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An Interview with Gail Steketee, PhD, on Hoarding and OCD (Obsessive-Compulsive Disorder)

David Van Nuys, Ph.D. Updated: Sep 15th 2009

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Gail Steketee, Ph.D., MSWIn this edition of the Wise Counsel Podcast, Dr. Van Nuys interviews Gail Steketee, Ph.D., MSW on the topic of Hoarding and OCD (Obsessive-Compulsive Disorder). Hoarding (filling a home with clutter to the point where clutter takes over the house) is a surprisingly common behavior, but it is only recently that serious research attention has been brought to bear upon it. Dr. Steketee describes some of the recent findings from the research, among them (surprisingly) that hoarding is probably not best considered a subtype of OCD. The interview touches upon diagnostic and measurement issues associated with studying this problem, as well as information on the cognitive behavioral therapy protocol which has been shown effective in treating hoarding.

David Van Nuys: Welcome to Wise Counsel, a podcast interview series sponsored by CenterSite, LLC, covering topics in mental health, wellness, and psychotherapy. My name is Dr. David Van Nuys. I'm a clinical psychologist and your host.

On today's show we'll be talking with Dr. Gail Steketee of Boston University about obsessive-compulsive disorder and hoarding. Dr. Gail Steketee received her undergraduate degree from Harvard, and her MSW and PhD degrees from Bryn Mawr in 1973 and 1987. She joined the faculty at the Boston University School of Social Work in 1986 and is currently professor and dean at the school. She's conducted multiple research studies of obsessive-compulsive disorder, panic and OC Spectrum conditions, including body dysmorphic disorder and compulsive hoarding. She's received several grants from the National Institute of Mental Health to study OCD and hoarding, and she currently leads a multi-disciplinary team studying the psychopathology and treatment of compulsive hoarding, as well as web-based and group treatments and community task force initiatives to address this problem. She's published over 180 articles, chapters, and books on anxiety, OCD, and related disorders, including eight books. Her most recent books include Cognitive Approaches to Obsessive-Compulsive Disorder, Compulsive Hoarding and Acquiring, and Buried in Treasures: Help for Compulsive Hoarding.

Now, let's go to the interview. Dr. Gail Steketee, welcome to Wise Counsel.

Gail Steketee: Thank you very much.

David: Well, tell us a bit about your background and training.

Gail Steketee: I am a trained social worker, so I have my master's in social work; and I also went back a few years later to get my PhD in social work as well. My clinical training comes from the clinic at Temple University some years ago that Joe Wolpe ran.

David: Oh yes, I know Temple.

Gail Steketee: Do you?

David: Well, I did my undergraduate work at the University of Pennsylvania and, of course, they're both in Philadelphia.

Gail Steketee: Right, and so Dr. Joseph Wolpe was one of my early mentors, along with Edna Foa who got me into working on OCD.

David: Oh, yes, I've interviewed Edna, as a matter of fact, on the same series.

Gail Steketee: Great.

David: Yeah, so you have a great background.

Gail Steketee: Well, thank you.

David: Yeah, and now you're involved in both research and, I guess, university administration as well.

Gail Steketee: Yes, I'm a dean here at the School of Social Work, but I also am an active researcher. We just had our research team meeting with many things going on. And that's a lot of fun for me.

David: Oh, well, that's good because, being in an academic-administrative role, you need something fun to counterbalance that.

Gail Steketee: Yes, that's true.

David: So how did you come to be interested in OCD and hoarding, in particular?

Gail Steketee: Well, the OCD part came many, many years ago, I think probably more than 30 at this point - or at least pushing 30 - when I worked as a young clinician on a complicated case of a young man who had been unable to complete his medical career because he had extensive washing routines. And I enjoyed very much working with him. He had a very successful outcome and I was hooked in doing, at that time, the behavioral treatments, the exposure and response prevention that we did for OCD, and still do very successfully for OCD. The hoarding interest came from my work with Dr. Randy Frost, who's at Smith College. Randy became interested in looking at hoarding symptoms because he had been giving an OCD seminar to his undergraduate students at Smith, and one of the students had picked out hoarding as a class project to work on; in fact, I think there were several students working on it. And when they put an ad in the newspaper to try to do some interviews and collect some information from people that they called pack rats, they got a very large number of responses. And as they collected the information they became more and more interested and aware of the magnitude of the problem and the prevalence of the problem.

