Features Behavioural Sciences
Hoarding behaviour: Part 1

As a social history buff, I knew about hoarding behaviour long before I became a physician. In junior high, I read an account about the Collyer brothers: they were a local legend in New York City, and were subject to a newspaper story in 1938 that appeared in the New York World-Telegram titled “The Hermits of Harlem”. After the story appeared, the brother’s run-down brownstone became a source of urban myths; the house was subject to gawkers and the taunting of neighbourhood kids from outside the residence. This only served to increase their shared paranoia.

The Columbia University trained bothers lived with their mother and inherited the house when she died in 1929. Homer, the older of the two, was a lawyer. Langley, the younger brother, was an engineer and a talented concert pianist. When Homer lost his sight, Langley left his profession to care for him. Over the years, Langley would only venture out at night to purchase food for the two of them or bring back items that were of interest to him.

In March 1947, the police received an anonymous call stating there was a dead body in the residence. After great difficulty they entered the house. The front entrance was impassable due to unsteady towers of newspapers and police had to enter through a second-floor window. The emaciated body of Homer was discovered, and the medical examiner theorized that Homer had been dead for less than a day. Langley was nowhere to be found. There were reported sightings of Langley in other states, but one of the workers hired to clean out the house found Langley’s rat-chewed body only three metres from where Homer had been found two weeks earlier. The medical examiner theorized that Langley died a month earlier, suffocated in a tunnel of newspapers and other debris after accidentally setting off one of his booby-traps.

Police and workmen removed approximately 120 tons of items from the Collyer brownstone. This included baby carriages, a doll carriage, rusted bicycles, old food, potato peelers, a collection of guns, glass chandeliers, bowling balls, camera equipment, the folding top of a horse-drawn carriage, a canoe, rusty bed springs, the kerosene stove, a child’s chair (the brothers were lifelong bachelors and childless), more than 25,000 books (including thousands about medicine and engineering and more than 2,500 on law), human organs pickled in jars, eight live cats, the chassis of the old Model T with which Langley had been tinkering, tapestries, hundreds of yards of unused silks and other fabrics, clocks, 14 pianos (both grand and upright), a clavichord, two organs, banjos, violins, bugles, accordions, a gramophone and records, countless bundles of newspapers and magazines, thousands of bottles and tin cans, a great deal of garbage and much, much more.

Hoarding behaviour can begin relatively early in life and increases in severity with each decade.

Possessions can have a magical quality for many of us. Our most cherished ones contain an essence that goes beyond their physical qualities, like a ticket stub from a favourite concert, or a piece of clothing belonging to a deceased parent. Hoarding is not the same as collecting; collectors typically acquire possessions in an organized, intentional and targeted fashion. Acquisition of objects in people who hoard is largely impulsive, with little active planning, and is triggered by the sight of an object that could be owned. Objects acquired by people with hoarding lack a consistent theme, whereas those of collectors are narrowly focused on a particular topic. In contrast to the organization and display of possessions seen in collecting, disorganized clutter is a hallmark of hoarding disorder.

Pathological hoarding is not uncommon in the general population. It’s estimated that clinically significant hoarding occurs in 2.6 per cent of the population with higher rates for people over 60 years old and people with other psychiatric diagnoses, especially anxiety and depression.

Most individuals with hoarding disorder display the trait of excessive acquisition. The most frequent form of acquisition is excessive buying, followed by acquisition of free items (such as leaflets or items discarded by others). Stealing is less common.

Hoarding occurs with equal frequency in men and women. Hoarding behaviour can begin relatively early in life and increases in severity with each decade. The severity of hoarding ranges from mild to life-threatening. Some research has indicated that hoarding is associated with more work interruption than most other psychiatric disorders. In some instances, hoarding has been associated with fire-related deaths, and people have lost custody of children because of the condition of the home.

The American Psychiatric Association’s 5^th Edition Text Revision diagnostic criteria for hoarding disorder is:

1. Persistent difficulty discarding or parting with possessions, regardless of their actual value.

• The difficulty refers to any form of discarding, including throwing away, selling, giving away, or recycling. Some individuals have difficulty because of their perceived utility or aesthetic value of the items or a sentimental attachment to the possessions. Others may feel responsible for the fate of their possessions. Fear of losing important information is also common. The most saved items are newspapers, magazines, clothing, plastic bags, books, mail, any paper but virtually anything can be saved.

2. This difficulty is due to a perceived need to save the items and the distress associated with discarding them.

• The hoarder will feel distress including anxiety, frustration, sadness, guilt, and regret when faced with the prospect of discarding their possessions.

3. The difficulty of discarding possessions results in the accumulation of possessions that will congest and clutter active living areas and will substantially compromise their intended use. If living areas are uncluttered, it is only because of the interventions of third parties (e.g., family members, cleaners, or the authorities.)

• Typically, individuals accumulate large numbers of items that fill up and clutter active living areas to the extent that their intended use is no longer possible. For example, the individual may not be able to sleep in their bed or sit in a chair or even be able to cook in the kitchen. Clutter is defined as a large group of usually unrelated or marginally related objects piled together in a disorganized fashion in spaces designed for other purposes such as table tops hallways and stairs. Often their possessions can spill beyond the active living spaces and can impair the use of vehicles, yards, and hallways.

4. The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others).
5. The hoarding is not attributable to another medical condition.
6. The hoarding is not better explained by the symptoms of another mental disorder.

Now that we have presented a basic understanding of what hoarding behaviour is, the next column will address how police can respond to individuals who display this behaviour.

For the record, despite what my daughters state, my collection of rare and antiquarian books, vintage postcards from Nipissing County, World War I and pre 1940s restaurants in Toronto is not hoarding but collecting.

References

• American Psychiatric Association (2022) Diagnostic and Statistical Manual of Mental Disorders, 5^th Edition Text Revision. American Psychiatric Association Publishing, Arlington, VA.
• Falkoff, R. (2021) Possessed: a cultural history of hoarding. Cornell University Press: Ithaca, New York.
• The Oxford handbook of hoarding and acquiring (2014) eds Randy O. Frost and Gail Steketee. Oxford University Press: New York.

Peter Collins is the operational forensic psychiatrist with the Ontario Provincial Police’s Criminal Behaviour Analysis Section. He is also a member of the crisis/hostage negotiation team of the Toronto Police Service Emergency Task Force. Dr. Collins’ opinions are his own. Contact him at peter.collins@utoronto.ca.