A recent study came out detailing the biochemical differences between the brains of hoarders and those of normal functioning people. Brain scans of those diagnosed with Obsessive Compulsive Disorder with hoarding tendencies showed abnormally high levels of activity in the region of the brain tied to decision-making processes. When OCD participants were presented with objects that belonged to them and were asked to consider giving them away brain activity spiked. This important research shows that for some people there truly are physiological barriers to purging and collecting personal belongings.
In our work we often come across clients who are likely borderline hoarders if not clinically diagnosed. Many times, these people are referred by friends and family of the client when their own efforts at controlling the ever-growing collection fail. Their homes are generally rendered unusable by the amount of stuff and often the lives of those living in the environment are suffering because of it. The approach to working with these types of clients is different than with most. If you are someone helping a loved one deal with the effects of hoarding we recommend several strategies.
1) Like-with-Like: Gather all similar items throughout the house and count the total number. For example, if there are 100 boxes of soap, discuss with the hoarder how many they think they can part with and still have enough. Perhaps 50 can be culled. The resulting number may still seem excessive, but for them it is a crucial step in the process of downsizing the collection.
2) Start with the Easy: It may seem to you that everything is trash, but to the hoarder each item has meaning and need. There are usually, however, certain items that they are more willing to give up than others. Identifying things like clothing that will never fit again, expired medications or food, and dead plants will help them to get in the mood for purging.
3) Timing: Although hoarding TV shows often depict large amounts of stuff being thrown away in one day, the reality is this type of strategy can be physically and mentally debilitating for a hoarder. Instead, plan to work slowly through the collection letting go of things in a gradual process. It may take weeks or months to get to a point of liveability, but the long-term sustainability of this strategy is greater.
4) Everything Has It’s Place: Often hoarders will acquire so many things that the belongings start to live in odd places, such as laundry detergents in the hallway. Once you clear much of the stuff out of the home, label appropriate ‘homes’ for items. Discuss with the hoarder that if a certain type of item lives in a certain drawer that if the drawer is full, they must not purchase another until there is space. 
5) Maintenance: As a strategy for long-term maintenance of the clean and organized home, work with the hoarder to commit to a goal of one-in, one-out. Every time a new item comes into the home, they must donate, trash, gift, or otherwise cull something already in the home. For the first few donation experiences, it’s best to leave the hoarder at home. After the process is more fully underway consider bringing them with and discussing with donation staff what the items will do for those receive them. The understanding that their stuff is going to a much more needed situation can lessen the stress of the process for hoarders.
6) Therapy: The physical process of getting rid of things is important, but the best thing you can do to maintain the new order to to encourage the hoarder to get therapeutic help. A trained mental health specialist, experienced in hoarder compulsions, can do much to work through the underlying reasons for hoarding and stop further collections from developing.
We know that having a Compulsive Hoarder in your life can be difficult, but just remember that they are not a lost cause. And if you need help, professional organizers and therapists can be a good place to start.
Good Luck!
TWOW
