MS. DIANE REHMThanks for joining us, I'm Diane Rehm. Modern storage facilities, bigger homes have made it easier for people to hoard. Estimates put the number of hoarders in the U.S. between 6 and 15 million people. Many cities now have task forces dedicated to working with hoarders in their community. With me here in the studio to talk about this increasingly public problem is Life Management Consultant, Dr. Darnita Payden, and psychologist, Elspeth Bell. Joining us from a studio at Smith College, North Hampton, Mass., is Randy Frost. He's professor of psychology and author of a book titled "Stuff."

MS. DIANE REHMAnd if you'd like to join us, 800-433-8850, send us your email to drshow@wamu.org, join us on Facebook or send us a tweet. Good morning to all of you. Nice to have you with us. Professor Frost, I'd like to start with you. In your book, "Stuff: Compulsive Hoarding and the Meaning of Things," you site many, many examples drawn from the time you've spent with hoarders. Tell us first about Irene.

PROF. RANDY FROSTWell, Irene is a woman who called me some time ago and she was desperate at the time. She had had a hoarding problem ever since she was a young girl and it had not gotten to the point of being terribly serious until the last 10 or 12 years, during her marriage. And at that time -- at the time she called me, her husband basically told her that she needed to clean up the clutter or he would leave and she couldn't do it. So he left and she was now concerned that she was going to lose custody of her two children because of the condition of her home.

REHMHow widespread do you think that kind of problem is or are the Irenes of the world few and far between?

FROSTWell, when I started this line of work back in the early '90's I assumed, as did many other people, that this was a very unusual and isolated kind of case. And as -- to begin this process of doing the research, I thought maybe I would put an ad in the newspaper to try to find just one person who I could interview, I might be able to locate in the local community and I got hundred telephone calls to my ad in the paper. So from that point on...

REHMWow.

FROST...it became clear to me that this was really something that was much more widespread than we thought.

REHMAnd to you, Elspeth Bell, as a psychologist, working with hoarders in private practice, I know you're also working with the Montgomery County Council Hoarding Task Force. Tell me why that task force was first created?

DR. ELSPETH BELLI think, as Dr. Frost has been talking about, there's a growing awareness as to the impact of hoarding, not just on the individual, but also on the community at large. And with that, there's a growing impact on resources available to address hoarding issues, so one of the main focuses for the Hoarding Task Force in Montgomery County was actually a two-prong fold. It was looking at both the combination of more from a legal side. So housing code, you know, safety of the environment, the impact on the community at large, but also being very sensitive and aware of the needs of the individual.

REHMGive me an example of the impact on the community at large.

BELLWell, one thing of the big concerns about hoarding is that it's also -- there's a significant fire hazard potentially. So there have been cases in Montgomery County where there have been significant fires damaging homes and that can then have an impact on other homes in that same neighborhood. So a fire might spread from one townhouse to another and because of the quantity of stuff in the space, it can be more difficult to contain the fire and it poses a greater risk to other people.

REHMSo how widespread has this been in Montgomery County, which we should point out is one of the wealthiest counties in the country? How widespread a problem do you think this is?

BELLWell, based on the estimate of, you know, there's maybe about two to three out of every 100 people who are hoarders. That's one of the most recent statistics. And for that -- for Montgomery County alone, there'd probably be 24,000 hoarders in Montgomery County alone, but keeping in mind that that's also on a spectrum of severity of hoarding. Hoarding is a behavior and it can be from, you know, a small level of clutter to so much clutter that the property actually ends up being condemned.

REHMAnd that clutter, Dr. Darnita Payden, is where you come in.

DR. DARNITA PAYDENYes.

REHMYou are a Life Management Specialist with a Ph.D. in counseling psychology. What happens when you are called in by an individual or by Montgomery County to help a person or a family who've become clutters?

PAYDENWell, initially, we make sure that we have -- we're building trust. That's the first thing that we want to do in the initial conversation. After that, we're doing an assessment of the home and it's very important when we walk in, that we let them know that this is not about judgment, you know, this is their life. We're only there to help them improve their functioning. We're not there to make them feel any worse than everyone else has already made them feel.

