“Makeover” shows can be very entertaining—they usually involve making over the appearance of someone who may have low self-esteem, or building a new home for a family devastated by loss. Some shows offer cleaning services to families who households are disorganized and chaotic. These shows can teach, instill kindness, or even be beneficial or rewarding for its viewers. But there is a much darker reality that is not prevalent in these reality entertainment shows; some people who are characterized as “packrats” may actually have a serious underlying mental disorder. These aren’t the people who pride themselves as collectors or admit to being unorganized or a shopaholic. People who habitually collect and never discard items are compulsive hoarders. Hoarding, also known as compulsive hoarding or compulsive hoarding syndrome, is a chronic mental health disorder characterized by excessive collecting of items in one’s home to the point where living conditions become confining, hazardous, or unsanitary. Over 2% of the population, or more than 3 million people, are considered to be compulsive hoarders. Hoarders may inhibit symptoms that indicate the presence of other anxiety or mental disorders such as depression, post-traumatic stress disorder, attention-deficit disorder, or dementia. Their habits may seem to parallel obsessive-compulsive disorder, yet hoarding does not have all of the characteristics of OCD; unlike individuals afflicted with obsessive-compulsive disorder who do not take pleasure in their compulsive acts, hoarders often gain a sense of satisfaction from their compulsive collecting. The act of collecting in hoarders is considered to be a dissociative experience, as if the hoarder is isolating rationality from their desire to hoard objects. Hoarders believe that they can make use of the items that they collect and that they may possibly regret throwing it out. They may also have difficulty departing with items that hold fond or painful memories, such as treasures from childhood, a departed parent or spouse, or a lost job. To them, trash can even be made useful, as in recycling wasted items into a crafted ornament or tool. Yet the items ultimately join the amassed piles, and are suppressively forgotten. Hoarders may feel justified in their thinking and defend their rationality; most of the time, however, their hoarding compulsion remains a dark secret kept from family and friends. This may indicate that the hoarders are unconsciously aware that their hoarding habits are irrational or unnecessary, but they find themselves incapable of stopping. Hoarding can happen to anyone regardless of gender, age, or social status, although hoarding is often discovered in seniors’ homes due to years of hoarding having amassed. While walking among layers of trash and hazardous material and living in unsanitary conditions either alone, with children, or sometimes with multitudes of animals, the hoarder may feel that their situation is out of their hands. At one point in time, they may have thought that the mess could have been tackled or items could have finally been sorted through. Over time, however, the accumulation of items and trash becomes so massive that it gets to the point where it seems impossible to reverse the damage. They feel so ashamed or guilty that they stray even further from the problem. The problem becomes too difficult to even face, and instead they repress their emotions, turning a blind eye to the situation. Gail, a 58-year-old hoarder who appeared on the popular A&E TV show “Hoarders,” aptly describes her hoarding problem as “the elephant in the room.” Hoarders often harbor animals in their home—from dozens to even hundreds of animals, pets and pests alike—oblivious to the animals’ threatened welfare as they are convinced they are saving the animals from homelessness or other danger. The piles of combustible materials such as newspapers stacked beside ovens or heaters, the buildup of animal (and sometimes even human) fecal matter, excessive garbage, clothing, mail, and the endless accumulation of needless belongings are a recipe for disaster. Not only are conditions already unsanitary or unfit for living, but hoarders may not foresee even more devastating dangers looming in the future. A large pile of items or trash may collapse upon them; infestations of bugs, rodents, or parasites may seriously risk their health by causing disease or even death; and the stacked piles that allow for small walkways throughout the house may prohibit them from escaping danger, such as a house fire. That was the case in the December 4th house fire in Tulsa, Oklahoma, when firefighters were unable to break into a home engulfed in flames due to the massive amounts of clutter blocking walkways and entry passages. The 71-year-old female resident later died in the hospital due to smoke inhalation. Similarly, a senior citizen known for hoarding perished on November 30th when his house in Winnipeg, Manitoba caught fire; the clutter restricted firefighters from entering the home and rescuing him. Of course, these homes are typically fined or restricted by the Health Department, and may eventually become condemned. Earlier this year, a code enforcement officer in New York deemed a senior’s home unfit for living, and ordered the senior to be removed from the property. The officer found excessive “hoarded” items strewn throughout the front yard, patio, and inside the home. He also noted loosely hanging electrical wires and unstable flooring. On November 30th, the vacant house caught fire, and firefighters were unable to salvage the unsafe house. Fortunately, the resident of the house was not home when the fire took place due to the officer’s enforcement of city code. Hoarders will even adjust to unimaginable circumstances because they feel the problem is too out of control to be mended. They commonly refuse much-needed repair service because they are too embarrassed to have anyone enter their home. Utilities such as water and gas are commonly shut off, making everyday bathing, cooking, or cleaning impossible. Electric wiring can become faulty and create fire hazards, and plumbing lines can collapse under pressure and cause floorboards to break. Caved-in ceilings or floors that are neglected expose the resident to the elements or to deadly chemicals and germs. When addressing someone suffering from a compulsive hoarding disorder with anger, remember that hoarding is a mental disorder and individuals afflicted by it need to be treated with patience, understanding, and support. Their hoarding should be considered as an exhibition of their initial mental state. Since they may be embarrassed or ashamed of their compulsion, it is important not to threaten their dignity, as their home and way of living are to be exposed and scrutinized. Hoarders should not be offered help to clean or organize their homes as they may see this as a threat or invasion of their lifestyle, and will commonly lead them to revert back to their hoarding compulsion or even exacerbate their condition. They often require the assistance of medical counselors and professional organizers who are usually trained to deal with compulsive hoarders. It is extremely difficult for a hoarder to allow their homes to be cleaned or to stay on track and healthy once their homes have been organized. The task requires extreme dedication and persistence; it can be draining, emotional, and overwhelming. To treat compulsive hoarding, therapy and antidepressants are usually recommended. Cognitive behavioral therapy can help hoarders reevaluate their level of logic when it comes to hoarding and help manage what is actually important in their lives. Support groups for hoarders or regular counseling is a good way to level the tensions that may already exist between hoarders and their family members and to ease the burden of having to monitor their habits.