private. By all outward appearances, she was functioning extremely well. She had friends and was getting straight A's. As her senior year progressed, however, her tightly controlled world began to unravel.
Irene majored in art history and decided to write a senior thesis on Iranian art and architecture. As she collected and read book after book on the subject, she began to see connections everywhere. One obscure fact led to another, and when she saw these connections, she felt compelled to pursue them. To keep track of it all, she kept copious notes on each book she read. Sometimes her notes approached the length of the book itself. She felt the need to collect information until she had a "complete" picture before sitting down to write. For the perfectionist Irene, anything less than perfect meant disgrace. As the end of the term approached, she had written very little, and for the first time in her life, she faced the prospect of failure. Still, she couldn't quite see how to limit her material, and she went on collecting.
When she realized that she didn't have time to complete her thesis, she became suicidal. It began as a thought that gave her some respite from her terror about the upcoming deadline. Soon she found herself thinking about how to kill herself every day. Instead of writing, she made plans to drive her car into a nearby lake. Death seemed like a better alternative than failure. In the end, she put all her notes and the few pages of her thesis she had been able to squeak out in a manila envelope and gave them to her professor with an explanation of her problem. He took pity on her and gave her a Câ, her only grade below an A in college.
She had struggled with depression since then, though she had never again been suicidal. Irene's depression impeded her ability to deal with her clutter. During her depressive episodes, no sorting or discarding occurred, and one of the few things that made her feel better, shopping, only added to the problem. Depression is a common affliction among hoarders. In fact, nearly 60 percent of the participants in our research meet diagnostic criteria for major depressionâmuch of which results from the hoarding itself. People draw conclusions about their worth and competence based on their inability to control their living space, and not being able to entertain people in their homes isolates them and limits their social lives.
On my first visit to Irene's house, she said something unusual. When I asked her if she would agree to be studied while we tried to help her manage her stuff, she said, "Why would you want to waste your time on someone like me?" When I asked her more about what she meant, it became clear that her low opinion of herself reflected ambivalence or uncertainty rather than pure low self-esteem. When she was at work, talking to other people, or shopping, she did not have the same feelings. But when she was at home, her unworthiness was more apparent to her, mostly when she focused on the clutter. When she focused on individual items, however, her possessions seemed more comforting than threatening. The irony that her hoard could be comforting and tormenting at the same time was clear to her.
After college, Irene lived at home with her parents for a year and took some additional courses at a local college. She planned to start graduate school the following year. This was the first time she remembered living in a messy room. She saved all her college books and notes and packed them in "clean" paper bags that nearly filled her room. The room had two twin beds, but only one was visible. She recalled someone looking into her room and not being able to tell there were two beds there. Thirty years later, she still had those books, papers, and clothes.
The following year, Irene entered graduate school in library science. She had no problem categorizing, cataloging, and organizing library materials, as long as they did not belong to her. If they were hers, she