Hoarding TV shows are perhaps my guilty pleasure. But as a psychologist the intrigue me to no end. It's the development of a new disorder, slowly being realized by the APA (both of them) and the DSM. It's like being back, over half a century ago, when psychologist began to organize and debate ensued. Back when DID was still MPD and hysteria still diagnosable. It's just enthralling to see the progress in action.
Abnormal psychology is outside my trained purview, but I do have some education in it. Hoarding was only discussed in passing during one laboratory class, but my nerdy friends and I have often spent mindless conversations over post-class beers discussing the psychopathology of the disorder.
Often it's described as an extreme extension of obsessive-compulsive behaviors, tied in closely with depression and anxiety. But after watching an episode this afternoon (not the above video), where a woman, Laurie, claimed "it would feel like you really didn't care much for me," in response to the unknown end of a doll she hypothetically gave to her therapist. "If he had said he'd take care of it, I'd given it to him right there on the spot. But he said he couldn't answer what he'd do with it, I couldn't stand it."
In this instance, I believe hoarding shows its complexity. It is interaction between the compulsion to acquire and the obsession to keep that prevent hoarders from moving forward without help. But it's also misattributions and cognitive distortions, often brought on by an acute traumatic experience, that generally start the behavioral change.
What Laurie's statement reveals is an extreme form of projection. She sees that others do not value her, when she, in fact, has little value for herself. She projects her desire to feel loved onto others, through, in this case, the doll and the therapist's love of it. Her conduit for her defense mechanisms is all of the stuff she hoards, which she also uses to introject from. The objects she has are always there for her, and they never make her feel sad or hurt her, they are her "safe haven" as she calls it. In this way, the fact that none of her family comes around because the hoard is a problem she introjects this as she is the problem. They do not love her, so she does not love herself, thus starting the projection cycle again.
This combination of projection and introjection often manifest into projective identification:
In other words, the patient both projects internal objects and gets the person on whom they are projected to behave like those objects, as if the target person has those same introjects.... The "self-fulfilling prophecy" quality of projective identification was once explained to me as a natural consequence of a person's being disturbed enough to have avery primitive ways of perceiving reality, short of psychosis. A woman who is invested in staying anchored in reality will feel less crazy if she can induce in someone else the feelings she is convinced the other person already has.
Laurie elicits the responses of not coming around and lack of loving remarks from her family by continuing to hoard. And she continues to hoard because her family continues to avoid her. This entwined nature, seen in OCD and the anxiety-depression cycle, needs intense CBT, and--dare I say--insight to help remove oneself from the loop. Without proper help, any step forward will be three steps back as soon as a hiccup occurs, because the root of the cognitive distortions will not be known.
Then again, that's only my slightly-educated opinion.
(McWilliams, N. (1994). Psychoanalytic Diagnosis: Understanding personality structure in the clinical process (pp 110-111). New York: The Guliford Press.)