Hoarding as a result of Obsessive-Compulsive Disorder (OCD) is a psychobiological symptom that is treatable.

A few months ago I was talking with a friend who was concerned about her aunt who was about to be evicted from her apartment due to “hazardous conditions” deemed by the Fire Department. Her aunt, Kay, at the time lived amongst mountainous piles (of what most would call trash) as high as the ceilings, with barely passable tunnels to the bathroom, kitchen, and doorway. She described her aunt as a “serious pack rat”. As we continued the discussion, it sounded familiar.

For several years, I have worked with people plagued by hoarding as a result of obsessive compulsive disorder (OCD), a potentially debilitating illness. After explaining the genetic psychobiological nature of OCD to Audra – a deficiency in the system regulating the neurotransmitter serotonin – she decided to intervene with my help. After some family discussion and gentle persuasion, Aunt Kay (who was adamantly opposed to psychiatric medications) agreed to come and see me for cognitive behavioral psychotherapy in order to gain control of her hoarding.

I completed a full assessment which included Kay’s family history which revealed genetic markers for anxiety and OCD in her family. Kay described her mother as a “neurotic” woman who “collected” so many things in the attic that it had started to cave. She also spoke of her paternal grandfather who “washed the dishes three to four times after each meal until his hands peeled and bled.”

After completing the assessment, we developed a treatment plan including weekly cognitive-behavioral therapy to reduce the frequency and intensity of Kay’s fears about throwing things away. After two months of intense work, to my disappointment there was only mild improvement – she had learned to identify main sources of her clutter (junk mail, newspapers, and magazines) and brought them to a halt by canceling subscriptions. However, she was still raptured by intense worry about older more “sentimental” items.

That is when Kay and I stepped up our work and began splitting the sessions – with a portion dedicated to psychoeducation in the hopes that she would understand the biological component of what she was dealing with and agree to meet with a psychiatrist. After a month of psychoeducation Kay agreed to receive a psychiatric evaluation. The doctor diagnosed Kay with Obsessive-Compulsive Disorder and prescribed the medication Paxil.

She reluctantly took the medication and I began visiting her at her home to assist in processing irrational fears and psychological hurdles, as well as aiding in the development of an organized system to reduce feelings of being overwhelmed and assist her in managing her time and items in an emotionally and logistically efficient manner.

During Kay’s third month taking Paxil, I went to her home for a visit after a two week hiatus. I was astonished. Her apartment was relatively clear and organized. As I collected my tongue from the floor we talked at length for an hour about her incredible progress. She told me that all of our talks and the medication had finally “sunk in” and that she was tired of being held captive in her own home.

She went on to describe a feeling of freedom that she hadn’t felt since she was a little girl. Kay is a testament to the remarkable improvement that the partnership between medication and structured psychotherapy can bring to an OCD sufferers life.

Through the use of modern psychopharmacology and individualized targeted psychotherapy it is possible to conquer chaos (mental and physical) and maintain healthy living.

Gregory H. Salerian, MCSW is the coordinator of Conquer Chaos – an individualized program designed to assist people to increase their organizational, emotional and logistical efficiency in day to day life.