by Randy O. Frost and Gail Steketee
Houghton Mifflin Harcourt, 2010
Review by James K. Luiselli, Ed.D., ABPP, BCBA on Sep 14th 2010
Psychologists Randy O. Frost and Gail Steketee are highly regarded clinical and research psychologists specializing in obsessive compulsive spectrum disorders (OCD). In Stuff, they address compulsive hoarding, a complex problem that has recently gained media attention through reality television series (Hoarders and Buried Alive) and a flourishing self-help book market. Thanks to the dedicated efforts of Frost, Steketee, and other social scientists, we know that compulsive hoarding is widespread (about 3 million people are affected), does not constitute a single psychopathology, and is not simply a variant of OCD. Furthermore, there is effective treatment for compulsive hoarding, albeit time-intensive and many times, lifelong.
Frost and Steketee adopt a case study approach in describing the causes and phenomenology of compulsive hoarding. Each chapter in the book introduces us to one or more people the authors have treated as well as historical accounts of famous “cases” plagued by the disorder. Concerning etiology, the chapters reveal that compulsive hoarding can result from cognitive influences such as distorted thinking about the value of objects and relationships with possessions. Impaired executive function also appears to be implicated in compulsive hoarding, notably when someone can’t decide about keeping or discarding objects (at its most basic level, hoarders keep everything). Other dominant characteristics of compulsive hoarders are perfectionism, a preference for ordering and categorizing things, and depressed mood. Stuff makes it clear that to understand compulsive hoarding, professionals and the people afflicted with it must adopt a wide lens when contemplating causation.
The authors have spent many years developing treatment for compulsive hoarders. Their case histories are replete with experiential and psychotherapeutic procedures, which, like the topic of etiology, dictate a multi-faceted approach. For the most part, Frost and Steketee endorse a treatment model that directs the compulsive hoarder to gradually abandon collected objects, work through anxiety associated with the experience, eliminate discarding-induced negative thinking, and learn to tolerate the distress at not acquiring material goods. For readers who have a hoarding problem, the authors advise finding a professional who has requisite expertise, locating one of a growing number of local support groups, and checking out reasonable self-help publications (listed in the final chapter).
Stuff is a comprehensive overview of compulsive hoarding in all of its manifestations. The book is not a self-directed guide for overcoming hoarding problems but instead, a detailed narrative by expert clinicians, something akin to the medical biographies written by Oliver Sacks. So, if someone is troubled by compulsive hoarding, or if you are concerned about another person, Stuff would be a valuable resource. If you function as a mental health professional, reading the book will give you the most up-to-date and research supported information about compulsive hoarding.
Although Frost and Steketee explain various elements of their treatment program for compulsive hoarding, I found it difficult to understand fully the typical sequence and course of intervention. The reference list contained in the book cites many of their peer reviewed publications and there is no question that they have produced treatment outcome studies. Accordingly, I think the book would have benefited from a brief appendix which outlined stages of treatment, including the focus of in-home therapist guidance, cognitive-behavioral therapy, and building family alliances so critical in changing the behavior of compulsive hoarders. Or the authors could have reprinted one of their journal publications for the discerning reader.
In one chapter in the book Frost and Steketee write: “Pictures have proved to be a good way to keep track of how clients do in treatment. Photos document progress far better than memory, and reviewing them has been rewarding to our clients later in therapy as rooms are cleared.” It is curious then that Stuff does not have pictures that illustrate this point. It could be argued, of course, that compulsive hoarders reading the book don’t need visual referents and that before-treatment and after-treatment photographs would not persuade someone who isn’t bothered by excessive clutter and actually enjoys hoarding. I think that the authors may have omitted pictures in deference to the privacy of the people they portray so sensitively. But for readers interested in but unfamiliar with compulsive hoarding, a few representative photographs would be powerful.
My minor critiques notwithstanding, Stuff is the best account of compulsive hoarding available to the lay public and professionals alike.
© 2010 James K. Luiselli
James K. Luiselli, Ed.D., ABPP, BCBA is a psychologist affiliated with May Institute and a private-practice clinician. Among his publications are 6 books and over 200 journal articles. He reviews books for The New England Psychologist.