David: It sounds like they were shocked that they received so big a response.

Gail Steketee: Yes, they were definitely surprised. And as he and his students continued to work on it - and Randy and I had been working on other OCD-related research - he finally said to me that I think that we can't ignore this, I think it's very important. And so I started paying more and more attention, and I agreed with him very quickly that this is a remarkably common problem and can be quite a severe one. In fact, the thing that disturbs us all is when it's life threatening and that does happen to some people; fortunately it's rare.

David: Yeah, I wasn't aware of that, and I should rush to say here, in case anyone doesn't recognize that OCD stands for obsessive-compulsive disorder. I think it's pretty much in the common knowledge these days, because I've noticed it crops up in a number of TV shows, like Bones and other shows, and people will actually say OCD without even spelling it out, so it's pretty well known at this point. But I don't think most people would associate hoarding with OCD. Has the mental health establishment always linked the two, and if not, when and how did that come about?

Gail Steketee: Well, I think that researchers in the field of OCD and what we call OC Spectrum conditions - that includes things like hair pulling, tourette's syndrome, a few other conditions that people associate with OCD - those researchers have often considered hoarding to be a subtype of OCD. That's looking less and less likely the more we study this problem.

David: Oh, really.

Gail Steketee: It's looking that hoarding is, in fact, a different problem from OCD.

David: Oh, that's interesting, because currently in the DSM it is listed under OCD. Isn't that the case?

Gail Steketee: Well, in the DSM-IV it is listed as one symptom of obsessive-compulsive personality disorder, what we call the Axis II or personality conditions. And then it's mentioned in the OCD section but not as a diagnostic criteria item; it's just mentioned that in severe cases we should consider a diagnosis of OCD. But in fact, that's probably none of it particularly accurate right now, and I think DSM-V we will see some changes.

David: Well, that's interesting. Are you on that committee?

Gail Steketee: I'm not on the committee, but we've been in close touch with members of the committee and, in fact, right now they are considering whether or not to do some field trials on hoarding and its characteristics for the possible inclusion of hoarding as a separate diagnostic entity, perhaps one of the OC Spectrum conditions.

David: Okay, now, I imagine the tendency to not want to throw stuff away, to accumulate stuff, probably runs along a continuum from normal to pathological. Most of us have lots of clutter - or many of us have lots of clutter in our lives - especially I notice among my older friends. How do you decide when a person has crossed over that border from kind of normal accumulation to something that you would call hoarding?

Gail Steketee: Well, you're absolutely right, it does run a continuum and the crossover happens when there's impairment, when people can no longer use their homes in the way that they used to or that most people can use their homes. So, for example, when the clutter fills up your kitchen and you don't have anywhere for the family to sit to eat breakfast, then you start to have a hoarding problem. When the living room is so cluttered that you can barely find the furniture, let alone sit on it, again we've got a hoarding problem. And, of course, in some of these cases it may run over into a dangerous situation, where things are piled so high that they could fall on people or things are piled near sources of heat so that a fire could break out. Sometimes we'll even see damage to a point where we're worried about floor boards and the structure, the integrity, of the physical structure.

David: Oh my goodness. Earlier you had said that it could be a life threatening condition.

Gail Steketee: Yep, and that's on the far end of that continuum you were talking about, from normal to pathological.

David: Yes, and as you were talking it reminded me, again, of a TV show that I've caught my wife watching a couple of times. I don't know if you've seen it, but there's a TV show where a team of people come in - you know, it's one of these reality TV shows - and somebody's…

Gail Steketee: Clean Sweep or something along those lines?

David: What was it?

Gail Steketee: Clean Sweep? There are several of them; it's not the only one.

David: Oh, okay. They come in and they've had some pretty dramatic examples, you know, kind of like you're describing where the kids can't sleep in their beds because there's so much clutter.

Gail Steketee: Yes, and, as you can imagine, that obviously presents pretty serious family problems as well as problems socializing with other people outside the family.

David: Yes, yes, I'm thinking of my own situation and whether to go into that or not; my wife being, I think, more of an accumulator than I am. But we'd better not go there.

