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Brain Scans of Hoarders Reveal Why They Never De-Clutter

The views expressed are those of the author and are not necessarily those of Scientific American.

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hoarder brain scan ocd fmri

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Jill, a 60-year-old woman in Milwaukee, has overcome extreme poverty. So, now that she has enough money to put food in the fridge, she fills it. She also fills her freezer, her cupboard and every other corner of her home. “I use duct tape to close the freezer door sometimes when I’ve got too many things in there,” she told A&E’s Hoarders. Film footage of her kitchen shows a cat scrambling over a rotten grapefruit; her counters—and most surfaces in her home—seemed to be covered with several inches of clutter and spoiled food. “I was horrified,” her younger sister said after visiting Jill. And the landlord threatened eviction because the living conditions became unsafe.

Jill joins many others who have been outed on reality TV as a “hoarder.” We might have once called people with these tendencies “collectors” or “eccentrics.” But in recent years, psychiatrists had suggested they have a specific type of obsessive-compulsive disorder (OCD). A movement is underfoot, however, for the new edition of the psychiatric field’s diagnostic bible (the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5), to move hoarding disorder to its own class of illness. And findings from a new brain scan study, published online August 6 in Archives of General Psychiatry, support this new categorization.

Hoarding disorder is categorized as “the excessive acquisition of and inability to discard objects, resulting in debilitating clutter,” wrote the researchers behind the new study, led by Yale University School of Medicine’s David Tolin.

Many of us might feel our homes or workspaces are far more cluttered than we would like—or than might be good for our peace of mind. But those with diagnosed hoarding disorder usually have taken this behavior to a different level. The Mayo Clinic even has a guide for treatment and prevention of hoarding disorder. One recommendation they provide: “Try to keep up personal hygiene and bathing. If you have possessions piled in your tub or shower, resolve to move them so that you can bathe.”

Some people hoard particular types of things, such as newspapers, craft supplies or clothing. Others, with a condition known as Diogenes syndrome, keep trash, including old containers, rotting food or human waste. Finally, as Animal Planet’s Animal Hoarders has shown, many hoarders collect more pets than they can appropriately care for, risking both their own and their animals’ health and safety.

To find out more about how the brains of hoarders might actually differ from those of healthy adults—and potentially even those with OCD—Tolin and his colleagues recruited 43 adults with a diagnosed hoarding disorder, 31 with OCD and 33 healthy adult controls to undergo fMRI brain scans. Each subject was asked to bring in a stack of miscellaneous, unsorted papers from their home, such as newspaper and junk mail. A similar collection of paper items from the experimenters was intermingled. Fifty items belonging to the subject and 50 items belonging to the experimenter were scanned and projected into the subject’s field of view in the fMRI. Subjects were asked to choose whether they wanted to keep a displayed item (either belonging to the subject or to the experimenters) or get rid of it by pressing a button. Afterward (and in a shorter pre-experiment training session), all of the discarded items were shredded right in front of them—ensuring that they knew that their decisions would have a real and immediate consequence.

Healthy controls chose to discard a mean of about 40 of the 50 items they brought. Those with OCD discarded about 37 items. But those with a hoarding disorder discarded only about 29 of the 50 things they brought. It also took hoarders slightly longer than healthy controls (2.8 seconds compared with 2.3 seconds) to make their decision about what to do with the items. And they reported substantially more anxiety, indecisiveness and sadness than healthy controls or those with OCD while making decisions.

Those with hoarding disorder showed key differences in the fMRI readings in both the anterior cingulate cortex, associated with detecting mistakes during uncertain conditions, and the mid- to anterior insula, linked to risk assessment, importance of stimuli and emotional decisions.

Interestingly, hoarders showed lower brain activity in these regions when they were deciding about other people’s items. But when they were faced with their own items, these areas of the brain showed much higher rates of signaling than those in either people with OCD or the healthy controls. Those with hoarding disorder also reported “greater anxiety, indecisiveness and sadness” during the decision-making process than those with OCD or the healthy controls.

As Tolin and his co-authors noted, hoarders are not necessarily eager to keep everything they possess, but rather “the disorder is characterized by a marked avoidance of decision-making about possessions.” And the extra activity in the anterior cingulate cortex and insula while evaluating what to do with their own items “may hamper the decision-making process by leading to a greater sense of outcome uncertainty,” the researchers noted. In other words, hoarders might often feel that they are at risk of making a wrong decision—and that that decision could bring with it greater risk than it actually would. “The slower decision-making may be a central feature of impaired decision making in hoarding,” the researchers noted.

