What Is Hoarding?

Hoarding, also known as hoarding disorder and compulsive hoarding, is a serious psychological disorder where people accumulate a large number of belongings. People who hoard are called hoarders. Even when these objects have little to no value or are considered garbage by others, hoarders struggle to get rid of them.

Definition of Hoarding

People with hoarding disorder excessively save items that others may view as worthless. As a result, items are cluttered inside a home until rooms and furniture can no longer be used as intended. This can lead to unsafe and unsanitary conditions (including fire hazards and tripping hazards) for the hoarder, who may be unable to acknowledge and address their problem.

Hoarding may also lead to family strain and conflicts, isolation and loneliness, unwillingness to have anyone else enter the home, and an inability to perform daily tasks, such as cooking and bathing in the home.

Hoarding disorder occurs in about 2% to 6% of the population, and often leads to substantial distress and problems with daily functioning. Some research has shown that hoarding disorder is more common in men and older adults. There are three times as many adults 55 to 94 years old who are affected by hoarding disorder compared with people who are 34 to 44 years old.

Symptoms

The urge to collect and keep a large quantity of objects often occurs alongside other mental health conditions, such as obsessive-compulsive disorder (OCD) and depression. While hoarding disorder exists within the spectrum of OCD and related disorders, it is considered independent from other mental disorders. Research shows that just 18% of people clinically diagnosed with hoarding disorder have additional OCD symptoms present.

Some researchers conceptualize hoarders as having addictive traits when it comes to objects. This means they have a strong desire to acquire items, and keeping them fulfills an emotional need that makes discarding the item highly upsetting. 

The symptoms of hoarding disorder include:

• Lasting problems with throwing out or giving away possessions, regardless of their actual value
• The problems are due to a perceived need to save the items and to distress linked to parting with them
• Items fill, block, and clutter active living spaces so they cannot be used, or use is hampered by the large amount of items

Diagnosis

According to the Diagnostic and Statistical Manual of Mental Disorders, 5^th Edition (DSM-5), a person must meet several characteristics to be clinically diagnosed with hoarding disorder. This diagnosis is typically made by a psychologist or psychiatrist.

These criteria include:

• Persistent difficulty parting with items despite actual value of the items.
• This difficulty is due to a perceived need to save the items and to the distress associated with discarding them.
• The difficulty discarding possessions results in the accumulation of possessions that clutter active living areas and substantially compromises their intended use. If living areas are uncluttered, it is only because of the interventions of family members, cleaners, or the authorities.
• The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning, including maintaining a safe environment safe for oneself or others.
• The hoarding is not attributable to another medical condition like brain injury or cerebrovascular disease.
• The hoarding isn’t better explained by symptoms of another mental health disorder, such as psychotic disorders, depression, or obsessive compulsive disorder.

Mental health professionals may also ask permission to speak with friends and family to help make a diagnosis or use questionnaires (rating scales) to help assess level of functioning.

In addition to the core features of difficulty with getting rid of possessions, excessive saving, and clutter, many people with hoarding disorder also have associated problems like indecisiveness, perfectionism, procrastination, disorganization, and distractibility. These associated features can contribute greatly to their problems functioning and overall severity.

Causes

Hoarding can happen for a variety of reasons. However, research shows that most people who hoard have experienced a traumatic life event (TLE). That refers to any incident that caused physical, emotional, or psychological harm, including childhood neglect, physical assault, loss of a loved one, serious injury, or a natural disaster.

Research demonstrates that 51% of people diagnosed as hoarders also have major depressive disorder. The same study showed that 24% of hoarders have social phobia and 24% experience generalized anxiety.

These disorders can occur as a result of hoarding and its consequences, or hoarding can simply be associated with these other psychiatric disorders.

Researchers have also found that hoarding can have a significant genetic basis.

Types of Hoarding

How hoarding interferes with one’s safety and hygiene depends on what they hoard. The main types of hoarding include:

• Object hoarding: This is the most common type of hoarding. It includes the hoarding of items that are no longer useful, including empty containers, garbage, old or expired food, and unwearable clothing.
• Animal hoarding: This type of hoarding is characterized by the collection of pets. People who hoard pets have difficulty maintaining the health of their animals and cannot clean up after them properly. It’s common for animal hoarders to keep dead animals in the home. 
• Compulsive shopping: This is also a type of hoarding where someone is focused on acquiring more items, no matter how many things they already have. People who shop compulsively continuously buy things they don’t need and struggle to get rid of things they already bought.

Treatment

Scientists continue to study the best treatments for hoarding disorder. More randomized controlled trials are needed to determine the best approach. However, there has been some demonstrated success with the following treatments for hoarding disorder:

• Group therapy: Highly structured in-person support groups can give people the community and motivation they need to recognize and change their hoarding habits.
• Cognitive behavioral therapy (CBT): This therapy involves identifying and changing one’s negative thought patterns and behaviors. It could help with hoarding by improving the underlying conditions that contribute to obsessive collecting, like anxiety and depression.
• Medications: Medications have not generally been found to be robustly effective in treating hoarding, however certain medications have been tried, including selective serotonin reuptake inhibitors (SSRIs) and stimulants.

Coping

Someone who hoards might not think they need help. If you suspect someone you know has hoarding disorder, reassure them that nobody is going to go into their home and throw everything out. You're just going to have a chat with their doctor about their hoarding to see what can be done and what support is available to empower them to begin the process of decluttering.

If you think you have hoarding disorder, talk to your primary care provider about your problem and they may be able to refer you to a mental health professional who can help with diagnosis and treatment.

It's generally not a good idea to get extra storage space or call in someone just to clear the rubbish away. This won't solve the root of the problem—and may actually make matters worse.

A Word From Verywell

Hoarding is a great disruption to a person’s quality of life. It may also interfere with their safety and health, as well as the well-being of their family members inside the household. Maintaining compassion when helping someone with hoarding disorder can ensure their dignity while improving the potential of positive treatment outcome.