Gail Steketee: Okay. I have to say that we give a lot of trainings in the mental health field for helping people learn how to treat hoarding, and when we do that, there's always a little bit of discomfort in the audience as we describe the symptoms and show some pictures of what it might be like. There are always some people, even among mental health professionals, who are going to have this problem. So I sympathize, I understand, and I think we all kind of look around and go uh oh, if she sees my office, what will she think?

David: You know, you're in university administration, and I think she was actually a vice president at our university or a provost or something pretty high up in the structure. I had occasion to go into her office and there were papers scattered everywhere. Her desk was totally cluttered, her floor was covered with file folders and papers and so on. And I was tempted - well, I think I did - almost reflexively and automatically have a pretty strong negative judgment on her capability. And yet I have to say, she was a very capable woman and evidently she knew where everything was and could lay her hands right on it.

Gail Steketee: Well, that is true for a number of people. Unfortunately, others with that much clutter will lose track of things, and so there's a lot of variability, and we certainly shouldn't judge competence by the amount of clutter; those are two really very different things.

David: Yes, and speaking of the marital situation, managing marital relationships can be tricky and people can fall out over all sorts of differences, but I would think that the accumulation of stuff might be a fairly frequent battle line.

Gail Steketee: Source of conflict.

David: Yeah, have you run into that?

Gail Steketee: I think we have known quite a number of people with a hoarding problem whose hoarding is kept in check by the partner who won't allow it to get outside of their workroom or their office or rooms that they kind of stake out a territory, where the spouse who doesn't have the hoarding problem kind of declares the lines of the house that have to be clear and free. We've seen a few situations where both members of the couple have a hoarding problem and then, of course, it's quite chaotic in the home.

David: I can imagine.

Gail Steketee: And we've seen some situations where, since hoarding occurs in a somewhat older population - our average age of people seeking help, for example, is right at 50, so there are a number of folks who are 60, 70 and even in their 80s - and if they lose a partner who has kept it in check, we often see a real strong resurgence of the hoarding problem that becomes seriously problematic at that later age.

David: What are some of the weirdest cases you've run across or heard of?

Gail Steketee: I guess one that strikes me as unusual is a woman who - it's hard to remember the details of it, but I believe that her husband fell down the basement stairs - and rather than let paramedics into the home, because she knew her home was so cluttered that she would be taken to task by the public health department for it, she let him lay on the floor of the basement for almost two days before she would allow anybody in. And I think that reflects a very severe sort of problem with the priority here of her husband's health versus protecting her home from people who would be upset by the clutter. And that's very, very unusual and I certainly know of only one such case I have heard of. But we do know, in my own neighborhood or on route from my neighborhood to work, I remember the day in which the fire trucks were out front of a home that I had spotted on my way in as having a very cluttered yard, and I could tell that the windows in the house had all the shades pulled and you could see that things were leaning up against the shades, against the windows, so I knew it was a home with a lot of hoarding in it. And it was burning at that point and indeed, although it didn't burn to the ground, the man in his 80s who lived in the home, they were unable to save him because the fire department could not get through in time to get to him because of the amount of clutter in the home. So that was stacked very, very high against the walls and to the ceilings in some cases.

David: Wow.

Gail Steketee: The worst case is probably the Collyer brothers, a case anybody can Google and take a look at it. It was in New York City. This is a case of a pair of elderly brothers who filled their brownstone to the brim, all five stories and the basement of it, with massive amounts of clutter, including things like grand pianos and automobiles. And it took them weeks to empty out the house. One brother died in it because I think a pile of things had fallen on him - a booby trapped pile of things - and the other brother died when… I think the first brother was a caretaker for that brother, and when the caretaker was gone under the pile, then there was no one to care for the ailing brother, so they both ended up dead in the middle of that massive mess.

David: Oh my goodness.

Gail Steketee: So that's probably the worst known and the most publicized case; and that's back in the late '40s.

David: This makes me think of "cat ladies," and I'm wondering if there's any relationship between hoarding and these instances where - and it seems like they've all been women that I've heard of, I don't know if it's unique to women or not - but people who have tons and tons of cats, so much that the public health officials or some other organization has to kind of come in and forcibly intervene.

