DEAR DOCTOR K:

I have an aunt whose house is filled to the ceiling with junk in some places. I worry about her safety navigating around all that stuff. I think she is a hoarder. What causes this, and how can I help her?

DEAR READER:

If your aunt's house has become so filled with "stuff" that she can't get around easily, I'm inclined to agree with you. She may indeed suffer from compulsive hoarding. Hoarders accumulate objects of questionable value in large and disorganized amounts.

Until recently, compulsive hoarding was considered a less-frequent symptom of obsessive-compulsive disorder (OCD). But the majority of hoarders don't have other OCD symptoms, such as compulsions and repetitive behaviors.

Compulsive hoarders may have a hard time throwing things away. This is true even when the things in question aren't valuable or useful. One of my patients with this problem once said, "If I throw it away, it's gone forever." If it has no value, what's wrong with it being gone forever?

In many cases, compulsive hoarders may accumulate so much stuff that they can no longer use their home the way it's supposed to be used. They may be embarrassed at the state of the home and withdraw socially. This can lead to social isolation.

A hoarder's home can become so disordered and unsafe that it's difficult or impossible to navigate. Hoarders are much more vulnerable to falls and serious injuries, particularly if they are older than 60. As we age, our reflexes and balance get worse, and our muscles get weaker. Add in a house full of things to trip over, and you've got a prescription for serious injury. Also, dust and mold can cause asthma and other allergic reactions.

Unfortunately, family interventions don't always help. They can cause rifts in relationships. If you want to help your aunt, be available to her, but it may be best to leave the heavy lifting to the professionals.

What to do? First, ask your doctor to help you identify a mental health professional who can help. Most moderate-sized communities have professionals with special experience dealing with compulsive behaviors. Once you get that name, you can have a talk with your aunt. OCD and depression are sometimes tied to compulsive hoarding, and there are effective treatments for both.

Hoarding also can be an early sign of dementia. If you think your aunt's memory, her ability to speak or her ability to organize her activities is starting to fail, a neurologist can be helpful.

Another approach to finding a therapist with experience in the treatment of hoarding is to check the hoarding section of the International OCD Foundation website, ocfoundation.org/hoarding.

A behavioral therapy program may help your aunt. These programs help hoarders recognize and deal with their distorted thinking or beliefs. They also help strengthen hoarders' organizational and decision-making skills and manage anxiety. Therapists may also make home visits to help with sorting, organizing and discarding. In short, there are many options to help your aunt.

(Dr. Komaroff is a physician and professor at Harvard Medical School. Go to his website to send questions and get additional information: www.AskDoctorK.com.)

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