Step inside any hoarder's home and the piles of paper, debris, rotting food and shopping bags filled with untouched craft projects or clothes with price tags still attached look like an impermeable barrier.
But the person who lives there sees something entirely different.
"They don't see clutter. They see memories," said Johanna M. Lewis, clinical psychologist with the Counseling Center of Nashua.
Every yellowed paper, brittle photo, stack of Tupperware containers, mounds of clothing and cartons of clutter not only are precious memories, but a comforting presence.
And unsolicited offers to help sort through the clutter — no matter how well meaning — could easily be viewed as a threat.
"That would send them into a panic attack because they attach … meanings and feelings to the objects. So it's almost like throwing a family member out — emotionally that's how they feel about it," Lewis said.
Disorder can turn deadly
That's why hoarding is a such a difficult challenge for those who suffer from this obsessive compulsive-related disorder, she said. It's also why it poses a public health and safety risk that easily can turn deadly, experts said. Falls, disease, infection, social isolation and fires are among the hazards hoarders face.
Such was the case in New Hampshire this week when Paul W. Morrill Sr., 72, and his wife, Betty, 68, died in a house fire in Bridgewater on Monday, and Sarah Storer Robinson, 72, died in her Manchester house Tuesday. Each died from smoke inhalation.
In both fires, firefighters found no working smoke detectors and had to fight through clutter and debris to get into the homes and conduct search and rescues.
While there only have been about a half dozen fatal and non-fatal hoarder fires in the state within the last 20 years, they present a particular danger to firefighters and homeowner alike.
"You can see that, when they do occur, they are catastrophic," State Fire Marshal J. William Degnan said.
"It's dangerous to the occupants because of the rapid fire spread. Once something ignites, because of the amount of combustibles in the building, it makes it much more difficult for them to find their way to an exit," Degnan said.
Debris and clutter also endanger firefighters.
"It's very difficult finding your way through a building like that," Degnan said.
Firefighters often are the first to come in contact with hoarders when they respond to ambulance and medical calls.
Manchester officials formed a Hoarding Task Force about a year ago to help address cases that came to their attention — often through the fire department, but also through relatives and friends, Manchester Public Health Director Timothy Soucy said.
"It's probably grossly underreported. We probably saw that in the fire on Bowman Street. A lot of the difficulty with single-family homes is someone lives by themselves without a lot of social interaction," Soucy said.
The 83 Bowman St. house had not come to the task force's attention, he said.
Robinson was found dead on the second-floor of her home in a bedroom too cluttered to be used for sleeping. Fire officials speculate she became disoriented and turned in there instead of heading downstairs on the narrow path that cut through the stacks of waist-high debris throughout the house.
The Hoarding Task Force has handled about a half dozen hoarding cases in the last year — some significant, Soucy said. Besides the health and fire departments, state Elder Affairs Department representatives and members of various social service agencies have a seat at the table where members try to determine what resources are available to help people who came to their attention because of unsafe living conditions.
Social isolation is a key problem facing hoarders because their cluttered homes bar them from inviting people inside, Lewis said. Some won't bring in people to make needed home repairs because they fear they might be reported and lose their homes, she added.
"Usually family members have not been at the house for years," Lewis said.
Progress comes slow
People who struggle with hoarding process information in the brain differently from those who don't, Lewis said. They have difficulty with organizing, sustaining attention, regulating moods and often have an intense emotional need to collect and hold on to their possessions, she said. Many suffer from depression and anxiety. While hoarders are hard-wired to this type of thinking, a traumatic event such as a significant loss can exacerbate it.
Progress often comes slow, even to hoarders highly-motivated to overcome their behavior, Lewis said.
"It can take years to clean out a house," she added.
They best benefit by working in combination with an outpatient therapist, a psychiatrist and a professional organizer with experience with hoarders, Lewis said.
Working with family members "could be dicey."
"There is a lot of baggage with family members and they usually wanted it done by yesterday," Lewis said.