When the pandemic began and the contours of Susan’s life contracted — no lunches out with friends, no babysitting the grandkids — she sought comfort in QVC and the Home Shopping Network.

She bought six pairs of shoes. A suede jacket. Purses. A watch that looked sharp on television but turned out to be “cheap, ugly silver.” And as those packages thumped onto the stoop of her Center City townhouse, their contents added a fresh layer to the clutter that Susan, a retired language arts teacher, had been accumulating for decades — Scholastic magazines, boxes of 45 rpm records, pins from the poodle skirts she wore in high school, size 8 stockings that haven’t fit for years.

“I am a shopper and a hoarder,” she says. “I find reasons to keep things. The pandemic has absolutely made it worse. I used to be out. Now I’m home. It’s not like the hoarders on television. But it’s embarrassing.” Shameful enough that Susan, 77, asked to be identified only by her middle name.

She may feel stigmatized, but she’s not alone.

While supply shortages and anxiety, especially in the early months of the pandemic, drove many people to panic-buy toilet paper and hand sanitizer, that type of hoarding was short-lived.

For those with hoarding disorder — a clinical diagnosis that includes an extreme reluctance to part with items and a level of accrual that renders living spaces unusable — the pandemic was a perfect storm. Isolation, stress, uncertainty, and grief — combined with extra time at home, the ease of one-click shopping, and the absence of visitors who might suggest curbing the clutter — exacerbated a problem that psychologists say affects up to one in 20 people in the United States.

Hoarding disorder, which affects people of all genders and races, can begin as early as adolescence and typically increases in severity over the life span; the average age of a person seeking treatment is 50.

A study in the April Journal of Psychiatric Research showed that hoarding disorder worsened during the pandemic. Of more than 800 respondents, nearly all from the United States, the number with clinically significant hoarding symptoms rose by nearly 4% during the pandemic. A smaller study, published in June in Frontiers in Psychiatry, showed COVID-era spikes in compulsive hoarding symptoms among 43 men in quarantine in Italy.

“Folks who were struggling with hoarding disorder before COVID were already existing with this extra layer of stress in their lives,” says Dara Leinweber, coordinator of the hoarding support program at Jewish Family and Children’s Services (JFCS). “So [the pandemic] was like adding fuel to the fire.”

While local entities that offer support (some free, some with sliding-scale fees) for those with hoarding disorder — among them JFCS, Community Legal Services, and the Philadelphia Corporation for Aging — say it’s too early for hard data on hoarding behavior in the region, all have seen evidence of hoarding that was both exacerbated and more easily hidden during months of quarantine.

At JFCS, caseworkers received more inquiries about the hoarding program, which includes an annual webinar series, a 16-week support group called Buried in Treasures, and one-on-one case management, an intensive and long-term form of help for which there is a 10-month waitlist.

Leinweber also noted an uptick in calls from hospital discharge planners about patients who had been treated for COVID-19 and could return home — except that their homes were too cluttered to be safe.

Ironically, the pandemic allowed JFCS to increase services for those with hoarding disorder; because virtual groups don’t require physical space, the agency was able to launch two concurrent series of Buried in Treasures, along with a monthly drop-in group and a new art therapy series for those who hoard.

But for everyone with hoarding tendencies who reaches out for help, caseworkers say, there are dozens more who are in denial, downplay the problem, or feel paralyzed by possessions even as they cling to them.

Yasmin Goodman runs Organized at Last!, a business that helps people who struggle with hoarding and cluttering. She’s a member of the Philadelphia Hoarding Task Force, a coalition formed in 2013 to raise awareness and provide education about hoarding disorder.

Most people, when they think of hoarding, focus on the things, Goodman says; she tries to understand the human beings who value those objects. “When you start looking more deeply and curiously, you begin to see the lifetime decisions, or traumas, or creativity of the individuals: What’s woven into each of those items?”

Ron, a retired mechanic in Delaware County, began collecting when he was a boy — comic books, bicycle parts, a half-dozen empty aquariums. “It got worse as I got older,” he says, as his garage, basement, and bedroom filled over the decades with toolboxes, magazines, dart boards, extension cords, and mountains of paper.

“With the pandemic, when things became unavailable, it became harder to release things,” he says. “I started to feel depressed. My church activities were cut out. I had the perfect opportunity to clear things out, but procrastination keeps me from doing it. Justifications. I make so many excuses.”

Psychologists say that’s common among those with hoarding disorder. People who hoard see specific utility — someone might need that shovel — or sentimental attachment in objects that others would deem useless. And in many cases, those who hoard don’t see their behavior as a problem. It often takes the prodding of a family member — or a landlord’s eviction notice — to prompt them to seek help.

Researchers are just beginning to unravel the origins of hoarding disorder, says psychologist Marla Deibler, founder of the Center for Emotional Health of Greater Philadelphia and a specialist in hoarding, anxiety, and body-focused repetitive behaviors such as skin-picking. Current thinking is that genetics play a role, along with neurochemical differences and, often, a major stress or traumatic experience that triggers or exacerbates hoarding behavior.

Gari Julius Weilbacher, a life coach and owner of DeClutter to DeLight: Compassionate + Green Clutter Control, based in Philadelphia, says that even before the pandemic, consumer culture provided fertile ground for hoarding tendencies.

“We live in America, and we are told to buy things,” she says. “There’s planned obsolescence. We’re constantly told to upgrade. Also, things hold memories; they hold experiences. But when you can’t walk in your home, or relax, or enjoy the things you have, it’s time to start moving them out.”

Theresa’s adult sons had been telling her that for years.

Theresa, a 69-year-old hospital clerk, had 10 large, wheeled bins stuffed with the clothing she couldn’t seem to stop buying, pieces of furniture she could barely see, and a room in her Northwest Philadelphia house too cluttered to use as an office when the pandemic sent everyone home from work. When repair people showed up, she was frank with them — ”You know, I have a hoarding disorder” — as they picked their way through the obstacle course.

Theresa joined the Buried in Treasures group in fall 2020 and began to set modest goals: Get rid of the old table and television to make room for a computer in her home office. Use brief work breaks to cull through papers. Give away the high heels, the extra towels, the size 2X clothes that swam on her after she lost weight. Buy decorative hat boxes to store socks, gloves, hats, and swimwear.

The group didn’t only change her hoarding habits; it shifted her mindset, even her financial outlook. “Now I make a plan with an end goal,” Theresa says. When she considers a new purchase, she asks herself: Will this add value to my life, or to my home? She finally unboxed the Breville Smart Oven, the Instant Pot, and the Vitamix blender she bought at the start of COVID-19.

“I have a lot more pride in myself now,” she says. “I’ve gotten rid of a lot of clutter all over. Sometimes I get frustrated — oh, God, I’ve still got more to go — but I just set up a schedule for it.

“I’ve realized that I can do this. I’m falling in love with my home again.”