Gail Steketee: We call that animal hoarding, and we don't really know the relationship of the hoarding of animals to the hoarding of objects or possessions. We have done some interviews with people and, of course, people who hoard animals tend to have more than 20 animals that are not well cared for, are not getting adequate health care, and sometimes not good enough food. They can number in the scores of animals; they're not always cats, they can be dogs, they can be gerbils, they can be almost any kind of animal. And they often do not recognize the extent of the problem and the extent to which the animals are in poor health, and not adequately cared for. And you're right; they come to the attention of the Society for the Prevention of Cruelty to Animals, the SPCAs in the country. But we have sometimes noticed that there's also a great deal of clutter and disorganization in those homes, but it's not clear to me whether the two are linked.

David: Okay, well, you mentioned in the beginning that you felt that hoarding might be misunderstood, misclassified, under OCD. So of course I'm wondering how you're seeing it differently, and I'm wondering if there are any known brain correlates with all the attention to the brain now and the new imaging technologies and so on. What do we know about either the neurological or…?

Gail Steketee: What we know at this point, we don't know exactly where the source of whatever may be different in the brains of people who hoard. There are a number of studies that have been done. They implicate a number of areas of the brain at this point. At some point we hope these data kind of coalesce to guide us with regard to causes or sources of the problem, but we're quite a distance from that at this point, because the studies have very small numbers of people in them and they're somewhat discrepant in terms of the areas that are highlighted and the methodologies used. What we do know is that people who hoard have brains that look rather different than people who have obsessive-compulsive disorder, because that's been the main comparison. They certainly look different from people who don't have psychiatric problems, but we're a long way from knowing just what's wrong and what to do about it. But I would say we're confident, not only in the brain imaging information, but also in the genetic information, that hoarding is a different problem than OCD.

David: Yes, I wanted to ask if there were any genetic correlates.

Gail Steketee: There are, they're pursuing them now. Some have shown up of great interest. I am not myself a geneticist, so I can't represent the data available. I do know that our colleagues down at Johns Hopkins and in other places have begun to do some research on hoarding to identify the family history patterns as well as the genetic linkages. And they're working on it now. They're pretty confident that something will show up that is fairly specific to hoarding, but I don't think that they have enough data right now to know exactly where the loci are.

David: Okay, now, you mentioned that the age of onset tends to be in later life, starting around age 50. Is there anything else that you either know or speculate about the causes of…?

Gail Steketee: Well, it's interesting that the actual age of onset is probably quite a bit earlier, but in a much milder form. So when we have interviewed people with serious hoarding problems that certainly qualify as clinically problematic for them, the people who've come into us are averaging age 50, but when they track back to when they remember the kind of collecting that they did and the amount of clutter and accumulation of stuff, they'll figure out - most of them - that somewhere in their middle, late teens they were already aware that what they did was different from that of the children around them; that they were more attached to things, that they saved more of their things, they had a great deal more difficulty getting rid of things, they acquired more - either for free or because they were able to buy them - and so forth. So I think we think that the onset is probably in the teenage years, and there are documented cases of children with serious hoarding problems as well, so it could be earlier for some people. But it doesn't get bad until somewhat later in life, when they begin to lose control over it.

David: You know, something that just popped into my mind is I'm wondering if, to some extent, we don't live in a hoarding culture.

Gail Steketee: That's a good question. It's a very good question, and I think at this point the culture, at least in the United States - in which there's such a focus on marketing and advertising to buy, buy, buy - creates a fertile ground for people who have a tendency to accumulate too much, to do so.

David: So like so many other things, probably multi-causal, multiple causes.

Gail Steketee: Right. In order to have a hoarding problem, you would not only have to accumulate it, but you would also have to have it be disorganized and have it everywhere, so it's really interfering.

David: If it's organized, you're a collector.

Gail Steketee: Well, collectors we think of as people who are collecting things that will be valuable and each item is typically different from the last. So you wouldn't just collect multiple copies of something; you would want your copies to be different. And people who collect often get together with other people who collect in order to look at their collections. They sell and buy from each other and so forth. So that's a little bit different, I think, the collecting interest that many people have. And, you know, we all know of children who collected stamps when they were younger and so forth.

