What is hoarding disorder?

Mental Health
Hoarding disorder is a condition that makes it difficult for people to throw things away, regardless of their value. There are a range of treatment options available.

Hoarding disorder can have a significant negative emotional, social, financial, and legal impact.

This article provides important information about hoarding disorder, including the symptoms, causes, and treatment options.

Symptoms

a man looking depressed because he has Hoarding disorder
A person with hoarding disorder may also experience disorganization, indecisiveness, and distractibility.

People with hoarding disorder may find it difficult or stressful to throw away items that others view as worthless or of little value.

Unlike collectors — who choose to collect a specific type of item — people with hoarding disorder tend to acquire various items. These may include piles of clothes, old magazines, food wrappers, and childhood trinkets.

Over time, they may run out of room to store these things, so they may have to display their belongings chaotically.

Some people with hoarding disorder might even start to acquire living things, including companion or farm animals. This can endanger both human and animal welfare due to factors such as overcrowding, unhygienic conditions, and a possible lack of veterinary care.

Other symptoms that people with hoarding disorder may experience include:

  • emotional distress, such as being overwhelmed or embarrassed by their possessions or living situation
  • suspicion or fear of other people touching their items
  • obsessive fears and actions, such as checking trashcans for discarded items or a fear of needing an item in the future
  • feeling responsible for objects, and sometimes thinking of inanimate objects as having feelings

People with hoarding disorder also tend to experience associated issues with:

  • indecisiveness
  • disorganization
  • distractibility
  • procrastination

Typically, the symptoms of hoarding disorder will begin during a person’s early teenage years, with the average age of onset being 13 years old.

Complications

Hoarding disorder can result in a range of negative emotional, social, physical, financial, and even legal complications.

For example, clutter may overrun someone’s home, blocking access to important living, cooking, and working spaces.

Other common complications or consequences associated with hoarding disorder include:

  • difficulty functioning in daily activities
  • poor hygiene
  • poor diet or nutrition
  • living in unsafe environments, with factors such as tripping hazards, fire hazards, or large piles of items that may collapse
  • strained or severed marital, family, or friend relationships
  • social isolation and loneliness
  • lost work or employment
  • debt
  • reluctance to let others into their home
  • financial difficulties
  • legal problems, such as those involving child custody and animal welfare
  • lost property value or eviction

As well as these complications and consequences, people with hoarding disorder may also experience mental health conditions such as:


Treatments

a woman receiving psychiatry for hoarding disorder
CBT is one possible treatment for hoarding disorder.

With the right treatment, most people with hoarding disorder can reduce their major symptoms and the risk of complications.

Healthcare professionals tend to treat hoarding disorder using a type of therapy called cognitive behavioral therapy (CBT).

During CBT sessions for hoarding disorder, a mental health professional will gradually teach people how to part with unnecessary items less stressfully.

CBT can also help a person improve relaxation, organization, and decision making skills. This can help with future management of hoarding behaviors.

In some cases, medication may also play a role in treatment. This is particularly the case when hoarding disorder is related to other conditions that respond well to medication, such as severe anxiety or depression.

Causes and risk factors

Researchers do not yet know why people develop hoarding disorder.

Usually, people with hoarding disorder are driven to obtain and keep items that:

  • they believe may become useful or valuable in the future
  • are free or are more affordable than usual
  • have perceived sentimental value
  • seem irreplaceable, unique, or perfect (often only to them)
  • are a reminder of an important memory of a person, place, time, or event that the person fears they will forget

Surrounding themselves with these items may also comfort the person.

Although researchers are not certain what causes people to develop hoarding disorder, several risk factors seem capable of triggering or worsening the symptoms. These include:

  • a family history of the condition
  • brain injuries
  • very stressful events, such as severe illness or the loss of a loved one
  • differences in brain function and neuropsychological performance unique from people with other conditions, such as obsessive-compulsive disorder (OCD)

Hoarding disorder can also be a symptom of another condition, most commonly:

Less commonly, hoarding disorder is also associated with:


Diagnosis

Diagnosing hoarding disorder can be difficult, as many people with the condition are not willing to admit that they have it or are unwilling to seek treatment, often for fear of losing their belongings.

To diagnose someone with hoarding disorder, a psychiatrist will usually ask the person some questions about themselves, their belongings, and their homes. Common questions include:

  • How hard or stressful is it to get rid of (sell, give away, recycle) things that other people seem to discard easily?
  • How hard is it to use rooms and surfaces at home because of clutter?
  • How hard is it to organize things or decide where they should go?
  • To what extent do items or clutter impact overall daily functioning?
  • Does clutter impact work, school, social, or family obligations or relationships?
  • How common are fears about other people touching, using, or destroying belongings?

The doctor may also ask to see pictures of the person’s major living areas or ask to visit it themselves to better assess the extent or impact of their symptoms.

For a diagnosis of hoarding disorder, someone will need to display:

  • long term problems with getting rid of possessions, regardless of their value
  • significant distress tied to losing items
  • items that block, fill, or clutter primary living spaces and prevent proper use

For an accurate diagnosis, a psychiatrist will also need to make sure that hoarding disorder is not a symptom of another condition.

How common is it?

According to the American Psychiatric Association, around 2–6% of the population of the United States has hoarding disorder.

Some research suggests that hoarding disorder is more common among males than females.

When to see a doctor

People with symptoms of hoarding disorder should try to talk to a doctor, particularly if these symptoms:

  • are severe, chronic, or accompanied by other symptoms
  • interfere with everyday activities, such as cleaning, cooking, bathing, working, or attending school
  • cause significant interpersonal problems
  • cause severe anxiety or embarrassment
  • have made living environments unsafe or unhealthful


How to help someone with hoarding disorder

a daughter gently touches her mother shoulder
It may be beneficial to have a loved one accompany a person to their first mental health meeting.

Family members or friends may want to meet with a doctor or mental health professional to learn how to broach the topic of diagnosis and treatment with someone they suspect has hoarding disorder.

Loved ones may also want to accompany someone to their first mental health meeting to make them feel more comfortable.

Having someone else attend early mental health appointments may also help give the doctor a better perspective of the person’s habits, home, and interpersonal relationships.

It is also worth noting that community public health agencies may have programs and services dedicated to helping people with hoarding disorder.

In extreme cases, local state or governmental authorities and agencies may need to become involved in someone’s treatment, such as to provide child or animal welfare services.

Outlook

Early recognition, diagnosis, and treatment usually increase the likelihood that someone with hoarding disorder can reduce the severity of their symptoms.

Untreated hoarding disorder is likely to become chronic, often getting more severe over time.

People with signs of hoarding disorder should try to speak to a doctor or mental health professional as soon as possible.

People who think that someone they know may have hoarding disorder should consider contacting a mental health professional to learn how to help the person seek treatment.

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