Recently, the Mental Health Association of San Francisco hosted a talk by Dr. Randy Frost on "Hoarding and Clutter." Though this is a common problem for adults with ADHD, it is generally associated with Obsessive Compulsive Disorder (OCD). People can become quite compulsive about collecting and stashing ever greater hoards of possessions that have dubious value.
The dangers from this problem are real. In the more extreme cases it can lead to fire hazards and health issues. The more common problem is that it leads to isolation, when a person wouldn't dare let anyone else visit where they live. Of course it also makes it nearly impossible to organize or find anything that is important.
Part of Frost’s approach is to try to look at hoarding and clutter with fresh, unbiased eyes. When we do, we find a lot of issues with "executive functioning", a hallmark if not the definition of ADHD. Though I suspect that some hoarding and clutter is distinct from ADHD, there is a great deal of common ground for some of the core problems.
Thomas Brown now claims that ADHD and executive functioning should be considered to be synonymous. What are the "executive functions" which are impaired in ADHD? They are not related to IQ, and they are not like the "domain specific" functions like those involved in reading, processing language or motor coordination. As the name suggests, they are the higher-level functions that integrate, prioritize and coordinate other brain functions. To see what happens when some of those executive functions are failing, it is helpful to look more closely at hoarding and clutter.
There are three fundamental aspects to hoarding and clutter, according to Frost: Acquisition, Saving, and Disorganization. The acquisition aspect is so much a part of our culture as to seem normal, even when it is quite dysfunctional. Hoarders frequent our most sacred cultural institutions: eBay, the home shopping network, discount malls, flea markets and garage sales. What is probably most dangerous about these machines of marketing is that they prey on the ADHD person's tendency to buy on impulse. Not being able to make a slowly reasoned decision about the real utility and value of a purchase, it seems safer to buy it now than to risk losing the opportunity. Clever marketing hones in on that fear with time-limited pricing and other tricks to "close the deal" before the decision process can play out.
An additional complication in hoarding is the temptation to buy something because one can't remember if they already have it. Or it can be frightening that the intention to buy whatever it is will be forgotten if it isn't purchased now. Poor memory will make it seem worthwhile to cover your bases and get it.
Buying way more than anyone could practically use would not be so problematic if it was balanced with an ability to discard the things that, through years of shuffling and stacking, have proven to be quite useless. But it is rarely so. The second aspect of hoarding is the compulsive saving of objectively useless things.
Saving itself has several dimensions to it. One part of it seems to be connected with an exaggerated sense of sentimental attachment to things. Trivial objects can trigger a flood of memories and associations. Given that power, it seems risky to abandon the object, lest the memories are lost with it. In a chaotic ADHD world, when so much is getting lost all the time, that can seem like a substantial risk.
More complex is the dimension of "instrumental" saving. We save things because we can imagine a use for them. Some hoarders fill closets with items purchased at great prices, just to be able to give them as gifts to someone else who will have a use for them. That is all well and good, except that with a poor sense of planning, time-management and the scope of projects, instrumental saving can be unrealistic in an ADHD person.
A common situation is that someone will save something that is broken, in order to fix it. It looks like it will not be so complicated, and the item will again be useful. It may also connect with an unrealistic future plan: Not only has that broken exercise bike been in the living room for 8 months, there is a plan to "get back in shape" as soon as it is repaired. Probably, the repair is being held up while some small part is looked for. Rather than buy the part new, the person with ADHD judges that it is bound to show up soon, since it was carefully saved (and lost) as part of this whole plan in the first place. A prodigious ADHD imagination makes these sorts of unrealistic plans proliferate.
A compounding factor can be the distress experienced with the thought of wasting something. The imagined scenario is that if the item is saved just a little bit longer, its usefulness will be triumphantly achieved, redeeming the plan and the planner. Getting rid of it now would amount to tragic foolishness. At some level, that way of thinking may not be wrong, but if the judgments of the relative likelihood of different scenarios is impaired, the tragedy of discarding may balloon up to obscure the tragedies of saving.
The third aspect of hoarding and clutter is the inevitable disorganization that results. The ability to categorize, sort and prioritize is fundamentally an executive function. Without that ability fully engaged, managing the acquisitions and saved belongings becomes futile. Despite heroic efforts, the attempts to cut down the clutter and put things away may never work. Part of prioritizing is knowing what is truly important. But with ADHD, the salience of what is in front of one's nose always increases. So as a pile is "excavated", each unearthed object triggers the plans, hopes and memories associated with it. These then swamp the other priorities in one's life.
Given that surge of significance, whatever the object is, it is not likely to be discarded. But it is not likely to be dealt with either. If it is dealt with, well, of course the day's organizing project has been derailed. More likely though, that object will be placed in a "special place" where it won't be forgotten again. The creation of "special places" leads to a proliferation of "places that will never again be remembered", or at the very least, new piles. As soon as that object's special disposition is complete, the next object below it is exposed, with a similar result. After creating numerous new piles, the result of a great deal of effort and anxiety will be the "churning" of hoarded belongings.
After a lifetime of this behavior and its predictable results, the very prospect of getting organized will be fraught with anxiety. The attempt to hold onto things and avoid tragic foolishness leads to futile churning of useless objects and at least self-derision, if not puzzled patronizing from less ADHD-hampered folks. So an additional symptom will be the secondary distress and avoidance around cleaning up the clutter. Now when we excavate that first piece of paper, we will need to quickly dispatch it to its "special place" and go take a break. The whole challenge is unapproachable.
Where is the way out? Like the treatment for most other compulsive behaviors, there is one fundamental rule: Get help! Borrowing someone else's executive functioning will be a big help. Even another person with ADHD will have less trouble with your sentimental attachments than you will. But you need to stay in control. You can't afford to be swamped with anxiety in the process. Good places to start are with a professional organizer, a CHADD group, or a hoarding and clutter group. The Mental Health Association of San Francisco runs one of the latter, and can be contacted at 415-241-2926 or at www.mha-sf.org
Rule number two is to reject the shame associated with your trouble. It blocks your asking for help and your realistic appraisal of what you are up against. Don't wait for magic. Don't just try harder. Refer back to rule number one and join in with others.
Now, if you decide to save this article, write on it the date that you will throw it out. Otherwise, just remember that you can always look it up again at www.millsconsulting.com
An excellent self-help book is: Overcoming
Compulsive Hoarding: Why You Save & How You Can Stop
by Fugen, Ph.D. Neziroglu, Jerome, Ph.D. Bubrick, Jose A., M.D. Yaryura-Tobias
Support groups are available through the San Francisco Mental Health Association (Resources on Hoarding and Clutter)
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