The psychologist, who co-founded the San Francisco Bay Area Center for Cognitive Therapy in 1994, regularly works with patients who compulsively hoard possessions, and with family and friends who want to help a loved one deal with this behavior. Last year, at least six San Francisco residents were evicted from their homes because of excessive hoarding, which can become a safety hazard.
What causes people to start hoarding stuff? We don't really have good answers to that. It's definitely a mental health issue. It seems to have the most in common with obsessive-compulsive disorder, although recent research suggests it's a different disorder.
Do people with this condition hide it, or do they realize they're different? A large number of people do hide it, because they recognize the problem is so big. Often their home has become dilapidated, because they're afraid of inviting people in to do repairs.
Why can't they stop? [Some] have perfectionist beliefs and want to organize their possessions, but they want to find the perfect way to file an item. Similarly, when they try to let go of something, they experience a great deal of distress. They're much more reassured by having everything in sight, [which] means all horizontal surfaces are covered.
What's the worst case you've seen? I saw a gentleman who was facing eviction. I did a home visit, was able to squeeze through the front door, and immediately began climbing the hoard. When I got to the top, I could not stand up without my head touching the ceiling. I've seen other cases in which food and empty food containers were left, and there were rats and pests and the smell of rotting food.