PAYDENWe also want to let them that there's help, that they can get better because there's a lot of hopelessness, a lot of helplessness and so much stigma attached that these people basically socially isolate and go into hiding.

REHMRandy Frost, explain to us your definition of a hoarder?

FROSTWell, hoarding consists of three different kinds of problems that are all sort of go together. The first is a level of excessive acquisition. Now, all of us buy perhaps and pick up more free things than we should, but people who hoard have excessive levels of this kind of acquisition. The second component is a difficulty letting go of things or discarding things. Now, by discarding, I don't mean throwing away, but just letting go of it, selling it, giving it away, recycling and so forth.

FROSTAnd the final characteristic, the third characteristic, is an inability to keep all this stuff organized and perhaps this is the key component because in many ways, many of the folks that we see who hoard have a lot of stuff, but if they were able to keep it organized, it might not be so overwhelming. But what happens is it all ends up in the middle of the room in a very disorganized pile.

REHMAnd is that what you see when you walk into a hoarder's home, Elspeth Bell?

BELLVery much so. I remember with some of the clients, when I've gone into the home, it's event difficult to open the front door all the way because of the accumulation of stuff behind the doors, in walkways. So maybe even opening this door maybe only 18 inches wide, having to turn sideways to be able to get through and as you look through these items, there doesn't seem to be a systematic way of what's being kept where.

BELLSo clothes may be on top of the coffee table, there can be books on the floor in the bathroom, there can be magazines in the hallways. So each of these individual items may be of value, may have some importance to the individual, but when you have them all together in a giant pile, you end up losing track of each of these individual things.

FROSTDiane, I might add, related to that, that one of the chief characteristics we know is associated with hoarding is a problem -- an information processing deficit problem, a problem with the ability to organize. Now, most of us live our lives categorically, so if we have -- if we get an electricity bill, we put it in a category where we know where it is, with the other bills or with the utilities bills or something and then we -- when we need it, we go to that category to find it.

FROSTBut people who hoard tend to live their lives differently. They live their lives visually and spatially. So people who hoard will put that electricity bill on top of the pile a little bit over to the left and now they've created a mental map for themselves, a visual and spatial map of where that object is. And so when they need to find it, they have to go to their map to remember where it is and that's why stuff ends up in the middle of the room, because they like to see it when they put it there and that sort of solidifies this map in their head.

REHMDr. Payden, do you want to comment?

PAYDENI did. That's one of the important things that we work on when we're working with hoarders, is to put things into categories because what we find is every item becomes a treasure. And so we need to get their mindset on putting things in some assemblance of order that improves their function. Instead of having a mountain of items with, you know, the electricity bill sitting on top, you do have a special place when that item -- when that bill comes in that it goes to so that you can go back and find it without having to, you know, tear through mountains of items.

REHMBut is it, is it a psychological problem of, as Randy said, you cannot let go of everything, Elspeth?

BELLI would say without a doubt. When you look at hoarding by itself, it's a behavior and behaviors -- these can be exhibited by anyone, but when you reach a certain threshold, that's when it becomes problematic and when we think about hoarding behaviors in an individual, there's also the association of a lot of anxiety, depression, information processing. And when we have those things culminating, all those pieces together lead to the excessive acquisition, the difficulty making decisions, the attachment to the items, hard time letting go, the clutter builds and it becomes a crisis.

REHMYou know, it's interesting. We've had a posting on Facebook from Matt who says, "I'd be interested to know why some people like myself hoard things until suddenly, I decided I need to get rid of it all, then throw away a whole room full of stuff in one day. One minute I want to keep everything, the next it's gone." Elspeth?

BELLI would tend to look at that as almost an all or nothing thinking, where you reach a threshold. So as long as it's below that threshold, I'm okay, but then once it crosses that threshold, it's too much and it needs to go.

REHMElspeth Bell, she's a psychologist who works with hoarders. Short break, right back.

REHMAnd welcome back. With me as we talk about the problem, and it is a problem, of hoarding, Elspeth Bell, she's a psychologist who works with people who have this problem in her private practice. She also works with the Montgomery County Council Hoarding Task Force. I'll bet you didn't know there was such a thing. Also the City of Gaithersburg Task Force. Also here in the studio, Dr. Darnita Payden, she's a Life Management Specialist with a PhD in counseling. Her company is Dr. DClutter Life Management and it helps hoarders.

