They aren't actually gathering stuff, it's that they can't bear to let anything go, frequently due to the deep decision paralysis that comes with major depression. Then, because there is so much stuff, they can't find things and purchase new ones. There are people who found, when they finally got help and cleaned up, that they had a dozen brooms or ten tool kits or other such small things. It builds on itself
Most of the stories I've read start with one traumatic incident (like a major medical crisis or the death of a loved one) that knocks the person into depression and they withdraw from others. A few months of not cleaning or tossing anything is enough to make the project of cleaning up seem nearly impossible to someone who is in a bad space. Then they start hiding it, which makes it worse, and start keeping their garbage so the neighbors won't see how much there is. They feel acute shame and fear that they'll be found out, even if the depression lifts, so they continue to hide (which of course keeps the mess going).
Complicated and tragic.
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