Hoarding: What to know about this mental health disorder

On the surface, hoarding may appear to be a relatively straightforward problem to address. But hoarding is an often-misunderstood mental health disorder that can put a person's health and safety at risk.

What Is hoarding disorder?

Hoarding is a mental health condition characterized by an inability to discard certain belongings to the point of unhealthy accumulation. A person with hoarding disorder acquires an excessive number of items they don't need and stores them in disarray.

The items accumulated vary from one person to another. Someone might hoard boxes, magazines, containers, bags, or old clothing. An individual with hoarding disorder believes the items might be useful for them someday, or they derive great joy from their belongings and they are hesitant to discard them.

Because the items in a hoarding situation accumulate in excess and in a chaotic fashion, the living space of a person with hoarding disorder is often cluttered. The clutter can reach an extreme level so that living space can no longer be used as intended. For example, a kitchen table becomes so cluttered there is no space for a place setting, or a hallway is so stacked with possessions it is difficult to walk through.

The overwhelming amount of clutter can affect relationships, hygiene, or work of a person with hoarding disorder. It can create an unhygienic situation, leading to infestation of pests such as cockroaches or rodents. People with hoarding disorder may avoid having visitors over. In some cases, the clutter can present physical dangers such as a fire hazard, danger of falls, or other risks from the inability to safely navigate the space.

Who is at increased risk for hoarding disorder?

Hoarding disorder affects approximately 2% to 6% of the adult population, and occurs evenly in men and women. Hoarding is more common in individuals who have a family member with the disorder, and it is seen more often in people who live alone.

Studies have found that the first symptoms of hoarding disorder are typically seen during the teen years, with symptoms worsening over time. Hoarding is not seen often in children because their parents take a more active role in controlling their environment.

Hoarding occurs three times as often in older adults as in the general population. This is of particular concern because hoarding can exacerbate the risks of older adults falling, or of misplacing important items such as medications or prescription glasses.

More than 60% of people with clinically significant hoarding also have another psychiatric disorder. The most common coexisting psychiatric conditions are major depressive disorder, generalized anxiety disorder, and social phobia. In some cases, conditions such as dementia or stroke may be responsible for hoarding behavior.

Symptoms of hoarding disorder

In 2013, the American Psychiatric Association (APA) recognized hoarding as a disorder under the umbrella of obsessive-compulsive spectrum disorders. According to the APA, hoarding disorder is characterized by ongoing difficulty in letting go of possessions, regardless of their actual worth. This is driven by a strong urge to save items and distress about discarding them.

As a result, belongings pile up, cluttering living spaces and interfering with their normal use. If these areas are kept clear, it's usually because family, friends, or professional cleaners have stepped in. The hoarding also leads to considerable distress or challenges in daily life, affecting relationships, work, and the ability to maintain a safe living environment.

Stressful life events can intensify symptoms of hoarding.

Why do people with hoarding disorder feel compelled to hoard?

Though hoarding has been studied for over two decades, there is still more to learn about the disorder, including why people with hoarding disorder feel compelled to hoard. While research indicates a connection between hoarding and difficulties in information processing skills like planning, problem-solving, memory, learning, attention, and organization, that deficit does not adequately explain the need to hoard.

Many people who hoard do not see it as a problem. They have little awareness of how it's affecting their life or the lives of those around them. Some studies have shown that family members of individuals who hoard tend to rate the severity of the hoarding behavior significantly higher than how they believe the person who hoards would rate their own symptoms.

Treating hoarding disorder

Hoarding disorder is a challenging condition to treat, but with the right support, individuals can make meaningful progress toward changing their habits.

Cognitive behavioral therapy (CBT) for hoarding

The most successful treatment for hoarding disorder is cognitive behavioral therapy, or CBT. CBT is a type of talk therapy in which an individual works with a trained therapist over a length of time to address emotions, thoughts, and behaviors related to problematic conduct.

In a person with hoarding disorder, CBT would help the person develop a better understanding of why they need to hoard objects, along with training on decision-making, sorting and discarding, and organization.

Relaxation techniques may also be incorporated into the therapy. CBT does not involve home cleanup, nor does it target the social consequences of hoarding.

Medications

There are no FDA-approved medications for the treatment of hoarding disorder. However, a class of medications known as selective serotonin reuptake inhibitors (SSRIs) are often prescribed in people with hoarding disorder who also have anxiety or depression.

Coping with hoarding disorder

Coping with hoarding disorder can be difficult, but there is help. Getting support from a therapist, especially through cognitive behavioral therapy (CBT), can help you understand why it's hard to let go and teach you strategies for avoiding clutter.

If you or someone you know is struggling with hoarding disorder, reaching out to a healthcare provider or mental health professional is the first step toward finding support. It can also help to surround yourself with supportive friends or family. Progress takes time, but every step can lead to a safer and more comfortable space.