Hoarding Disorder

However, people with hoarding disorder face significant difficulty and distress when faced with the prospect of getting rid of any personal possessions, leading to the gathering of increasingly large numbers of items. The effects of hoarding can cause a profound impairment in a person’s day-to-day functioning.

Key takeaways

• Hoarding disorder is a mental health condition characterized by an ongoing difficulty with discarding possessions. This can lead to the buildup of excessive clutter.

• We do not know why some people hoard. However, family history, brain function, personality, and stressful life events are all thought to contribute to the risk of developing hoarding disorder.

• Cognitive behavioral therapy (CBT) is the main form of treatment used to support people with hoarding disorder.

Understanding hoarding disorder

Hoarding disorder is a mental health condition in which individuals have ongoing difficulty getting rid of possessions, believing that items need to be saved. The idea of parting with possessions can result in considerable distress, leading to a decision to keep them. Over time, clutter builds up, disrupting the person’s ability to use their home as intended. ^{[1] [2]}

Hoarding disorder is classified as an obsessive-compulsive disorder (OCD) related condition. Previously, hoarding was just seen as a part of the broader OCD spectrum. However, more recent evidence suggests that hoarding is a distinct condition, with symptoms, psychological processes, and features profoundly different from OCD. ^[1]

How common is hoarding?

Hoarding is more common than you might expect. It is estimated that 2-6% of the world population has a form of hoarding disorder. The prevalence of hoarding is fairly consistent across cultures, with similar levels seen in both men and women. ^{[1] [3]}

Hoarding often begins in adolescence and early adulthood, typically between the ages of 15 and 19. However, most people don't come to the attention of support services until much later in life (in their 50s and 60s), as by then, clutter has had time to build up to harmful levels. ^{[1] [2]}

Symptoms

The primary symptom of hoarding disorder is a strong need to retain possessions. However, there are several other recognized symptoms of hoarding, including: ^{[4] [5]}

• Being unable to let go of possessions (regardless of the value of the item)

• Needing to ‘save’ items and experiencing distress at the idea of getting rid of them

• The accumulation of items that leads to excessive clutter

• Hoarding causes significant difficulties with social and occupational functioning

• Experiencing anxiety about the need for items in the future

• Withdrawing from others due to shame or distrust of people interacting with their possessions.

• Living in an increasingly cluttered and unhealthy environment

Levels of hoarding

The diagnosis of hoarding disorder does not require a breakdown of the ‘severity’ of hoarding. However, many clinicians find it helpful to quantify the level of hoarding to assess the intensity of support interventions needed.

Many scales exist to assess the impact of hoarding symptoms. The UCLA Hoarding Severity Scale is a ten-item questionnaire, with each question rated on a scale of 0 (none) to 5 (extreme): ^{[6] [7]}

• How much of your home is affected by clutter?

• How embarrassed would you be if someone were to see your clutter today?

• To what extent is the excessive buying or acquiring of things a problem in your life?

• How strong is the urge to keep things that others might not keep?

• How anxious would you become if you had to discard something that you thought you would need or want in the future?

• To what extent does your clutter affect your personal relationships or ability to socialize?

• To what extent does your clutter affect your ability to work, daily functioning, or hobbies?

• Do routine tasks take longer than they should, either because of clutter or a need to do things completely or perfectly?

• Do you have trouble making decisions, even about little things other people wouldn’t think twice about?

• How much do you procrastinate doing tasks?

Is collecting the same as hoarding?

Hoarding is very different from collecting. People who collect usually acquire items from a specific niche that have value (either monetary or emotional) that others can appreciate. Collections are typically displayed as a source of pride. ^[1]

This starkly contrasts with hoarding, where a wide range of objects of little or no value are indiscriminately kept. Hoarded objects are usually cluttered and disorganized, and they are not intended for display. ^[1]

Is hoarding associated with any other disorders?

Although hoarding is a mental health condition in its own right, it can be a feature of another health condition: ^[8]

• Physical health conditions - Physical health conditions can limit an individual’s ability to organize possessions and take action on clutter.

• Obsessive-compulsive disorder (OCD) - People with OCD may hoard items, not because they are attached to them, but because of a compulsive fear about what will happen if they are removed.

• Memory and learning disorders - Conditions such as dementia and learning disabilities can impact a person’s ability to organize themselves and their belongings.

• Other mental health conditions - Hoarding may also be a feature of conditions like depression, schizophrenia, and bipolar disorder.

