Download PDF

Back to Previous Page

CASE STUDY
"Sister Elizabeth" • Hoarding

Sheila M. Harron, Ph.D. is a psychologist in the Talitha Life Program at St Luke Institute.

Sister Elizabeth, a 65 year old sister, is a parish social worker. She has been a compassionate and effective minister for her entire religious life. Her community and the parish staff with whom she works admire her and respect her work.

Over the years Sister Elizabeth has accumulated a great deal of clutter. Her work space in the parish office is virtually unusable. Her desk is piled high with stacks of files, papers and phone messages. Her office is crammed with "things" that might be useful to someone in the future. Most of the items are overflow from the storage room the parish has provided for her work or are things she rescued from the trash. The storage room is piled from floor to ceiling with furniture, clothing, cleaning equipment and various types of supplies. Sister Elizabeth does not allow anyone into her office or the storage room. She keeps both of them locked. Other staff members are not aware of the extent of the clutter. They are conscious that sometimes she is scattered, does not return phone calls or get paper work done in a timely manner and has periods of little energy. She characterizes these as minor flaws related to her focus on helping people and not getting caught up in trivia.

In the convent where Sister Elizabeth has lived for several years her clutter has spread from her own bedroom and small office to several closets and basement storage space. Her bed is stacked high with papers so that she sleeps in the reclining chair. There is a path from the door of the room to her bed and to the closet. The surrounding stacks of catalogues, magazines, junk mail, reports and newspapers reach more than waist high. Napkins, food wrappers and paper plates are strewn around among the stacks. As at work, she is possessive about her space and won't let anyone in. The sisters who live with her have expressed their concern about how she is taking over the storage space in the house. She views this as their problem and thinks that they are being petty. She has taken to bringing items into the house when she knows the other sisters won't be around to see what she is doing.

Hoarding as a Clinical Problem
Hoarding is widely recognized as a symptom of Obsessive Compulsive Disorder. It is also known to occur in instances of anorexia, psychotic disorders and organic mental disorders. Recently, the phenomenon of hoarding is being seen as a clinical disorder in its own right when it is not a symptom of another disorder. Hoarding, characterized as acquiring, and at the same time failing to discard possessions that seem to be useless or of little value, gets progressively worse. With things coming in and not being disposed of, living spaces become so cluttered as to preclude their use.

Hoarding is an under-reported problem because those suffering from it do not seek treatment; rather, they resist it. They know it is unacceptable to others, consequently, they conceal it. Social constraints at work ordinarily keep the tendency under control in that setting, whereas, at home where few constraints operate, the hoarder begins to acquire. Neighbors, co-workers, friends and acquaintances would be completely surprised to see the extent of the junk stored in the house of the person who appears so competent and well-put-together.

The data suggest that hoarding begins in teenage or early adulthood years but gets out of hand as people age and are less able to manage their collections. Men hoard as equally as women do. Some characteristics of hoarders include problems with organizing and decision making (especially around their collections); emotional attachments to saved items; beliefs (such as "I must be responsible not to let anything be wasted" or "I must read everything that comes in") and avoidance of unpleasant tasks. Hoarders tend to be somewhat socially isolated.

Therapists are just beginning to develop treatment for hoarding. Antidepressants have had about 17 % effectiveness with this treatment group. Self help groups such as Clutterers Anonymous (www.clutterers-anonymous.org) and Messies Anonymous (www.messies.com) are beginning to form for those whose problems appear to be less severe. Currently, the treatment of choice is a cognitive-behavioral approach. This treatment includes psycho-educational group work and individual sessions with a focus on practice in organizing, not acquiring and discarding things. In addition the therapy attempts to help the person restructure the problematic beliefs that feed the collecting-such as "If I throw this out I will lose an opportunity". Those with the most severe hoarding problems need the help of home sessions with a coach to help make decisions about his or her collection, to execute these decisions and to plan relapse prevention. The goal is to create and maintain living space. The treatment can extend over a year and a half or longer because all decisions about discarding are made by the client.

Helping Hoarders in Community
When the hoarding problem comes to light the community might begin by describing what they see with the sister, giving her some reading materials about hoarding and self-help groups, and offering to assist her in discarding items and organizing material. Chances are that the sister will refuse help and resolve to do something about it on her own. She is often ashamed and humiliated by the community's awareness of the extent of her collecting. She may become angry and view the community as being punitive or unreasonable. Perhaps nothing changes.

At this point the community needs to intervene. The intervention can be conducted in a way similar to those with sisters who are actively alcoholic. The community clarifies before the intervention how they intend to provide treatment for the sister and to assure that the mess gets cleared out. The sister may already be in therapy (hoarders are often depressed) but very likely the therapist has no idea about the problem because the sister does not see it as such. Sometimes the situation does not allow the hoarding to be cleared out gradually (as in the behavioral treatment described above) because of impending moves, the unsanitary conditions caused by the hoarding, the sheer magnitude of the collection or the frayed nerves of the community. In these cases, others will clean out the things that have been hoarded. The sister will feel invaded and violated when this happens. The community needs to respect her hurt and anger and to give her help to process these feelings and to begin to realize that her collecting is of concern to the community and that she does have a problem.

Unfortunately, for the sister to stop collecting is not a matter of just saying no. The community would do well to understand that the symptom has been temporarily erased but the root remains alive and well. Even when everything gets cleaned out she will need to learn new behaviors of decision making and organizational skills about incoming material. She has to develop habits of disposing the accumulating "stuff". The sister cannot do this on her own. Besides cognitive behavioral therapy she needs people to act as "buddies" to help her stay on track with new behaviors and beliefs. The sister will do better if her "buddies" are persons she trusts who educate themselves on hoarding and who will function, not by imposing orders, but as friends to support her in maintaining her own space liveably. The buddies will be more patient and supportive if they realize how arduous and painful it is to change collecting behavior. Further complicating their task, the sister may be engulfed in shame about her problem and believe that she is neither a good person nor good community member. Her support system will attempt to mirror their acceptance of her even as they are helping her to change unacceptable behavior.

Treatment for this disorder is still in the beginning stages. Communities have an advantage that gives more hope for the sister who hoards because of the support she receives both in the bonds among the sisters and in the structures of accountability and responsibility.

LUKENOTES is a bimonthly publication of Saint Luke Institute.
Permission to use these materials must be requested in writing by contacting
lukenotes@sli.org

SLI EDUCATION DEPARTMENT
Saint Luke Institute
8901 New Hampshire Ave.
Silver Spring, MD 20903
(301) 422-5499 • (301) 422-5519 (fax)

back to top