REHMAnd on the line with us is Professor Randy Frost. He's professor of psychology at Smith College and author of "Stuff: Compulsive Hoarding and the Meaning of Things." I'd like to open the phones shortly and take your calls, but I'd like to first talk to Randy Frost about a lot of hoarders who have what you call, Randy, a magical attachment to things. What do you mean by that?

FROSTWell, this is one of the most fascinating things about hoarding is that in many ways, the types of attachments people have, people with hoarding problems, are no different than the attachments the rest of us have with our objects or our possessions. For all of us, possessions have a magical quality. So for instance, the ticket stub that -- from a favorite concert has a value to you that goes beyond the physical characteristics of that ticket stub. The emotion that's wrapped up in that ticket stub does not exist in the physical object itself, but in your head. So the value you place on it is a value that in some ways is magical because the object itself has -- does not have that value.

FROSTThe same is true with any sentimental object or a chunk of concrete from the Berlin Wall or any kind of souvenir that's attached to another person. It's a little bit like what anthropologists call sympathetic magic, where we believe that somehow we have this magical connection with the events that are associated with this object.

REHMTell me, is there or have there been any studies suggesting that there is a genetic component to hoarding? Randy.

FROSTYes. There have been a number of studies now and it's not a -- we're not -- it isn't conclusive, but in six or seven different studies now, what we find is that hoarding tends to run in families. We also find evidence of a genetic linkage in twin studies. And we also find some evidence of certain chromosomes that are involved in linkage studies of people who hoard. So there's growing evidence that there may be a genetic component to this. And maybe as much as half of hoarding behavior we might be able to explain genetically. Although...

REHMAnd...

FROST...exactly what is being inherited is not so clear. I suspect it's...

REHMWell...

FROST...something like the information processing deficits that I talked about earlier.

REHMWell, I was wondering about the whole process of Obsessive Compulsive Disorder and whether that's part of what's going on here?

FROSTWell, as it turns out, in the last, oh, five or 10 years, those of us doing research on hoarding have come to the conclusion that hoarding itself is different than OCD. And in fact, we've made a recommendation to the American Psychiatric Association that they consider making hoarding a distinct disorder in the upcoming revision of the diagnostic code.

FROSTAnd right now it looks like that may happen. The final decision hasn't been made, but the working groups who are responsible for putting the new code together have proposed a new disorder called Hoarding Disorder that's related to OCD, but yet distinct.

REHMTurning to you, Elspeth Bell, Randy Frost was talking about the magic attached to the items that a hoarder keeps or even conceals. What is your experience with that magic?

BELLWell, think about a small child who has a security blanket or a favorite teddy bear and will hold on to that. And, you know, a teddy bear, it's just fluff.

REHMForever.

BELLAnd it -- but it's got this -- it's got a name, it's got a history and that teddy bear is held onto. You know, you cringe if someone maybe even looks at taking it away from you. Now, imagine that type of attachment to other items in your life. To the ticket stub from the concert, to a t-shirt that maybe an ex-boyfriend gave you, to a magazine that has something in it that reminds you of your mother. So being able to make that kind of association and that strong an emotional attachment to just about anything.

REHMDo people who are hoarders see themselves as having a problem, Elspeth?

BELLThere's a continuum and actually, as Dr. Frost was talking about with the proposed separate diagnosis for hoarding disorder, one of the differentiations for it will be the level of insight that an individual has. So when an individual has more insight, they may be able to reflect more on it being a problematic issue, a behavior that they'd like to change. If they have less insight, they may be less likely to engage in treatment because of it.

REHMBut by the time you see them, Darnita Payden, what do they say? Are they resistant, are they ready to change, are they cooperative? What's -- what do you see?

PAYDENWell, it depends on the individual, of course, and you run the gamut. You have those who have just hit their rock bottom and they're ready to go. And that...

REHMBecause the house is just jammed.

PAYDENThey're overwhelmed -- they're overwhelmed...

REHMYeah.