David: Now, the people who come to see you or other clinicians for treatment, I guess they have some sense of discomfort, that something's wrong, that they're different from other people or that they're being judged. Are there other people who are sort of blissfully unaware; this is just what they do and somehow they're out of touch? Does that vary along a continuum?

Gail Steketee: Well, there are certainly quite a number of such people out there and what we get are the calls from the family members and friends who are very worried about them and upset about the problem, and want to know what to do because the person who's doing the hoarding is not seeking help and, in fact, doesn't want to hear it. One of the problems with hoarding is it takes a long time for people tor recognize that the difficulty is truly out of their control and is really creating a problem, not only for them but for the people around them.

David: I saw that you presented a paper in Paris on "Diagnostic Issues in Compulsive Hoarding." What are some of the diagnostic issues?

Gail Steketee: Well, the main features of hoarding which we would consider to be diagnostic is first, that you have to accumulate a large number of things, and you have to be unable to get rid of them, or have very great difficulty discarding those things. That creates clutter and, you know, clutter varies in amount, but clutter that interferes with functioning. And either distress about the clutter of impairment because of the clutter. And as we were just talking a little bit ago, not everybody recognizes that the clutter is really seriously problematic so it may be impairing their functioning, and the functioning of those around them, but it may not be distressing to them, it's distressing to somebody else. Those are some of the main diagnostic features. One of the things that we have been batting around a little bit is whether it is essential that people have excessive acquiring; that is, do they need to be buying things or picking up freebies on a regular basis and that's part of the symptom, or if we had someone, for example, who just lived at home and never threw out their junk mail or the things that come into the home in a natural way, would that make for a hoarder. And we suspect it would; it would just take longer. But we do see a great deal of accumulating of new items on a regular basis for the vast majority of people who hoard.

David: What can you tell us about your research? How does one go about researching this sort of thing?

Gail Steketee: Well, it's actually not very hard to do because this is a very prevalent problem, as far as we can tell. The data suggests right now that it's somewhere between 2 and 5% of the population. That's a pretty large number when you start to take a look at it. And so we have actually not had to do very much advertising; we've just kind of let word of mouth spread. Now, I'm here in Boston and we have never had a shortage of people interested in either getting help for the problem and seeking treatment, or in being willing to participate in our studies of psychopathology of hoarding.

David: How would those studies be structured?

Gail Steketee: Well, the treatment study that we did, we compared people who were receiving a cognitive and behavioral treatment for hoarding, that was really specifically designed to address the hoarding symptoms, to a wait list control, where they were just waiting for 12 weeks and then they got the active treatment. Our data show that the cognitive behavioral treatment worked very well for hoarding; not perhaps quite as well as we would like. It didn't eliminate the problem but it certainly improved it very much, whereas the people on the wait list did not improve. We've also done some studies on the nature of the symptoms, that is, how closely related is hoarding to OCD in terms of the various features: depression, anxiety, other emotional features as well as behavioral features. Unfortunately, though, we don't have the results of those data yet because we just finished that study, so we are just now beginning to take a look at the data that have come out of that. We should have a great deal to say in the next couple of years about hoarding in relation to obsessive-compulsive disorder and to people who don't have any psychiatric problem that we compared them to as well.

David: Well, we'll look forward to finding out about that. Now, I saw a reference to something called the Clutter Image Scale, do I have that right?

Gail Steketee: You do, that's one of the measures that we're very pleased with. It was a lot of fun to create it, so this is the fun side of research. That measure is a series of nine pictures for the living room, nine pictures for a bedroom, and nine pictures for a kitchen. So a person can just point to a picture and say, "My living room looks about that this."

David: Oh, so the pictures are graded, sort of, in terms of how much clutter is in the picture?

Gail Steketee: That's right.

David: Oh, that's fun.

Gail Steketee: From no clutter at all to quite sever clutter, although we have had a couple people tell us that, no, they're off the charts; we can give them a nine.

David: You don't have a picture here that captures my environment.

Gail Steketee: And the way we did that, of course, was we rented a little apartment and we filled it full of furniture and a large pile of stuff on top of the furniture and the floor and so forth. We parked one of Randy Frost's students in the middle of the group, and the student gradually handed things out and we just took a long series of photographs - I think about 36 for each room - as we gradually emptied the room from full clutter to completely clear of clutter. And then we selected the nine pictures that were rated as equidistant from each other, to make a scaling that would work for us. It's been our most popular measure; it's available in our Oxford books on it and it's, I think, made the work on hoarding much more accessible in terms of research.

