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A before photo from the A&E series Hoarders.

The Canadian Press

The house where Stuart lives is full of boxes. They are stacked up to two metres high in every room, blocking his front door, sitting among piles of dusty flyers he won't read, wine bottles that he will never drink, and bags of clothes he will never wear.

"There is no logic to it. I saw it. I liked it. I bought it," says Stuart, 57, who doesn't want his full name used. Shortly after his daughter started to live full time with his ex-wife, he went to an auction to find a bed, and discovered, in his loneliness, that he enjoyed collecting glass. Now, there is no empty space larger than 18 inches anywhere in his two-bedroom, Toronto-area home. His garage, his shed and his van are all stuffed. He has one usable chair, but no one visits. The girlfriend who tried to help him clean is gone.

It would be easy to call Stuart a slob, but he is clean-cut, tidy and well-spoken. He suffers from hoarding, which has made for riveting reality television, even as psychiatrists have increased research into and focused treatment on the mental-health issue. Peggy Richter, head of the newly expanded anxiety disorders clinic at Toronto's Sunnybrook Health Sciences Centre, and an expert in hoarding, says new research suggests that between 2 and 5 per cent of the population may struggle with problem hoarding, literally and figuratively behind a closed door.

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Last year, an investigation found that "excessive clutter" in as many as 15 units contributed to a major apartment-building blaze in Toronto in 2010. Dr. Richter recently completed a survey of Toronto-area paramedics in which they reported that about 10 per cent of their total calls involved a home with evidence of hoarding. In the past, the discovery of a dangerously cluttered residence would prompt a fine or the threat of eviction – now some cities, such as Vancouver, are intervening with mental-health workers.

The next edition of the Diagnostic and Statistical Manual of Mental Disorders, the bible for psychiatry, is likely to include it as a distinct disorder for the first time.

Aren't they just slobs?

There's mess and then there's mess. The clinical definition of a hoarder is someone who has collected so much stuff that they can't properly use rooms in their home, such as cooking on their stoves or sleeping in their beds. They are unable to throw anything out, or resist shopping for more. And they are often at health risks from insects, rodents, fire and even cave-ins caused by carelessly piled possessions.

Josie, 41, a secretary in Ottawa, realized she had a serious problem while watching an episode of CSI. At the time, she was sleeping on a tiny corner of her bed, the only spot free of clothes and books, and she couldn't use her bathtub, which was filled with empty containers and toilet-paper rolls. "I realized [the CSI murder victim's] house could be my house in a few years."

Is this a side effect of our shopoholic culture?

Consumerism (and Internet shopping) has contributed to hoarding incidents, but hoarding isn't a new disorder. The most infamous case dates back to the 1940s, when two brothers, Homer and Langley Collyer, were found dead in their New York home where they had obsessively collected everything from furniture to musical instruments. When the Fifth Avenue residence was searched, it was discovered that one brother, who was paralyzed, had starved to death; his sibling had earlier suffocated in their possessions while bringing him food.

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Hoarders aren't grey-haired grannies

The elderly widow who never tosses anything (possibly because she's too frail to put out the garbage) may be discovered by her landlord or family members, but age alone isn't a factor. Most of Dr. Richter's patients seek help in their 40s and 50s, but they often recall developing the habit as young as age 13. "I kept everything," says Josie, including every scrap of homework, from Grade 1 to high school.

But in adolescence, hoarding rarely gets extreme: Teens don't have the money to shop to excess, and mom might be doing the laundry. To tell the difference between a slovenly room and one with early signs of problem hoarding, Dr. Richter says that parents should ask: "Is this a child who isn't taking the time to clean things up, or who's unwilling to throw things out because it is too distressing?"

The emotional toll

Dr. Richter described two types of hoarders – those with "clutter blindness" who don't recognize they have a problem, and those who are horrified by their environment but too overwhelmed to deal with it.

People who hoard develop emotional connections to items, such as movie ticket stubs, and can't resist acquiring them. Or they worry about losing necessary information even if the shopping flyer is outdated. While Stuart recognizes that his glass collection is hindering his social life, he can't part with it: "I feel like I have a house full of RIM stock, and I don't want to sell it for $7 when I paid $50 for it."

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Hoarders may have other mental-health issues. Josie, for instance, suffers from post-traumatic stress and depression because of a sexual assault. She began hoarding cleaning supplies and toilet paper because she didn't like to leave her apartment and worried about running out.

Why you can't just go in and clean up

"It was traumatic," says Josie, recalling the time her family threw out the items in her apartment. "They had rented a big construction bin and I didn't have a say in it."

Cleaning up without the involvement of the person who is hoarding rarely works. As Elaine Birchell, an Ottawa-based social worker who counsels people dealing with hoarding, explains,"The loss is so significant, the person has a stronger, deeper need to replace all these things."

Letting go, one item at a time

With one patient, Dr. Richter says, therapy involved throwing out every newspaper in his apartment that was more than 10 years old; in the end, the patient had to read nearly every one before doing so. Another patient practised window shopping. Psychologists such as Karen Rowa, at St. Joseph's Healthcare Hamilton, may also visit a patient's home and lead him or her through the steps of discarding items.

Today, Josie's apartment looks pretty normal. She is still trying to discard books, but now uses a Kindle. Her bathtub has been cleared of garbage, and she sleeps on a tidy bed. She still has a hard time resisting the urge to buy gallons of cleaning supplies on grocery trips but if they end up in her cart, she can usually put them back on the shelf before leaving.

"I am always afraid of missing things," she says. "One of the most difficult things to do is not feel ashamed."

As for Stuart, he now avoids auctions and garage sales. He's trying to pack up his glass collection and put it in the attic, but he's not sure where to start.

"The little bit I managed didn't really make a difference." Maybe in the fall, he says, he'll try again.

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