I learned my father was hoarding 40 days before he died. He had suddenly fallen ill and been rushed to the hospital, where it quickly became clear he was not leaving. Our family began to make plans for his care. One of us would have to manage his home; that person would be me – and to say that I was taken aback by what I saw upon entering his condo is to use restraint. Nothing could’ve prepared me for the horror. My father, a Detroit Dandy if there ever was one, who only drove Cadillac sedans (that he kept pristine), who I can’t remember wearing gym shoes in public, who always smelled as good as he looked, had been resting in rot. He’d collected cigarette butts and disposable coffee cups into piles so great I couldn’t make out where he slept.

Up to 14 million Americans experience hoarding disorder (HD), and the majority of those diagnosed have another mental health condition, like social anxiety disorder, depression, or schizophrenia. Defined by a persistent difficulty in disposing of things, and the excessive accumulation of them, hoarding disorder is chronic – sufferers might have to manage the compulsion for the rest of their lives.

Trauma is often what prompts the condition to develop. “All the people who hoard I’ve ever met had traumatic childhoods, whether it’s physical abuse, sexual abuse, neglect, chaotic backgrounds, lack of parents,” Nick Neave, director of the Hoarding Research Group at Northumbria University in the United Kingdom, told CNN. The habit starts as a helpful coping mechanism, he said, but for some quickly turns “into a severe addiction and mental health problem that is very difficult to resolve.”

Part of the challenge in treating HD is that getting rid of the clutter resolves an increasingly unlivable environment, but it doesn’t resolve the psychological reasons the items were acquired or kept in the first place. “We call it the stuff under the stuff,” said Kim, 53, who runs a Facebook group to help herself and others with HD. She asked to be identified by only her first name to protect her privacy. “One of our therapists calls it the one, two, three punch. You can handle one trauma, maybe two, but after that, a lot of people will have hoarding disorder creep in.”

There is help available for people who suffer. Online groups, like Kim’s, provide empathetic listeners and good feedback on effective strategies for recovery. Many people also find help in cognitive behavioral therapy. And at Stanford, psychiatrist Carolyn Rodriguez is leading research on an innovative, virtual reality-based treatment for HD. 

It involves having patients take photographs of the most cluttered parts of their environments. The photos are then turned into a virtual room, where patients spend one hour practicing what people with HD find the hardest: discarding items. It’s practical too, Rodriguez said. “In many cases, real-life discarding is too difficult or in-home visits are unfeasible for reasons such as location, availability, or clutter being stacked so high that it’s dangerous for a team to go inside.” 

The simulation moves through the whole disposal process, requiring patients to select an item, place it in a bin for recycling or trash, and watch it be hauled away. Later, patients discarded the item in real life. “For people who experience considerable distress even attempting to part with possessions, it’s nice to be able to practice the activity in a virtual space as well as process the emotions of it,” Rodriguez said. With only nine participants in her initial trial, she is hoping to be able to expand.