but when seemingly useless possessions and even rotten food pile up, blocking exits and filling beds, sofas, sinks and bathtubs, it's evidence of a psychiatric condition called compulsive hoarding.
hoarding has spilled into the spotlight in recent years, thanks to 'oprah,' 'dr. phil' and the a&e series 'hoarders.' e.l. doctorow's new novel, 'homer and langely,' offers fictional insight into the reclusive collyer brothers, found dead in their fifth avenue mansion in 1947 amid 130 tons of trash, including 14 pianos, 25,000 books, decades worth of newspapers and the chassis of a model t ford.
yet most hoarders remain a family secret. experts estimate that as much as 2% of the population meets the criteria, a group that spans all education and income levels. 'attorneys, surgeons, business executives -- some very bright and successful people that you'd never suspect have this problem,' says san francisco psychologist michael a. tompkins, author of a new book, 'digging out,' aimed at helping families of hoarders. 'sometimes they're the life of the party, but nobody's ever been invited to their home.'
hoarders probably existed in other times and cultures, but psychologists are just beginning to understand what motivates them and how to help them. experts draw distinctions between hoarding and other forms of mess. collectors are discerning and display their treasures proudly; clutterers and chronically disorganized people are willing and able to clean up, and they welcome assistance. hoarders often strenuously resist help and turn a blind eye to the chaos.
psychologically, hoarding defies easy categorization. it's often seen as a form of obsessive-compulsive disorder, but some aspects don't fit the ocd pattern. nearly 90% of hoarders also acquire things excessively and experience a rush that's not typical of ocd. 'it's as if they go into a dissociative state where they forget that they don't have money to buy this or space to keep it,' says randy o. frost, professor of psychology and an expert on hoarding at smith college in northampton, mass.
some hoarders show signs of dementia, depression, post-traumatic stress disorder and attention-deficit disorder. many have trouble making decisions about objects and fear they'll later regret discarding something. their possessions are often extremely disorganized; bills often go unpaid because they are lost amid piles of videos and clothing. services get cut off, which compounds the squalor.
at the same time, some hoarders are extremely frugal, loath to waste anything that could be repaired or given to someone. some have lost jobs or loved ones and are holding onto physical reminders. some are highly imaginative: that empty toilet-paper roll could be covered with yarn and made into a doll . . . .
'i've seen many people who have an image of themselves as an expert cook or crafts person, and they collect all the objects that represent that craft until they are overwhelmed,' says gail steketee, dean of the boston university school of social work and another hoarding expert. 'it's a dream gone haywire.'
a subset of hoarders house large numbers of animals. experts at the school of veterinary medicine at tufts university report seeing cases with as many as 1,000 animals in a single home. hoarders are usually oblivious to the fact that the animals are malnourished or filthy, and they are convinced they're rescuing them from a worse fate.
indeed, most hoarders don't consider their living conditions to be a problem. the squalor bothers family members far more, particularly if they share the same home.
how can family members and friends help a hoarder? as tempting as it may be, experts say forcibly cleaning out a hoarder's home is bound to backfire -- and in some cases, cause severe psychological trauma. hoarders tend to feel violated and simply repeat the process in a new location.
instead, experts counsel patience and understanding, and letting the hoarder make his or her own decisions as much as possible.
one option is to hire a professional organizer, particularly one experienced with compulsive hoarding.
'shaming a person is never the answer,' says deb stanley, a professional organizer in clinton township, mich., who is also training to become a mental-health counselor. 'if you want the opportunity to effect change, you have to respect the person's dignity.'
some hoarders willing to seek treatment have found that antidepressants -- specifically selective serotonin reuptake inhibitors (ssris) -- can help manage emotions. cognitive behavioral therapy can also help change hoarders' thinking about their possessions.