Causes

There is no single driving cause of hoarding disorder. However, researchers have identified several contributing causes and risk factors that predispose someone to developing hoarding disorder: ^{[1] [2]}

Brain function and personality

Specific changes in brain function have been linked to the development of hoarding disorder. People who hoard are more likely to struggle with planning, problem-solving, spatial learning, attention, memory, and organization.

Family history and genetics

Hoarding is more common among people who have a family member who also hoards. Although the evidence is limited, both genetic and environmental factors may influence this.

Stress and adverse life events

Stressful life events can serve as a trigger for all sorts of maladaptive behaviors and mental health conditions. For example, experiencing personal loss may make it difficult for an individual to cope with the ‘loss’ of possessions.

Can hoarding disorder be present in children?

It’s not just adults who suffer from hoarding disorder. Many symptoms associated with hoarding first emerge in childhood. However, hoarding in children is underrecognized, as children are rarely able to accumulate the same level of clutter due to adult supervision. ^[3]

Children who hoard often retain small items that would usually be discarded, such as candy wrappers or scrap paper. ^[3]

What do people typically hoard?

People can hoard all manner of items. Objects can be purchased, delivered, or even found on the street. Items with seemingly no value, such as outdated takeout leaflets, are commonly hoarded. ^[8]

Some people may hoard animals. The welfare of these animals and the sanitation of living conditions may necessitate intervention by authorities. ^[8]

Risks of hoarding

Hoarding and the excessive buildup of clutter can present many risks to the individual and their wider environment: ^[2]

• Navigating clutter - The buildup of clutter can result in significant trip and injury hazards. In extreme cases, people who hoard can become trapped by their items.

• Fire risks - Fires can easily break out in cluttered and neglected areas of the home. Clutter can also prevent escape from a burning building.

• Sanitation - The home and wider environment are unlikely to remain clean. Pests and mold can pose a significant health risk.

• Social and family concerns - Hoarding can lead to family conflicts and social isolation.

• Occupational and legal issues - People who hoard may struggle to retain regular employment. They may also face legal consequences, such as eviction or fines, due to their living conditions.

Getting a diagnosis for a hoarding disorder

Hoarding disorder is a mental health condition that can be diagnosed by a suitably qualified healthcare professional (usually a psychiatrist). Clinicians will assess a person’s symptoms, guided by interview tools like the UCLA Hoarding Severity Scale, to make a diagnosis in line with the DSM-5-TR criteria. ^[1]

People who hoard may have limited insight into their condition. As a result, help is often initiated by concerned friends and family members. Mental health professionals will want to gain a holistic view by gathering information from family members and social support services, with the individual’s permission. ^[1]

Treatment options

The most effective treatment for hoarding disorder is cognitive behavioral therapy (CBT). CBT is a talking therapy that explores the link between thoughts, feelings, and behaviors, helping the individual to build practical coping skills. CBT can help an individual understand the need to let go of items and reduce the distress associated with clutter clearing. ^[1]

Other treatment options may be considered on an individualized basis: ^[1]

• Medication - Currently, there are no approved medications for treating hoarding disorder. However, small-scale studies have shown that paroxetine, venlafaxine, and methylphenidate have the potential to provide symptom relief in cases where CBT has been ineffective.

• Family therapy - Often used to explore relationships and find ways to build healthy communication.

• Social support - People who hoard may need support from social service organizations.

Helping someone with a hoarding disorder

It’s essential to recognize that hoarding disorder is a serious mental health condition that can cause significant distress to the person affected. Judging, berating, or just discarding a person’s possessions without permission are harmful actions that must be avoided. ^[2]

Recognizing the impact that hoarding is having on a person and approaching them with your concerns in a non-judgmental way can be a great way to open the door to a healthier future. With your loved one’s permission, seek support from healthcare providers, social services, or local support organizations.

Cleaning up a hoarder's home

Hoarding cleanup can be a daunting concept. Any sorting and cleaning should be done in conjunction with the individual and professional organizations. Always remember to: ^[9]

• Create a plan for decluttering with the individual. This is best done in conjunction with mental health services.

• Involve the individual affected and ask for permission before removing items.

• Wear appropriate personal protective equipment, such as gloves, eye protection, and a mask.

• Get support from professional deep cleaning organizations, especially if sanitation is likely to present a significant health hazard.

• Stop if the process is causing excessive distress. Involve mental health services to explore barriers to success.

• Dispose of items safely and responsibly. Help the individual to sell or donate any good-quality items that are removed.