PAYDEN...or there's a crisis looming. Child Protective Services is coming in, Adult Protective Services, they are about to lose their job or a spouse. There's some crisis that is pushing them forward. And then I have clients who have just, as they say, they've gotten sick and tired of being sick and tired and they want to regain that control.

PAYDENMore than not, there's somewhere in the middle, it's the person whose family has probably had and failed at multiple interventions. And to please them, to placate them or again, for their own, they're ready to move forward. But jumping on something Dr. Bell said, a lot of my clients still would not identify themselves as hoarders.

REHMOh, really.

PAYDENIt's too stigmatic. They don't want to be labeled a hoarder and that's okay. As long as they're willing to admit that they have the problem with the behavior, I tell them they can call themselves whatever it is that they like.

REHMTell me about the worst problem you've ever seen.

PAYDENOh, goodness, that's (unintelligible).

REHMNo names, no names...

PAYDENOh, of course not, never.

REHM...no locations.

PAYDENNo names, no locations. I would have to say that it was a home that was about to be condemned because we could literally not get through any exits, no doors, no windows. Light could not get into the home because it was so full of stuff.

REHMBut someone was living...

PAYDENSomeone was living in there, so...

REHMBy him or herself?

PAYDENNo, sadly it was a family. It was a family. So they would have to tunnel out, literally, just to get to a window or get to a door.

REHMOf course, that reminds me of the E. L. Doctorow novel about the brothers...

PAYDENYes. Yes.

REHM...in New York who both finally died...

PAYDENDied under a pile of newspapers, exactly.

REHMAnd you're saying that what had happened in that one home was the creation of those kinds of tunnels.

PAYDENIt was a tomb.

REHMWow.

PAYDENIt was -- it -- that's the best way I can describe it. It was just full of everything imaginable, but they were still living there.

REHMHow could they cook, how could they move?

PAYDENWell, that's the thing. Everything became difficult. There were no easy days in this home. Everything became an extra effort and I think maybe, you know, that became the tipping point because if you have to spend 30 minutes to get to the bathroom, you know, 40 minutes to get to a kitchen, you can't use it anyway, but you're expelling all of this energy just to do normal everyday things. And it started to just physically wear on them emotionally, psychologically. And then again, with the advent of, you know, neighbors calling in and complaining and it was really, really a sad situation.

REHMAll right. So if you can help someone. Let's assume you can, Elspeth. You've helped someone and perhaps Darnita has come in and helped them organize. What about the rate of recidivism?

BELLIt's difficult to assess that rate because hoarding, it's a lot like laundry. You can do all the laundry in the house, everything, so every piece of clothing is washed, cleaned and put away by the end of the day. I guarantee you, by the time you go to bed, there's going to be a pair of socks in that hamper. So if you don't stay on top of the laundry, it's going to end up re-accumulating.

BELLAnd stuff is very much like laundry. So if you don't stay on top of these hoarding -- these de-cluttering skills and you don't practice them on a daily basis, you're going to be very vulnerable to the reaccumulation of clutter. And you're going to be more vulnerable to it when you're experiencing more symptoms of anxiety and of depression. So the clutter, it might come and go like the tide. It comes down when you're in a more positive part of your life, but as you're under more stress and there are more demands being made of you, the clutter can start to grow again.

REHMDarnita.

PAYDENThat's exactly true. And what I would like for people to really take away from this is this is a lifelong battle. I mean, it's not a one-time fix. Even though Dr. Bell and myself may come in and we'll get them to a better space of functioning, if they, again, don't use the skills that we teach them on a daily basis, then they are more than likely to start to bring things back into the home and find themselves very quickly back in the same space or worse.

REHMAll right. I'm going to open the phones, 800-433-8850. First to Jane who's in Dallas, Texas. Good morning to you.

JANEHi, good morning. I am a hoarder and my problem is I'm also totally blind. And what you said about organization, that is a huge problem with my hoarding because I will -- my hoarding is resorted to my office in my house and I would say closets. Everything else is -- and drawers and on top of my dresser. And what happens is I will come across something I won't know what to do with it, it'll get thrown in a closet or in my office or, you know, in my dresser.