人人都会积攒东西，而且我们中许多人的壁橱和抽屉都凌乱不堪。但是如果看上去毫无用处的物品，甚至是腐烂的食物堆积起来，堵住门口，堆满床铺、沙发、水池和澡盆，这就是一种精神病症的表征，这种精神病症被称为强迫性储物症。
近年来，储物症问题已经引起了人们的关注，这多亏“奥普拉”（oprah）、“菲尔医生”（dr. phil）和a&e电视台的系列节目“储物狂”（hoarders）。e.l.多克托罗（e.l. doctorow）的小说新作《霍默和兰格利》（homer and langely）用带有虚构色彩的文字探寻了科利尔（collyer）兄弟的隐居生活，1947年，这对兄弟被发现死于他们在第五大道的公寓中，身边堆满了130吨垃圾，包括14架钢琴、25,000本书、好几十年的报纸和一只t型福特车的底盘。
美国加州的一位妇女在家里养了至少75只猫。然而，多数储物症患者仍然不为外人所知。专家估计，多达2%的人符合储物症患者的标准，这一群体覆盖了所有教育和收入阶层。“他们中有律师、外科医生、企业主管──有些是非常聪明的成功人士，你永远想不到他们会有这种问题”，旧金山的心理学家汤普金斯（michael a. tompkins）说。他是新书《重见天日》（digging out）的作者，这本书的目的是帮助储物症患者的家庭。“有时他们是派对中的灵魂人物，但却从未邀请别人到自己家做客。”
储物症患者可能存在于其他时代和文化中，但心理学家刚刚开始了解他们的储物动机以及如何帮助他们。专家们总结出储物症和其他形式的积存行为的区别：收藏家是有辨识能力的，并且会很自豪地展示他们的宝贝；乱堆东西的人和长期生活没有条理的人愿意并有能力进行清扫，而且他们欢迎别人的帮助；储物症患者通常十分抗拒别人的帮助，而且对于乱糟糟的环境视而不见。
从心理学上讲，不能简单地对储物症进行分类。它通常被视为一种强迫症，但某些方面并不符合强迫症的模式。近90%的储物者还会购置多余的物品，并有过抢购的经验，而这并不是强迫症的典型症状。“就好像他们进入了一种游离的状态，在这种状态下，他们忘记了自己没有钱买这种东西或者没有地方存放它”，马萨诸塞州北安普顿市史密斯学院（smith college）的心理学教授和储物症专家弗罗斯特（randy o. frost）说。
有些储物症患者表现出痴呆、抑郁、创伤后应激障碍和注意力不足等症状。许多患者难以作出关于物品的决策，唯恐以后因为丢弃东西而后悔。他们的个人物品通常摆放得极其混乱；他们的账单经常逾期未付，因为这些账单遗失在成堆的影碟和衣服中了。一旦水电等服务被切断，其本已脏乱不堪的生活环境将雪上加霜。
伊丽莎白•尼尔森小时候的房间同时，有些储物症患者极其节俭，不愿浪费任何还能修理或送人的东西。有些人已经失去了工作或所爱的人，却紧抓着纪念物不放。有些人非常有想象力：他们能将空的卫生纸筒芯包上纱线做成娃娃……
“我见到过许多自认为是烹饪专家或手艺人的人，他们收集所有可以表现这种手艺的物件，直到他们被其淹没。”波士顿大学（boston university）社会工作学院院长、另一位储物症专家斯特科蒂（gail steketee）说。“这是一个失去控制的梦。”
有一类储物症患者收养大量动物。据塔夫茨大学（tufts university）兽医学院的专家称，他们曾见过在一所住宅中收养多达1,000只动物的案例。储物症患者通常对动物营养不良或肮脏污秽的状况视若无睹，并坚称自己是将它们从更悲惨的命运中解救出来。
实际上，多数储物症患者并不认为其生活环境成问题。这种脏乱的环境对家庭成员造成的困扰要大得多，尤其是当他们住在同一屋檐下时。
家庭成员和朋友们该如何帮助储物症患者呢？尽管听上去很诱人，但专家们称，强行清扫储物症患者的房屋必定会事与愿违──在某些情况下，甚至会导致严重的心理创伤。储物症患者会感觉受到侵犯，而且只会在新环境中重复储物过程。
相反，专家们建议要有耐心并理解他们，尽可能让储物症患者自己做出决定。
一种选择是雇佣一位专业统筹师，尤其是有强制性储物症处理经验的专业统筹师。
“羞辱一个人永远不是解决方法”，密歇根州的专业统筹师斯坦利（deb stanley）说，他也在接受心理健康顾问培训。“如果你希望抓住机会，让你的努力见效，就必须尊重别人。”
有些愿意进行治疗的储物症患者发现，抗抑郁药物──具体来说，是选择性五羟色胺再摄取抑制剂（ssris）──有助于控制情绪。认知行为疗法也有助于改变储物症患者对个人物品的想法。