What is hoarding disorder?

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therapist.com team

Last updated: 11/17/2023

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Hoarding disorder (HD) is a mental health condition that makes it very difficult to get rid of things, even when they aren’t necessary, useful, or safe. Hoarding can also be related to compulsive shopping, collecting free items compulsively, or searching obsessively for specific items.¹

Around 2% to 6% of the global population struggles with hoarding disorder.² HD can affect people of any age, but symptoms often start in childhood and get worse over time if left untreated. Adults over age 55 may be especially vulnerable.

People with HD collect and have trouble discarding things like paper, clothing, bags, tools, materials, furniture, boxes, household supplies, or food. In some cases, people who want to care for animals end up with too many and don’t have the resources to look after them properly.³ This can create poor living conditions and cause unintentional but serious harm to the animals.

Hoarding makes it hard for a person to live comfortably and manage their own space. In severe cases, it can make an environment so cluttered and unhygienic that it becomes dangerous. For example, the kitchen may be unusable because the counters and stove (also a potential fire hazard) are piled with stuff.

It’s important to note that hoarding isn’t intentional. People with HD often don’t fully understand the negative outcomes of this behavior.⁴

Signs of hoarding

Signs of this behavior often start in someone’s teen years or early adulthood, and they tend to develop gradually. Ranging from mild to severe, common indicators include:

• Being strongly attached to your belongings
• Feeling anxiety or distress when trying to get rid of things
• Acquiring, looking for, and keeping things you don’t need or already have
• Finding it hard to make decisions about your possessions (such as where to put them, how to categorize them, and what to keep)
• Having trouble finding things and using your living space due to clutter
• Feeling overwhelmed, embarrassed, or ashamed about the clutter in your living space
• Avoiding having friends and family over, or being unwilling to let repair workers into your home
• Struggling with social isolation or relationship problems
• Having financial difficulties
• Avoiding activities that involve getting rid of things, such as cleaning, organizing, or decluttering
• Living with fire hazards, tripping hazards, unsanitary conditions, or other health and safety risks

Hoarding vs. clutter

Hoarding and clutter both involve having lots of stuff that makes a living space feel cramped and messy. The key difference between the two conditions is how severe they are and how much they affect your daily functioning. (The International OCD Foundation’s Clutter Image Rating Scale has sample pictures that can help you visualize the difference between clutter and hoarding.⁵)

Clutter is a milder form of disorganization that can generally be resolved through cleaning and organizing. It usually happens when someone doesn’t have the time, motivation, or resources to maintain a tidy space. People in cluttered environments usually know there’s a problem and can make changes to reduce the amount of mess without extensive help.

Hoarding, on the other hand, involves more severe clutter and is considered a mental health disorder. When you have HD, you don’t see your own behavior as a problem—and your attachment to your things can make it very hard to part with them, even if they make your living space hazardous or unusable. Hoarding requires specialized and intensive treatment to address underlying mental health concerns.

What causes hoarding?

It isn’t exactly clear what causes hoarding, but research links it to both genetic factors and life experiences. Going through trauma and having a family history of hoarding can increase your risk.^{6, 7}

Research also suggests that people with hoarding disorder may have less functional cognitive control and a tendency toward rumination (focusing repetitively on problems, worries, and negative feelings without taking action to make changes).^{8, 9} Personality can be a factor: Qualities like perfectionism, indecisiveness, and procrastination are associated with hoarding.¹⁰ Physical health problems, such as immobility or visual impairment, can contribute as well.¹¹

Hoarding and other mental health conditions

An estimated 56% to 85% of people with HD also have another mental health condition.¹² These can include obsessive-compulsive disorder (OCD), obsessive-compulsive personality disorder (OCPD), mood disorders like depression, anxiety disorders, and attention-deficit hyperactivity disorder (ADHD). In less common cases, brain injuries, dementia, and other conditions that affect decision-making can lead to hoarding behaviors.¹³

Reasons people hoard

Getting rid of things may feel challenging because making decisions about belongings seems difficult or distressing. Other common reasons people acquire and hold on to too many things include:

• Control: Keeping lots of belongings close may offer a sense of control over your surroundings.
• Security: You may collect and save things to prepare for future needs or emergencies.
• Sentiment: Discarding things like old photos, letters, and mementos may feel like losing touch with the past.
• Perfectionism: You may get stuck on decisions about possessions because you feel like you have to make the best possible choice, whether that involves using the items in particular ways or passing them on in the “perfect” way.
• Perceived value: Whether they’re collectibles, antiques, or other items, belongings may seem like important assets whose value could increase over time.
• Emotional self-protection: Acquiring and saving items can be a way to fill an emotional void, or to distract you from negative feelings.

How to treat hoarding disorder

This disorder can be challenging to treat. People living with HD may become socially isolated, avoid or reject treatment, and have trouble understanding their own condition.¹⁴ This impacts their safety and well-being, as well as the safety and well-being of other household members and loved ones who want to help.¹⁵

In serious cases where someone’s health and safety are at risk, their decision-making capacity may need to be assessed by a mental health professional. The legal system may also get involved to try and protect the person, their dependents, and others affected.¹⁶

Treatment options

Effective treatment options for HD usually include a combination of the following:

• Motivational interviewing (MI) helps you tie your values and goals to your behaviors. It can strengthen your motivation and commitment to change.
• Cognitive behavioral therapy (CBT) can help you address inaccurate thoughts and beliefs you may have about your belongings.
• Skills training can help you learn to manage your possessions, avoid acquiring new items, and strengthen your organizational skills.
• Family therapy can help family members collaborate to resolve conflicts related to hoarding behavior, or help multiple members of the same household with hoarding symptoms.
• Group therapy helps people with HD learn from one another’s experiences and get support in their recovery journey.
• Medication can treat co-occurring conditions that may contribute to hoarding, such as anxiety or depression.

How to help someone with HD

It’s helpful to remember that unless a person is internally motivated to make necessary changes, your efforts to help may not be accepted or appreciated. Also keep in mind that every person deserves to make choices about their own possessions and lives.

Cleaning out a loved one’s home without their consent or participation usually won’t solve the problem because it doesn’t allow them to address the underlying issues.¹⁷ In addition, the experience may be so distressing or traumatizing that it worsens their symptoms and makes them even less willing to accept help.

When talking with a loved one about their hoarding behavior, keep the following tips in mind:

• Have perspective. Listen to their concerns and try to understand their feelings.
• Be gentle and nonjudgmental. Avoid using critical or shaming language.
• Show empathy and compassion. Let them know you care about them and are there to support them in any way you can, even if they don’t want your help right now.
• Brainstorm with them. Offer to discuss possible solutions and make plans together. It can be easier to accept help when you feel like you have some control over the situation.
• Let them lead the way. Give them the opportunity to take charge. For example, let them decide which area of their home to tackle first, or give them full control over what items they’re not ready to let go of just yet.
• Be patient. Don’t expect the process to be quick—it can take a long time for someone to make lasting changes.

If you or someone you know is hoarding, help is available. Browse our directory to find a therapist who specializes in hoarding to help guide you or your loved one on the path to recovery.