David: It's a fascinating approach, very clever.

Gail Steketee: Yeah, it's worked fine. We have other measures that are both self-report and interview measures, which help us get at people's difficulty getting rid of things, the kinds of emotions they feel when they try to do that, the beliefs that they hold when they try to get rid of things or resist acquiring and so forth. You can't capture that in the pictures of clutter, but we have multiple ways of assessing the nature of the problem and how severe it is.

David: Yes, now, you're not only a researcher but you're also a clinician. Are you running a clinic there at Boston U. that's kind of devoted to this?

Gail Steketee: We don't have a clinic per se. We really have research studies that are of a clinical nature, so we do run treatment groups for hoarding here, and that's under the direction of my colleague, Dr. Jordana Muroff. I have another colleague here, Dr. Christiana Bratiotis, who studies community task forces and the community and policy responses to hoarding. So we cover quite a lot of ground. We don't see people individually for treatment at this time, because we don't have a current grant to do that. But we refer in the area to a number of places that have trained clinicians in hoarding and try to keep a referral list around the country for this purpose as well.

David: And is cognitive behavioral therapy the generally recognized treatment for hoarding and, if so, how effective is it?

Gail Steketee: Right now it's probably the only one that we have. It's effective for, I would say, the large portion of people, roughly 70 to 80% of people who receive the treatment and complete it - and it does take 26 sessions, as we've structured it currently. And that can take anywhere from six months to longer, even more than a year sometimes.

David: And that's in a group setting?

Gail Steketee: Well, we're running groups now but we've done it individually, and our individual treatment outcome data are probably the best that we have in terms of the greatest success. And so we do have a number of people who have benefited, but I would say that, just as in cases of people who have OCD, it's hard to get someone who's completely improved and recovered from the problem in the time frame that we're working with them. So they usually have to continue on after we stop working with them to benefit further from it. But they're doing well; they're certainly improved and can see the light at the end of the tunnel.

David: It's interesting that it's so intractable.

Gail Steketee: It is known as an intractable problem, and it hasn't responded to medication treatments, and that's been the frustrating part, I think, for many people. As you may know, OCD responds pretty well to serotonergic reuptake inhibitors and to some of the other drugs that have been tried for depression, anxiety and so forth. But those drugs don't seem to work well for hoarding.

David: So that might be another reason why it needs to be considered independently from OCD.

Gail Steketee: Well, that's another possibility, although there's a little bit of backwards reasoning: you know, if aspirin works for one person and not another, you don't look for aspirin as the source of the problem. It's a pain reliever.

David: Good point, yeah.

Gail Steketee: But nonetheless, we're encouraged that we're onto an appropriate treatment and it has specific components that really target the beliefs, target the emotions, target the acquiring, and the discarding and attachment that people have to their things.

David: Yes, boy, I can certainly personally relate to that. I've been doing some cleaning up and decluttering just recently myself.

Gail Steketee: Well, good for you.

David: Yeah, and it's hard though.

Gail Steketee: It is hard.

David: It's hard to let go of stuff.

Gail Steketee: It is hard, and I think, especially because people are somewhat older, they are looking back on things that they have held for some years and that can be particularly difficult. The other problem I should mention that we have noticed and think could be a central feature, and that is indecisiveness, that people who hoard often have trouble making up their minds.

David: Yeah, it does require making decisions and making decisions more or less on the spot.

Gail Steketee: Right.

David: You know, as mail comes in, as other stuff comes in, do you just let it pile up or do you decide, okay, this is relevant, I don't need this. It does require a certain kind of mental energy, I would say.

Gail Steketee: It certainly does. You know, we've been talking with our professional organizer colleagues as well, who work on the business end of that part of it, and they can be helpful to some people - probably not the most severe cases - but many of the people who have more moderate ones and have a lot of trouble making decisions about how to organize, where to put things, how to manage them as they come in, and so forth. So that's an avenue that has not been really studied in terms of outcomes, but could be helpful to people.