JANEAnd I'm in the process of de-cluttering my life and what has motivated me is my husband and I just got a new air conditioning unit with a dust and mold and -- anyway, it's for the whole house. And I'm realizing, my gosh, this unit won't work if I don't get rid of the stuff that creates dust.

REHMYeah.

JANEAnd the other thing that's happened, too, is because I've got so much stuff in my office, I have a computer in my office with speech ware and all kinds of stuff. I haven't been able to learn to use it because of my hoarding.

REHMInteresting. Randy Frost, what can you say to Jane?

FROSTWell, one of the issues that we see a lot is people who have hoarding in certain areas of their home. And typically, this is a marker for how serious the problem is. If most of the living areas of the home are okay, then the problem isn't so severe. And many of us have this tendency to pick something up and not know exactly where to put it so we put it in a drawer and have it as our junk drawer or our junk closet and so forth.

FROSTAnd so this isn't all that unusual, to have certain areas of the home that are places that are disorganized. But working through them slowly, getting those items organized into a usable format is certainly important, especially if it's preventing you from using a computer.

REHMIndeed. Randy Frost, he's professor of psychology at Smith College. He is the author of the book titled "Stuff: Compulsive Hoarding and the Meaning of Things." And you're listening to "The Diane Rehm Show." I'm going to take a call from Alexandria, Va. Our caller would like to remain anonymous. Good morning to you.

ANONYMOUSGood morning, Diane. This is really great show, a great issue. I'm so glad that you brought this to (word?). I need help here to help my wife. Help me to help my wife. My wife look -- tends to bring anything to the house, her car and she pays attention to almost everything except to none -- except to the important things. Nothing she can escape her attention to bring it out and just to store it in my -- in our house. Our house is full of all kinds of things we don't need, we never use. We -- basic -- to no use at all. And her car, the same thing.

ANONYMOUSAnd I sometimes get so angry that I refuse to ride her car because it's always full of junk and try to provoke her to make her feel ashamed or to (word?) something wrong. It doesn't help. It doesn't work at all. And (unintelligible) her friends to see her car, to see our house to just embarrass her. It doesn't work. It seems like very normal, it seems nothing's wrong with what's she is doing and they will urge her friends to help her, to see what's going on and they won't say anything (unintelligible)...

REHMAnd it's clear you're looking here for some help. Elspeth, what would you say to our caller in Alexandria?

BELLOne of the key pieces in here, and he even said it himself, these items appear useless. But to the individual who owns these items, each of these value -- each of them has value, has use, has potential. So being able to see a paper cup and, well, I want to recycle it. I want to be able to use it for something else. I could maybe put some pens in it. Every single item can be possibly used for something else.

BELLBut then, when you're around all of this clutter that someone else has accumulated, there is a lot of frustration. There can be anger, there can be resentment. And feeling as though, you know, here's, you know, this person in my life, they love their stuff, they care more about their stuff than they do for me. And one of the most important messages is that individuals who struggle with hoarding behaviors, they don't love their stuff more than they love other people in their lives.

REHMRandy, our caller mentioned attempting to shame his wife into changing her behavior. How effective is shame as a tool in breaking this habit?

FROSTWell, it turns out not to be too effective. And what happens typically in families is that family members get pretty frustrated because they've tried everything. They've tried what seems to make sense to them to help the person change or to help the person see the problem, but nothing works. And shame is kind of a last resort for doing that. But I think he probably has found that that doesn't work any better than anything else. And if anything, it harms the relationship.

FROSTI think part of the issue here is that when you talk about insight for people who have hoarding problems, I know thousands of people with hoarding problems and there are very few of them who have no insight. Now, his description sounds like his wife doesn't recognize this as a problem, but I think that may come about because of the nature of the relationship and where it's gone. We see this over and over again in families. The level of conflict escalates to where they can no longer talk about this issue.

REHMProfessor Randy Frost, he is a professor of psychology at Smith College and author of "Stuff." Short break, we'll be right back.

REHMAnd we seem to have touched a rather delicate nerve with this whole subject of hoarding. Let's go to Michael in Fayette, Ala. Good morning, you're on the air.

MICHAELGood morning. Thanks big time for taking my call. This Montgomery County where Dr. Elspeth -- I've forgotten her last name.

REHMThat's all right.

MICHAELWhich state is it located in?

