Diagnosis

People often don't seek treatment for hoarding disorder, but rather for other issues, such as depression or anxiety. To help diagnose hoarding disorder, a mental health professional performs a psychological evaluation. In addition to questions about emotional well-being, you may be asked about a habit of acquiring and saving items, leading to a discussion of hoarding.

Your mental health professional 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 disorders.

For diagnosis, your mental health professional may use the criteria for hoarding disorder listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Treatment

Treatment of hoarding disorder can be challenging because many 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 and quickly collect more to help fulfill emotional needs.

The main treatment for hoarding disorder is cognitive behavioral therapy. Medications may be added, particularly if you also have anxiety or depression.

Psychotherapy

Psychotherapy, also called talk therapy, is the primary treatment. Cognitive behavioral therapy is the most common form of psychotherapy used to treat hoarding disorder. Try to find a therapist or other mental health professional with experience in treating hoarding disorder.

As part of cognitive behavioral therapy, you may:

  • Learn to identify and challenge thoughts and beliefs related to acquiring and saving items
  • Learn to resist the urge to acquire more items
  • Learn to organize and categorize possessions to help you decide which ones to discard
  • Improve your decision-making and coping skills
  • Declutter your home during in-home visits by a therapist or professional organizer
  • Learn to reduce isolation and increase social involvement with more meaningful activities
  • Learn ways to enhance motivation for change
  • Attend family or group therapy
  • Have periodic visits or ongoing treatment to help you keep up healthy habits

Treatment often involves routine assistance from family, friends and agencies to help remove clutter. This is particularly the case for the elderly or those struggling with medical conditions that may make it difficult to maintain effort and motivation.

Children with hoarding disorder

For children with hoarding disorder, it's important to have the parents involved in treatment. Sometimes called "family accommodation," over the years, some parents may think that allowing their child to get and save countless items may help lower their child's anxiety. Actually it may do the opposite, increasing anxiety.

So, in addition to therapy for the child, parents need professional guidance to learn how to respond to and help manage their child's hoarding behavior.

Medications

There are currently no medications approved by the Food and Drug Administration (FDA) to treat hoarding disorder. Typically, medications are used to treat other disorders such as anxiety and depression that often occur along with hoarding disorder. The medications most commonly used are a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs). Research continues on the most effective ways to use medications 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:

  • Stick to your treatment plan. It's hard work, and it's normal to have some setbacks over time. But treatment can help you feel better about yourself, improve your motivation and reduce your hoarding.
  • 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, and help is often needed to maintain organization 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. Support groups for people with hoarding disorder can let you know that you are not alone and help you learn about your behavior and resources.
  • Try to keep up personal hygiene and bathing. If you have possessions piled in your tub or shower, resolve to move them so that you can bathe.
  • 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 nutritious 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 stand to gain by reducing clutter in your home.
  • Take small steps. With a professional's help, you can tackle one area at a time. Small 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 — and that's not possible if you can't provide them with proper nutrition, sanitation and veterinary care.

Preparing for your appointment

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

Because many 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.

You may want to first meet alone with a mental health professional to develop an approach for raising your concerns with your loved one. A mental health professional can help you prepare for a conversation 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 his or her house and start throwing things out. Here's some information to help the person with hoarding disorder symptoms prepare for the first appointment and learn what to expect from the mental health professional.

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 professional to know what kinds of items you feel compelled to save and personal beliefs about acquiring and retaining 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 with which you've been diagnosed.
  • Any medications, vitamins, supplements or other herbal products you take, and their dosages.
  • Questions to ask your mental health professional.

Take a trusted family member or friend along, if possible, for support and to help remember the details discussed at the appointment. Bringing pictures and videos of living spaces and storage areas affected by clutter is helpful.

Questions to ask your mental health professional may 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 medications that can help?

Don't hesitate to ask other questions during your appointment.

What to expect from your mental health professional

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

  • What types of things do you tend to acquire?
  • 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 discard some of your 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 appropriate 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?