The frequent theme on hoarder reality shows is that the individual does not realize that their lifestyle has spiraled out of control. Bernie, a 59-year-old Illinois woman featured on TLC’s Truth Be Told: I’m a Hoarder said, “I don’t consider myself to be a hoarder—not at all,” even after showing the film crew an entirely full house and a pool table room piled nearly to the ceiling with toys and other collected items—and after her daughter and son had implored her to clean up her house. As the authors of the new paper note, those with the disorder “are frequently characterized by poor insight about the severity of their condition, leading to resistance of attempts by others to intervene.” And as the Mayo Clinic notes, even if hoarders’ collections are disassembled, they often begin acquiring more items right away because their underlying condition has not been addressed.

As with for patients with OCD, those with hoarding disorder have had some success reducing negative symptoms by taking selective serotonin reuptake inhibitors (SSRIs). Psychotherapy and cognitive-behavioral therapy are also frequently employed to help patients overcome the disorder. Although neither of these approaches is a sure-fire way to cure hoarding, the biggest hurdle to recovery still seems to be recognizing the problem. And as the Mayo Clinic recommends, “getting treatment at the first sign of a problem may help prevent hoarding from becoming severe.”

Katherine Harmon Courage About the Author: Katherine Harmon Courage is a freelance writer and contributing editor for Scientific American. Her book Octopus! The Most Mysterious Creature In the Sea is out now from Penguin/Current. Follow on Twitter @KHCourage.

The views expressed are those of the author and are not necessarily those of Scientific American.

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  1. 1. tillotson 5:59 pm 08/6/2012

    hoarding_brain_scan_ocd …. interesting article, can keeping pix of items on computer lessen physical clutter? online magazines, online newspaper access, recipes, cookbooks, ebooks (i personally would not trade hard-copy for anything!) eliminate most hardcopy for savers? scanning receipts, guarantees, warrranties, bills…? research needed to see if can get physical safety, peace of mind — trying to do this myself!

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  2. 2. tillotson 6:11 pm 08/6/2012

    another take on “hoarding” — in its milder form, was a good survival practical tendency for centuries of pioneers, explorers — no supplies available on the frontier, in the wilderness, save all, in case needed. opposite tendency — the throw-it-all-out type was the “civilizer” — when outpost is served by post, pony express, trains, traders, etc — now we have connection with replacements, new items, trade coming in, the establishers of town dumps, businesses, things “in” and “out” of fashion, getting rid of excess, marginal – survival types, pushing discontents, curious, no-good-with-rules-or-laws (if they find too constraining and unwise) to leave the ever more civilized place to find new freedoms….

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  3. 3. tillotson 6:18 pm 08/6/2012

    ps — i am not a scientist, just like to think about things in different ways. i’m sure there are reasons why my ideas are probably wrong or flawed. not putting this out there to be an authority of any kind. would love to see what others think or know, though! have seen this tendency in my family: some with tendency “over-the-top” keepers, it negatively impacts their lives; some enjoying the fruits of “collecting” and enhancing their lives…

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  4. 4. ldobehardcore 6:38 pm 08/6/2012

    I currently live with a lot of junk. Mostly garbage.

    I’m NOT a hoarder. I’m disgustingly lazy. I absolutely throw stuff out when it physically inconveniences me. It’s just that I have a lot of space, and don’t take the effort to take out the trash as long as I know it won’t rot. If it doesn’t rot, I think I’ll do it later. Of course later never comes. Not a hoarder, don’t collect anything on purpose, just too lazy to clean. But that’s never stopped people from calling me a hoarder, even when they’ve seen me cleaning up for them when they come over.

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  5. 5. DonPaul 7:25 pm 08/6/2012

    So am I the only one wondering if the 1% are afflicted with a specific compulsive disorder that causes them to acquire more money than they need? Or do they really, really truly NEED their billions to be safe and happy?

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  6. 6. Rev.Corvette 9:22 pm 08/6/2012

    I like the way you think Don Paul…and would administering selective serotonin reuptake inhibitors be effective in reducing negative symptoms of Greed in the 1%?

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  7. 7. ironjustice 9:43 am 08/7/2012

    “OCD symptoms may be linked to hemosiderin deposition in the brain and the pituitary gland, just as hypopituitarism has been shown to be linked to hemosiderin deposition in the pituitary”

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  8. 8. sparcboy 10:49 am 08/7/2012

    “Saxena’s findings are corroborated by a recent study from the University of Iowa, involving a group of people who had suffered lesions in various parts of their brains as a result of strokes or other neurological diseases. Thirteen patients had never shown a tendency to hoard until they suffered lesions in the mesial frontal region—which encompasses the anterior cingulate gyrus—at which point they fell victim to what the scientists described as a “massive and disruptive accumulation of useless objects.”

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  9. 9. ironjustice 12:08 pm 08/7/2012

    “Intranasal administration of aTf protects and repairs the neonatal white matter after a cerebral hypoxic-ischemic event.”

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  10. 10. Rachel_Papworth 5:11 pm 08/7/2012

    That’s interesting. I help people all over the world declutter and create homes they love (I provide a free masterclass at and I have a background in Psychology (I have a Psychology degree). I’m fascinated by the physiological and psychological causes of hoarding and how understanding them can contribute to the development of effective treatments for this distressing, and much misunderstood condition.

