Hoarding disorder

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 who has expertise in diagnosing and treating the condition. You'll have a mental health exam that includes questions about emotional well-being. You'll likely be asked about your beliefs and behaviors related to getting and saving items and the impact clutter may have on your quality of life.

Your mental health provider may ask your permission to talk with relatives and friends. Pictures and videos of your living spaces and storage areas affected by clutter are often helpful. You also may be asked questions to find out if you have symptoms of other mental health conditions.

Treatment

Treatment of hoarding disorder can be challenging but effective if you keep working on learning new skills. Some people don't recognize the negative impact of hoarding on their lives or don't believe they need treatment. This is especially true if the possessions or animals offer comfort. If these possessions or animals are taken away, people will often react with frustration and anger. They may quickly collect more to help satisfy emotional needs.

The main treatment for hoarding disorder is cognitive behavioral therapy (CBT), a skills-based approach to therapy. You learn how to better manage beliefs and behaviors that are linked to keeping the clutter. Your provider also may prescribe medicines, especially if you have anxiety or depression along with hoarding disorder.

CBT

Cognitive behavioral therapy is the main treatment for hoarding disorder. Try to find a therapist or other mental health provider with expertise in treating hoarding disorder.

As part of CBT, you may:

• Learn to identify and challenge thoughts and beliefs related to getting and saving items.
• Learn to resist the urge to get more items.
• Learn to organize and group things to help you decide which ones to get rid of, including which items can be donated.
• Improve your decision-making and coping skills.
• Remove clutter in your home during in-home visits by a therapist or professional organizer.
• Learn to reduce isolation and increase opportunities to join in meaningful social activities and supports.
• Learn ways to increase your desire for change.
• Attend family or group therapy.
• Have occasional visits or ongoing treatment to help you keep up healthy habits.

Treatment often involves regular help from family, friends and agencies to help remove clutter. This is often the case for the elderly or those struggling with medical conditions that may make it difficult to keep up the effort and desire to make changes.

Children with hoarding disorder

For children with hoarding disorder, it's important to have the parents involved in treatment. Some parents may think that allowing their child to get and save countless items may help lower their child's anxiety and avoid family fights. This is sometimes called "family accommodation." This actually may do the opposite and strengthen the child's tendency to get and save items.

In addition to therapy for their child, parents may find professional guidance helpful to learn how to respond to and help manage their child's hoarding behavior.

Medicines

Cognitive behavioral therapy is the first treatment recommended for hoarding disorder. There are currently no medicines approved by the Food and Drug Administration (FDA) to treat hoarding disorder. Medicines are used to treat other conditions such as anxiety and depression that often occur along with hoarding disorder. The medicines most commonly used are a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs). Research continues on the most effective ways to use medicines in the treatment of hoarding disorder.

Lifestyle and home remedies

In addition to professional treatment, here are some steps you can take to help care for yourself:

• Follow your treatment plan. It's hard work, and it's common to have some setbacks over time. But treatment can help you feel better about yourself, improve your desire to change and reduce your hoarding. Have a daily schedule to work on reducing your clutter. Do this during times of the day when you have the most energy.
• Accept assistance. Local resources, professional organizers and loved ones can work with you to make decisions about how best to organize and unclutter your home and to stay safe and healthy. It may take time to get back to a safe home environment. Help is often needed to stay organized around the home.
• Reach out to others. Hoarding can lead to isolation and loneliness, which in turn can lead to more hoarding. If you don't want visitors in your house, try to get out to visit friends and family. Joining a support group for people with hoarding disorder can let you know that you are not alone. These groups can help you learn about your behavior and available resources.
• Try to keep yourself clean and neat. If you have possessions piled in your tub or shower, resolve to move them so that you can bathe or shower.
• Make sure you're getting proper nutrition. If you can't use your stove or reach your refrigerator, you may not be eating properly. Try to clear those areas so that you can prepare healthy meals.
• Look out for yourself. Remind yourself that you don't have to live in chaos and distress — that you deserve better. Focus on your goals and what you can gain by reducing clutter in your home.
• Take small steps. With a professional's help, you can tackle one area at a time. Small and consistent wins like this can lead to big wins.
• Do what's best for your pets. If the number of pets you have has grown beyond your ability to care for them properly, remind yourself that they deserve to live healthy and happy lives. That's not possible if you can't provide them with proper nutrition, clean living conditions and veterinary care.

Preparing for your appointment

If you or a loved one has symptoms of hoarding disorder, your health care provider may refer you to a mental health provider, such as a psychiatrist or psychologist, with experience diagnosing and treating hoarding disorder.

Because some people with hoarding disorder symptoms don't recognize that their behavior is a problem, you as a friend or family member may experience more distress over the hoarding than your loved one does. If this is the case, you may want to first meet alone with a mental health provider with expertise in treating hoarding disorder. A provider can offer support and help on how to encourage your loved one to seek help.

To consider the possibility of seeking treatment, your loved one will likely need reassurance that no one is going to go into their house and start throwing things out.

Here's some information to help prepare for the first appointment and what to expect from the mental health provider.

What you can do

Before your appointment, make a list of:

• Any symptoms you're experiencing, and for how long. It will help the mental health provider to know what kinds of items you feel you have to save and your personal beliefs about getting and keeping items.
• Challenges you have experienced in the past when trying to manage your clutter.
• Key personal information, including traumatic events or losses in your past, such as divorce or the death of a loved one.
• Your medical information, including other physical or mental health conditions.
• Any medicines, vitamins, herbal products or other supplements you take, and their doses.
• Questions to ask your mental health provider.

You may want to take a trusted family member or friend along, if possible. They can offer support and help remember the details discussed at the appointment. Bring pictures and videos of living spaces and storage areas affected by clutter.

Questions to ask your mental health provider include:

• Do you think my symptoms are cause for concern? Why?
• Do you think I need treatment?
• What treatments are most likely to be effective?
• How much can I expect my symptoms to improve with treatment?
• How much time will it take before my symptoms begin to improve?
• How often will I need therapy sessions, and for how long?
• Are there medicines that can help?

Feel free to ask other questions during your appointment.

What to expect from your mental health provider

To gain an understanding of how hoarding disorder is affecting your life, your provider may ask:

• What types of things do you tend to get and save?
• Do you avoid throwing things away?
• Do you avoid making decisions about your clutter?
• How often do you decide to get or keep things you don't have space or use for?
• How would it make you feel if you had to get rid of some things?
• Does the clutter in your home keep you from using rooms for their intended purpose?
• Does clutter prevent you from inviting people to visit your home?
• How many pets do you have? Are you able to provide proper care for them?
• Have you tried to reduce the clutter on your own or with the help of friends and family? How successful were those attempts?
• Have your family members expressed concern about the clutter?
• Are you currently being treated for any mental health conditions?