REHMMaryland. I'm so sorry. You're absolutely right, I should've said that.

MICHAELOh, oh, thanks for telling me. We sure could use more...

MICHAEL...at least as close as -- of those as close as University of Alabama at Birmingham 80 miles from where we live where, you know, WBHM public radio's located. My question is this, what's the difference between an antiques collector or a collector of modern collectibles such as limited edition collectors plates or Hummel figurines, et cetera, and a person who -- and a collector who is also a hoarder?

MICHAELI've listened to so many of these other stories and I -- the lady who telephoned and who was blind had so much courage. My heart really goes out to her. But -- and my room does not look like any of those that you see on the learning channel's program and "Buried Alive" and certainly not...

REHMBut tell me, Michael, what does your house look like?

MICHAELWe have a backyard studio where I do my commercial artwork and studio art. I'm a Christian social work volunteer part-time. And in the upstairs, where we keep six categories of automotive and advertising memorabilia...

REHMOkay.

MICHAEL...and publishing and entertainment memorabilia, but too many of my things are in my own room. I just like how -- I just like the looks of them, especially the model cars and the animation studio licensed merchandise, but also...

REHMOkay. Now, Michael, I have a question for you.

MICHAELYes, ma'am.

REHMHow do you identify yourself? Do you think you are a simply a serious collector or are you a hoarder?

MICHAELI identify myself as the first, but I also have obsessive compulsive disorder, temporal lobe epilepsy and adult ADHD, which really hurts my memory for important papers and so forth.

REHMAll right. And then to you, Elspeth, what do you think of the way Michael describes himself? Would you call him a hoarder?

BELLIt would be difficult to say without seeing the physical space itself because hoarding, it really is just a behavior. Everybody acquires things, everybody has difficulty letting go of things from time to time, but it's the accumulation of stuff where it ends up interfering with the use and the function of a specific living space, which can then transition into a disorder, hoarding disorder.

REHMDarnita.

PAYDENI always like to make this distinction. Collectors have items that they like other people to see. Usually when someone has a problem with hoarding, it's behind closed doors.

REHMInteresting. Would you agree with that, Randy?

FROSTYes, absolutely. We see a couple of differences between people who are purely collectors and people with hoarding problems. One is this sort of public persona that's a part of the collection. The other thing is that people who are collectors tend to keep their stuff well organized and that's a major difference between people who hoard and people who are mainly collectors.

REHMAll right. To Cincinnati, Ohio. Good morning, Nancy.

NANCYGood morning. Thank you for having me on the show.

REHMSure.

NANCYI have a question about -- I was wondering if this behavior, if some of its self-perpetuating aspects have to do with...

REHMOh, dear.

NANCYOh, I'm sorry, I thought I lost you. I'm sorry.

REHMOkay. Go on.

NANCYI was wondering -- I just know that for myself, I like for things to be very -- you know, rather minimal. I'm kind of a minimalist and I don't like going to shopping malls or anything because there's too much stuff, too much stimuli. So I was wondering if that might be true with people who hoard. Once they have so much stuff around them, if that doesn't kind of increase their anxiety and then they need to go out and get more things to kind of placate their anxiety and in that regard, it self-perpetuates.

REHMWell, I gather, Randy, as you said earlier, anxiety most definitely plays a part here.

FROSTAbsolutely. And what we see is a couple of things that happen. It's sort of interesting when people get into an acquiring episode where they acquire more than they need to. We know that people with hoarding problems have attention deficit disorder more frequently than other people do, so a lot of attention deficit problems, but when they're in an acquiring episode, it's almost the opposite problem, that their focus of attention becomes so narrow that they cannot think about anything but the item they're looking at thinking about getting. They forget about the fact that they don't have room for it, they don't have money for it, they already have three or four of them somewhere in the pile.

FROSTSo what happens is they end up coming home with things they already have and they don't realize it until they get home and remember and then see and so forth. But the caller mentioned something that is sort of interesting that we've observed in a number of hoarding cases as well and that is what we call a clutter blindness, that many times people, after they've been living in this kind of environment for a while, will become blind to the clutter.