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  11. 11. perfectlyawful 4:14 pm 08/8/2012

    One illness that often goes under the radar in connection with hoarding is OCPD (which many confuse with OCD). Many (not all) with OCPD hoard – it seems to be tied to perfectionism (can’t declutter unless you can do it PERFECTLY), frugality (might be a use for that!) and demand resistance (because you EXPECT me to do it, I’ll show you!).

    I’ve lived with a hoarder-in-progress, not yet to the rotting grapefruit point. Some things he could throw away, some he could not – even as he would tell you they had no practical use and were taking up valuable real estate, if you suggested throwing out an old, broken VCR tape you’da thunk you were suggested he cut off and throw away an appendage.

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  12. 12. bucketofsquid 4:32 pm 08/8/2012

    I don’t suppose I’m exactly a hoarder because while I do accumulate stuff, I tend to move it to an out of sight holding area and if it sits there for a couple of years without being needed I throw it out. I never collect trash. That is just creepy and I hope we find a treatment for that particular kind of hoarding soon!

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  13. 13. Germanicus 12:10 am 08/9/2012

    SSRIs to control brokers & bankers–cheaper than prefrontal lobotomy…

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  14. 14. joewayne 12:15 pm 08/10/2012

    from personal experiance I thing many hoarders are created during eatly childhood by rejection. I was given objects (Toys,clothes) I had most things I wanted but the needed things such as a close relationship with people including parents I never had . I wasnt allowed to interact with other kids often therefore not building social skills earlyon that made me a social reject as a teenager. When I did anything I had a step father that was always there to make sure I knew just how stuiped and worthless I was. I got to the point I would become sick hearing his voice. The low social skills killed me as a teenager. I would stay when I could in my room . People I was envolved with always rejected and hurt me. I got to the point where I put myself on level with the objects that surounded me.I became attached to every object I owned because they never caused me pain or rejected me. I was convinced I would never amount to anything and married the first girl I dated and that was a blind date due to the fact I felt below everyone else I couldnt ask anyone out . She cheated the whole time we were together but I took it because I knew I couldnt do any better. She found a man with money and left after 5 years. I was still down to the point that I couldnt deal in social places. A girl asked me out , she got pregnate so we wound up getting married. We were great for 4 years then she decided that sex wasnt somthing somthing women did no matter what . we lived this way for another 10 years . this rejection pushed me back to the level of an object again. I spent a few years researching on the web and found I wasnt the only as I saw myself “fruitloop” that became attached to every obeject I was around. I like a clean neat house but couldnt get rid of stuff. I knew I had a bad prob after a lot of stress and worry I came up with an Idea. I let a lady go through my stuff while I was not home and get rid of anything she wanted to. That was very hard she would text me a pic and ask should I keep it or get rid of it , I always said keep it. She stopped texting and got rid of a lot of stuff. That stressed me bad. I knew somthing had to give though. I then had her pick and get rid of somthing everytime I bought somthing. That was rough but latter she made it even worst by doing it while I was at home. Over time it became easier but still stressing.I hope one day I get over this but Im 43 now and working on it.

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  15. 15. dsayre 5:39 pm 07/12/2013

    I think there is another aspect to consider. If we consider the economic principle of utility and diminishing returns, then it’s evident that hoarders lack the rationale that the more times you buy or acquire something, the less value it provides for the buyer. Instead of diminishing returns, they have a feeling of consistent or even increasing returns the more times they acquire an object.

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  16. 16. carter45 10:31 pm 08/31/2013

    my Mom was an energetic successful person and in one year she fell down and literally broke. she was put in a mental health ward because she went days without sleeping, felt so tired I couldn’t function and found myself delusional and couldn’t stop the words running through my head. she was diagnosed bipolar and drugged up with medication. sometimes she act stupidly both at street and in anywhere she find myself, she cannot longer stay or tune up in one place, one day when going through a website to know more fact about metal disorder, i met a comment on a Brain Help Blog, on how a doctor called OLORUN ODUDUWA healed someone from MENTAL DISORDER, so i tried contacting him through number it wasn’t going through and i took off the email, and email him fast, within the next 10 minutes he replied me and started asking me some questions which i really knows,i was shocked and happy about his fortune visions to my my Mom life, so he told me what to do which i really did and to find my Mom HEALED in the next few hours from the terrible Brain problem who has kept her away from job because she was not fir anymore, i am very happy that Dr Olorun Oduduwa really work for me successfully by restoring my Mom MENTALLY BRAIN problem to normal, thank you sir, you can also reach him if you are in need of his help on: OLORUNODUDUWASPIRITUALTEMPLE@ GMAIL. COM or Call him on +2348165219949. thank you sir am so very happy to find someone like you to help me heal my Mental Problems

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