David: Do you have any suggestions as to where listeners might go for more information on this topic?

Gail Steketee: We try to maintain a website on the OC Foundation's main website that's specifically for hoarding. So is the source where I would send most people. I'm afraid we're a little out of date on it right now, and we were just talking today about needing to update the website. We hope to establish more comprehensive services in conjunction with the OCF organization that would specifically target hoarding and people who have hoarding. We're in discussion with them now about that and hope that that might improve the opportunities for many people over the coming years.

David: Okay, well, as we wind down here, I wonder if there are any final thoughts you'd like to leave our audience with.

Gail Steketee: No, I think that, in this case, the gathering of information about hoarding is a good thing, as long as they don't print them out and have many, many copies of it, and they actually take action instead of setting it in a pile and waiting to get back to it.

David: That sounds like good advice. Dr. Gail Steketee, you've been very generous with your time. Thanks so much for being our guest today on Wise Counsel.

Gail Steketee: Absolutely, thank you.

David: I hope you enjoyed this conversation with Dr. Gail Steketee and found it instructive. What a fascinating area of investigation. After the interview, I found myself reflecting more on my own observation that it seems to take a fair amount of energy to stay on top of making decisions about what to keep and what to discard. And that reflection leads me to wonder if there might be any association between hoarding and clinical depression, given that depression is characterized, among other things, by a lack of energy. I wish I had thought to ask Dr. Steketee about that in our interview. I have a hunch there might be something there.

You've been listening to Wise Counsel, a podcast interview series sponsored by CenterSite, LLC.

If you like Wise Counsel, you might also like ShrinkRapRadio, my other interview podcast series, which is available online at Until next time, this is Dr. David Van Nuys, and you've been listening to Wise Counsel.

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About Gail Steketee, Ph.D., MSW

Gail Steketee, Ph.D., MSWGail Steketee, Ph.D., MSW received her undergraduate degree from Harvard and her MSW and PhD degrees from Bryn Mawr in 1973 and 1987. She joined the faculty at the Boston University School of Social Work in 1986 and is currently Professor and Dean at the School. She has conducted multiple research studies of obsessive compulsive disorder (OCD), panic and OC spectrum conditions, including body dysmorphic disorder and compulsive hoarding. She has received several grants from the National Institute of Mental Health (NIMH) to study OCD and hoarding. She currently leads a multidisciplinary team studying the psychopathology and treatment of compulsive hoarding, as well as web-based and group treatments and community task force initiatives to address this problem. She has published over 180 articles, chapters and books on anxiety, OCD and related disorders, including 8 books. Her most recent books include Cognitive Approaches to Obsessive Compulsive Disorder (Wilhelm & Steketee, New Harbinger, 2006), Compulsive Hoarding and Acquiring: Therapist Guide and Client Manual (Steketee & Frost, Oxford University Press, 2007), and Buried in Treasures: Help for Compulsive Hoarding (Tolin, Frost, & Steketee, Oxford University Press, 2007). In the coming year she and Dr. Frost anticipate the publication of another book for the lay public on hoarding by Harcourt, Allyn & Bacon.

Editor's Note: For more information on Hoarding, click here to read a recent post from one of our blogger's on this topic.

Reader Comments
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Date of this Podcast Interview? - - Sep 29th 2009

How would I go about determining the original date of this interview? Help is greatly appreciated.

Dr. Dombeck's Note: The date of posting appears towards the bottom of the article (above these comments).  This particular interview was posted September 15th, 2009

Hoarding - Karen Wentworth - Sep 15th 2009

What an interesting interview, thank you so much.

I hoard. My 'excuse' is that I do mixed media art and can use a plethora of materials, and keep finding that I inevitably want exactly the things that I have recently thrown away. This only confirms that I shouldn't have thrown them out! None of those de-cluttering experts are ever coming to my home!

I have Bipolar 1 and I find that when I am depressed, things pile up because it requires effort to throw them out. Then, when manic, I go on a tidying spree and toss out.

My whole hoarding pattern follows my mood episodes, and the amount of energy available for making decisions about what to toss. I admit that even after manic tossing, my home is still cluttered, but at least functional.

The prospect of having OCD is a depressing thought, I'll be so happy if I don't have to add an OCD dx to my BP1 dx!

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