Overview

Hoarding disorder is characterized by the persistent difficulty of discarding or parting with possessions, driven by a belief that these items need to be saved. Individuals with hoarding disorder experience distress at the thought of getting rid of their possessions, leading them to accumulate a significant number of items, regardless of their actual value.

Hoarding often results in extremely cramped living conditions, with narrow pathways winding through stacks of clutter. Countertops, sinks, stoves, desks, and other surfaces become piled with belongings, making it challenging to use these spaces for their intended purpose. As hoarding progresses, the clutter may spread to other areas such as the garage, vehicles, yard, and storage areas.

The severity of hoarding disorder can range from mild to severe. While it may have minimal impact on some individuals’ lives, it can seriously affect daily functioning in others.

People with hoarding disorder may not view their behavior as a problem, making it challenging to convince them to seek treatment. However, intensive treatment can help individuals understand and modify their beliefs and behaviors, leading to a safer and more enjoyable life.

Symptoms

Hoarding disorder symptoms usually emerge during the teenage to early adult years. Initially, individuals may acquire and save numerous items, gradually building up clutter in their living spaces. As they age, the problem may worsen, and it becomes increasingly difficult for them to discard things they don’t need or have space for.

Hoarding disorder symptoms may include:

  • Getting and keeping numerous items that are not currently needed and lack space for storage.
  • Difficulty discarding or parting with possessions, regardless of their value.
  • Feeling compelled to save items and experiencing distress at the thought of disposing of them.
  • Excessive clutter that renders rooms unusable.
  • Perfectionism and avoidance or delay in decision-making.
  • Challenges in planning and organizing.

The accumulation of items and refusal to discard them results in disorganized piles or stacks of belongings, cluttered living areas, unsanitary conditions, and distress or problems functioning in the home. It may also lead to conflicts with others who attempt to reduce the clutter or address relationship issues.

Hoarding disorder is often driven by beliefs that these items are unique, have sentimental value, provide comfort, or shouldn’t be wasted. It is crucial to differentiate hoarding from collecting, as collectors carefully seek specific items and organize their collections without causing distress or functional impairment.

Hoarding Animals

Some individuals with hoarding disorder may also hoard animals, collecting dozens or even hundreds of pets. This can result in inadequate care for the animals, jeopardizing their health and safety due to unsanitary conditions.

When to See a Doctor

If you or a loved one exhibit symptoms of hoarding disorder, it’s crucial to seek help from a healthcare provider or a mental health professional experienced in diagnosing and treating hoarding disorder. Some communities offer resources for hoarding problems, so check with local or county government agencies for assistance.

If the hoarding disorder poses a threat to health or safety, consider contacting appropriate local authorities, such as police, fire, public health, child or elder protective services, or animal welfare agencies.

Causes

The exact causes of hoarding disorder are not yet fully understood, and research is ongoing to explore possible factors such as genetics, brain function, and stressful life events.

Risk Factors

Hoarding typically begins around ages 15 to 19 and tends to worsen with age. It is more common in older adults compared to younger adults.

Risk factors for hoarding disorder include:

  • Personality traits, such as difficulty making decisions, attention problems, and organization issues.
  • Family history, as there is a strong association between having a family member with hoarding disorder and developing the condition.
  • Stressful life events, with some individuals developing hoarding disorder after experiencing challenging life events like the loss of a loved one, divorce, or property loss.

Complications

Hoarding disorder can lead to various complications, including increased risk of falls, injuries, family conflicts, social isolation, unsanitary living conditions, fire hazards, work performance issues, legal problems, and association with other mental health conditions like depression, anxiety disorders, OCD, and ADHD.

Prevention

There is currently no known way to prevent hoarding disorder due to limited understanding of its causes. However, seeking treatment at the earliest signs of the problem may help prevent the condition from worsening, especially since clutter may have been accumulating unnoticed for some time before becoming noticeable.

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Diagnosis

People often don’t seek treatment for hoarding disorder, but rather for other issues, such as depression, anxiety, or relationship problems. To help diagnose hoarding disorder, it’s best to see a mental health provider with expertise in diagnosing and treating the condition. During a mental health exam, your emotional well-being will be assessed, and questions will be asked about your beliefs and behaviors related to acquiring and saving items, as well as the impact of clutter on your quality of life.

Your mental health provider may ask for permission to speak with your relatives and friends. Pictures and videos of your living spaces and storage areas affected by clutter can be valuable for the assessment. Additionally, you may be evaluated for symptoms of other mental health conditions.

Treatment

Treatment for hoarding disorder can be challenging but effective with a commitment to learning new skills. Some individuals may not recognize the negative impact of hoarding on their lives or believe they need treatment, especially if their possessions or animals provide comfort. Removing these possessions or animals may lead to frustration and anger, prompting them to acquire more to fulfill emotional needs.

The primary treatment for hoarding disorder is cognitive behavioral therapy (CBT), a skills-based approach to therapy. In CBT, you’ll learn how to manage beliefs and behaviors related to hoarding, resist the urge to acquire more items, and organize possessions to facilitate decluttering. Additionally, CBT can help improve decision-making, coping skills, and reduce isolation by encouraging meaningful social activities and support networks. Family or group therapy may be included in the treatment plan, and occasional visits or ongoing treatment can help maintain healthy habits.

Treatment may also involve assistance from family, friends, and agencies to help with clutter removal, especially for elderly individuals or those struggling with medical conditions that impact their ability to make changes.

Children with Hoarding Disorder

For children with hoarding disorder, involving parents in the treatment is crucial. Some parents may engage in “family accommodation,” allowing their child to accumulate countless items to lower anxiety and avoid conflicts. However, this can reinforce the child’s hoarding behavior. Parents may benefit from professional guidance on how to respond to and manage their child’s hoarding tendencies.

Medicines

While cognitive behavioral therapy is the primary treatment for hoarding disorder, medicines are sometimes prescribed to manage other conditions that often co-occur with hoarding disorder, such as anxiety and depression. Selective serotonin reuptake inhibitors (SSRIs) are commonly used antidepressants in such cases. Research is ongoing to determine the most effective ways to use medicines in the treatment of hoarding disorder.

Lifestyle and Home Remedies

In addition to professional treatment, individuals with hoarding disorder can take steps to care for themselves and improve their living conditions:

  • Follow your treatment plan and work on reducing clutter daily.
  • Accept assistance from local resources, professional organizers, and loved ones to make decisions about organization and decluttering.
  • Combat isolation and loneliness by reaching out to friends and family or joining a support group for individuals with hoarding disorder.
  • Maintain personal hygiene and ensure proper nutrition by clearing areas essential for daily living.
  • Focus on your goals and the benefits of reducing clutter to motivate change.
  • Take small and consistent steps with the help of a professional, addressing one area at a time.
  • Ensure the well-being of your pets, considering their needs and proper care.

Preparing for Your Appointment

If you or a loved one exhibits symptoms of hoarding disorder, your healthcare provider may refer you to a mental health provider experienced in diagnosing and treating hoarding disorder. If necessary, meet with a mental health provider alone first to seek support and guidance on encouraging your loved one to seek help.

To prepare for the first appointment, make a list of symptoms experienced, challenges with clutter management, and key personal information. Also, include medical history, medications, and any questions to ask the mental health provider. It may be helpful to bring along a trusted family member or friend for support. Bring pictures and videos of affected living spaces and storage areas.

During the appointment, your mental health provider will inquire about your hoarding-related behaviors, thoughts, and the impact on daily life.

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