Compulsive hoarding (a.k.a. pathological hoarding or disposophobia) is a hard condition to pin down. While no clear clinical definition or set of diagnostic criteria exist in the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), certain defining features have been identified by researchers in dealing with chronic hoarders. These criteria include:

The acquisition of and failure to discard a large number of possessions that appear to be useless or of limited value

Living spaces sufficiently cluttered so as to preclude activities for which those spaces were designed

Significant distress or impairment in functioning caused by the hoarding

Reluctance or inability to return borrowed items; as boundaries blur, impulsive acquisitiveness could sometimes lead to stealing or kleptomania

Due to the difficulty in diagnosing compulsive hoarding and its tendency to be masked by other psychiatric conditions, the actual incidence remains unclear. Although compulsive hoarding can take a variety of bizarre forms, including animal hoarding and Diogenes Syndrome, proper diagnosis and treatment remains problematic. Public interest in hoarders has grown due to high-profile cases as well as television documentary series such as Hoarders but questions surrounding the impact of hoarding behaviour on family members remain. This is especially true of children growing up with parental hoarding who often have difficulty with issues of shame or embarassment stemming from their parents' behaviour.

Dr. Randy Frost, a professor of psychology at Smith College, has spent two decades studying compulsive hoarding and obsessive-compulsive disorder and is the author of several primary reference texts and self-help guides for compulsive hoarders and their family members. He views children of hoarders as often experiencing a "tortured ambivalence" towards their parents due to their being forced to share their parents' hoarding lifestyle (as opposed to friends or spouses who are able to make a conscious choice). Although children often leave home as soon as possible, they are left with long-term adjustment issues as a result.

Dr. Frost adds that "“They grew up in this difficult environment and naturally came to resent it. But at the same time, these are your parents and you have to not only respect and love but take care of them. What happens when they get old?” Growing up with hoarders as role models leads to the risk of hoarding falling into a generational pattern with children demonstrating many of the same hoarding traits as their parents. The increased risk of generational hoarding has also led to researchers speculating on a possible genetic component although the complex relationship between genetics and environment makes a clear answer impossible.

To help combat the problems that children of hoarders often face, a series of support groups have been established to provide adult survivors of parental hoarding with information and community resources. Of these groups, the most popular is Children of Hoarders (COH for short) which recently celebrated its fifth year online. The COH website includes an online forum, community blogs, cleaning and homemaking tips, suggestions on raising their own children, and treatment options for dealing with parents trapped in a hoarding lifestyle. The unique nature of the COH support forum has led to a range of unusual topics being discussed including issues surrounding personal cleanliness, "doorbell dread", dealing with vermin, recognizing hoarding tendencies, and confronting parents in denial.

The website also includes information on "crisis cleaning" (including dealing with vermin), a page dedicated to books written by children of hoarders, and a comprehensive directory of support groups across the United States. While cognitive behavioural therapy has shown some success in treating hoarding behaviour, the long-term issues for hoarders and their families means that groups such as COH remain badly needed.

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