FROSTAnd when we go in as therapists to work with them, when we show up, it's almost as though they now see their home through our eyes and they start to feel depressed about it because it looks so terrible. But when we leave, they go back to this sort of ability to put it out of their mind and not notice the clutter.

REHMYou know, it's interesting because following up on that comment, Randy, David in Tulsa, Okla. wants to know about the role of spatial thinking in a hoarder's mind. Did you perhaps write about this?

FROSTAbsolutely. We talk a little bit about spatial reasoning in "Stuff." And it goes back to this notion of how we store stuff and how we remember what we have and it's tied up with a lot of these information processing deficits that we see, like attention deficit problems and so forth, that stuff gets placed in the middle of the room and the person creates a mental map of that item. We've got...

REHMYeah.

FROST...some people we describe in "Stuff" who has funny ability to take almost a picture of a room and know exactly where everything is and they will know if anything's been moved and it gives them an unsettled feeling, a feeling that somehow things aren't quite right until they reset their image.

REHMElspeth, do you have any idea whether hoarding is on the increase or are we simply becoming more aware of it?

BELLI'd say it's a combination of the two. There are definitely more opportunities for acquiring, people are living in the same space for a longer period of time, allowing for greater acquisition of items. On top of that, there is this growing awareness in our society about hoarding as an issue and you can see that with the number of programs on television, it was even a main storyline on an episode of "CSI" last season.

BELLSo knowing more about hoarding, we're seeing more of it, people are maybe more likely to identify a hoarding related issue. And are also, with more supports being available, more treatment options out there, they're going to be stepping forward and asking for support and asking for assistance.

REHMAnd yet from the general public's perspective, I think Gordon emails a question or a statement. He says, "Hoarders are just lazy." What do you think about that?

PAYDENWell, Gordon, I will have to disagree with that. If you think about the effort that a hoarder has to go through to acquire and keep all of those things, it is mind boggling. So laziness is not something that we would typically find in a hoarder. They expend a great deal of mental and physical energy maintaining this lifestyle.

REHMYou know, I was riding to work the other morning coming up Wisconsin Avenue here in Washington, D.C. and beneath a bus shelter was a homeless gentleman who had a shopping cart in front of him filled with stuff. And then on the benches on either side of him were piles...

PAYDENMore stuff.

REHM...of more stuff.

PAYDENExactly. And if you think about that, this is someone who doesn't have a residence, they don't have a place, but they still maintain their stuff, so that can tell you something about the attachment to the items. They're very important to them.

REHMSo...

FROSTWe do know...

REHMSure.

FROST...if I could butt in here, we do know from a couple of very recent studies, in fact they're not even published yet, but that hoarding is associated with homelessness, that a relatively large percentage of homeless people have hoarding as one of their problems and a large number of them have become homeless because of their hoarding.

REHMInteresting. All right. Let's go to Boone, N.C. Good morning, Doug. I gather you're identifying yourself as a hoarder.

DOUGOh, yes. Good morning, Diane. I love your show and...

REHMThanks.

DOUG...thanks that this is on today because I wouldn't have heard it. I was going to the garden and I stopped and I said, I've gotta get in on this.

REHMI'm glad.

DOUGI'm 58 years old. Yes, I am a hoarder (laugh). I feel like I'm at AA right now (unintelligible).

DOUGAnyways, there's a couple of things here I don't know that you guys have touched on and your professional folks have not touched on. Years ago, someone said to me, they said, you know, the reason that you collect all this stuff, and stuff it is, but it's stuff to me. They said, you know, your family and all grew up during the Depression times, when things were hard. They never threw anything away, they used everything. They used every ounce of anything that they found or they contributed it to something else to make it work.

DOUGAlso, you know, folks, yes, you get scared about things. I, in my lifetime, the things that I collect are very usable and mostly, a lot of them are new things, a lot of them are things that I can apply to other applications. What if we went into a horrible, horrible depression? What if we had a horrible stock market crash? What if there was nothing at the grocery store or at the hardware store? Those of us who have all these things that are in our basements, in our garages, in our barns, we can use them if we're smart enough to do so.

REHMAll right. Randy Frost, do you want to comment?

