Whatever the label, says code enforcement officer Tammy Michael, "it's a major safety issue." And one that Morgantown is trying to get a handle on.
The city is the first in West Virginia to create a task force on hoarding, bringing code and fire officials together with mental health agencies and others to identify homes that pose a danger to their occupants and to the emergency teams who might someday be called there.
"If you can't turn around in your house," Michael says, "first responders can't get to you."
The problem has been around for decades.
Capt. Ken Tennant, Morgantown's fire marshal, recalls going through the door of a burning home some 20 years ago. He found tires used as furniture and a car transmission in the bathtub. He quickly turned around.
"Sometimes it's not worth dying for," he says.
The difference today is that at least three cable TV shows are dedicated to exposing the problem and educating people about the underlying emotional and mental health issues: "Hoarders" on A&E. "Hoarders: Buried Alive" on TLC. Even "Confessions: Animal Hoarding" on Animal Planet.
The International Obsessive Compulsive Foundation says hoarding could affect as many as one in 20 people, and as many as one in four people who suffer with obsessive-compulsive disorder
To qualify as compulsive hoarding, the foundation says, three components must be present: A person collects many items, cluttering up their living spaces and preventing them from being used for the intended purposes, then allows those items to cause distress or problems in day-to-day activities.
While hoarding can be treated with therapy and medications, the foundation says the solution isn't to clean out the house for the person. That often creates extreme distress and intensifies the attachments to the possessions.
Michael, who came up with the idea for the task force, says she first explained to her bosses that hoarding is a bigger problem than grass that's grown too high. There are complex emotional and mental health issues at work, including intense feelings of privacy, anger and fear.
"I can't tell these people, 'You just have to get rid of everything in 20 days,'" she says.
Nor does she have many tools at her disposal when she does meet such people.
State building and fire codes give authorities access to property outside and to the interior of buildings with three residential units or more. But single- and two-family homes are exempt from most regulations.
"If you want to live like a pack rat, there's not a lot anyone can do," says Tennant. "We have ordered the removal of large piles of brush, tires, etc., but inside, we have no authority at all."
Public education officer Carol Nolte says the state Fire Marshal's Office has never pursued any regulatory change when it comes to one- and two-family dwellings. By necessity, she says, it focuses primarily on high-occupancy spaces such as schools, nursing homes, hospitals and government buildings.
"There are smoke alarm and carbon monoxide alarm requirements for certain residential occupancies," Nolte says, "but there again, nothing specifically dealing with excessive amounts of trash or belongings."
In March, authorities in Wayland, Mass., blamed hoarding for the death of an elderly man in a house fire. He'd piled too much stuff on an overloaded extension cord, and investigators said escape was nearly impossible.
Last December in North Carolina, Charlotte-Mecklenburg police cited similar circumstances in the death of a man whose home had been filled with combustible material and whose door was partially blocked.
Nolte says her office knows of no hoarding-related deaths or injuries in West Virginia, "but that's not to say there haven't been."
Michael and Morgantown Fire Chief Mark Caravasos say they're not patrolling the streets, looking for problem houses. Nor are they looking to interfere with genuine collectors.
"But when we come across it," Caravasos says, "we document it now."
The Monongalia County 911 center is informed, the buildings tagged internally as an "overloaded structure" so responding firefighters, police officers and ambulance crews know what they're getting into.
"If you choose to live in an unsafe situation, that's your choice," Caravasos says. "That doesn't mean my firefighters have to go into that unsafe situation.
"We're not looking to embarrass people or take anyone's livelihood away," he adds. "A man's home is his castle, and you should be able to do what you want to. But we have the right to know when we're entering a very dangerous situation."
Recently, Caravasos says, firefighters donned Tyvek suits and breathing devices in answering a resident's complaint about a neighboring animal hoarder. The odor of feces was so strong they could smell it from the street.
"It's your own home, but at what point does this become a public health hazard?" he says. "It's a regulatory gray area."