FROSTYeah, there are a couple of interesting points raised by Doug. First of all, this idea of having lived through a period of material deprivation being a backdrop for the development of hoarding, this is the hypothesis we began with back in the early '90s. And when we began asking people about this, we found no evidence that that was the case, that people who hoard -- many people who hoard did not grow up in any kind of deprivation situation with respect to material goods.

FROSTNow, emotional deprivation may be something else, but in terms of material things, that's not quite what we find. And the other thing related to what if something happens.

REHMWhat if.

PAYDENExactly.

REHMA big what if.

FROSTIt's important to remember here that hoarding -- the disorder of hoarding is defined only when it impinges on the living areas of the home. So if your basement's full or your attic's full or your barn's full, that really wouldn't qualify as hoarding. It's when the hoarding invades the living areas and prevents those areas from being used in the ways in which they were designed.

REHMRandy Frost and he is professor of psychology at Smith College. His book is titled, "Stuff: Compulsive Hoarding and the Meaning of Things." And you're listening to "The Diane Rehm Show." Let's go now to Mohammad here in Washington, D.C. Good morning, you're on the air.

MOHAMMADYes, good morning, Diane, great show. I am exposed to hoarding with my extended family and the likely -- the experts are saying, yes, it is connected to the obsessive compulsive disorder, depression and many other disorders. And the two of them are nonfunctional. Their homes are full like a rat's house. They're full of stuff. And they keep running away from the family.

MOHAMMADMy question is, how do you approach people who are inflicted with this issue in order to try to help them, not personally, but get them to somebody, to an expert who can help them? Because any time you talk to them about the situation, they'll close in or even they'll ask you to leave or now they don't allow you to visit with them. And if they come to see you, if you ask them any questions, that you are offending them.

REHMElspeth.

BELLOne of the big pieces here, and I like the way that he phrased this, was how do you try to get them to work with somebody else, recognizing that there are limitations as to what the family or friends can do themselves. One of the big things that I emphasize for families is to approach their loved one by being able to say, we're concerned about you.

BELLWe feel as though you're not able to live that life that we know that you can live. You seem to be unhappy. You seem to be restricted or limited in some ways. And it seems us to as though it's the clutter that's contributing to that. So we're not looking to shame you or to punish you or to make you feel bad. We'd like to see what we can do to help enhance the quality of your life.

REHMBut does that mean, Darnita, that you, as a professional de-clutterer, would go with a family member or with a caring friend to this person who has become a hoarder? How would you approach it?

PAYDENThat's sometimes the case. The family member will call in, say, well, I'm at my wits end. I've tried everything and nothing's worked. What should I do? So they -- I would, you know, meet with the family. We'd have an assessment. It almost seems like an intervention, but it's not because we're not confronting them to say, you're this horrible person, how dare you live like that. That will close anyone down.

PAYDENYou really want to have a more gentle approach, like Dr. Bell said, I'm really concerned about you. We see that you're not able to enjoy life. You used to be so vibrant. We really just want to help you return to that place.

REHMHow difficult is it, Randy Frost?

FROSTIt is difficult and I think especially for family members who have gone through usually years and years of conflict about this problem. And that's why it's important to get someone else in there involved in the case and with this gentle approach. And the other thing to emphasize, I think, is to try to help the person find resources to learn more about it.

FROSTI can tell you one thing, even the person who has absolutely no insight about their hoarding, they recognize that their home is different than everyone else's and they're curious about it. So if you can hook into that curiosity and get them to start learning more about hoarding, there's a better chance that they're going to start doing something about it.

FROSTOne of the good places to start is the International OCD Foundation website, which has a hoarding center which has up to date information about hoarding and accurate information, so that's a good place to start. And now there are lots of books and DVDs out on hoarding as well.

REHMAll right. And we'll have to leave it there. I'm sorry we couldn't get to all of our callers, one of whom wanted to talk about hoarding food, but that's for another program. Thank you all so much. Randy Frost is professor of psychology at Smith College, his book is titled "Stuff: Compulsive Hoarding and the Meaning of Things." Dr. Darnita Payden, she has appeared on A&E's program "Hoarders." And Elspeth Bell, she's a psychologist who works with hoarders in Montgomery County, Maryland. Thanks for listening, all. I'm Diane Rehm.