Hoarding disorder is a persistent difficulty discarding or parting with possessions because of a perceived need to save them. A person with hoarding disorder experiences distress at the thought of getting rid of the items. Excessive accumulation of items, regardless of actual value, occurs.

Hoarding often creates such cramped living conditions that homes may be filled to capacity, with only narrow pathways winding through stacks of clutter. Some people also collect animals, keeping dozens or hundreds of pets in unsanitary conditions because they can't care for them properly.

Hoarding ranges from mild to severe. In some cases, hoarding may not have much impact on your life, while in other cases it seriously affects your functioning on a daily basis.

People with hoarding disorder often don't see it as a problem, making treatment challenging. But intensive treatment can help people with hoarding disorder understand their compulsions and live safer, more enjoyable lives.

In the homes of people who have hoarding disorder, the countertops, sinks, stoves, desks, stairways and virtually all other surfaces are usually stacked with stuff. And when there's no more room inside, the clutter may spread to the garage, vehicles and yard.

Clutter and difficulty discarding things are usually the first signs and symptoms of hoarding disorder, which often surfaces during the teenage years. As the person grows older, he or she typically starts acquiring things for which there is no need or space. By middle age, symptoms are often severe and may be harder to treat.

Hoarding disorder affects emotions, thoughts and behavior. Signs and symptoms may include:

  • Persistent inability to part with any possession, regardless of its value
  • Excessive attachment to possessions, including discomfort letting others touch or borrow them or distress at the idea of letting an item go
  • Cluttered living spaces, making areas of the home unusable for the intended purpose, such as not being able to cook in the kitchen or use the bathroom to bathe
  • Keeping stacks of newspapers, magazines or junk mail
  • Letting food or trash build up to unusually excessive, unsanitary levels
  • Acquiring unneeded or seemingly useless items, such as trash or napkins from a restaurant
  • Difficulty managing daily activities because of procrastination and trouble making decisions
  • Moving items from one pile to another, without discarding anything
  • Difficulty organizing items, sometimes losing important items in the clutter
  • Shame or embarrassment
  • Limited or no social interactions

People with hoarding disorder typically save items because:

  • They believe these items will be needed or have value in the future
  • The items have important emotional significance — serving as a reminder of happier times or representing beloved people or pets
  • They feel safer when surrounded by the things they save

Hoarding disorder is different from collecting. People who have collections, such as stamps or model cars, deliberately search out specific items, categorize them and carefully display their collections. Although collections can be large, they aren't usually cluttered and they don't cause the distress and impairments that are part of hoarding disorder.

Hoarding animals

People who hoard animals may collect dozens or even hundreds of pets. Animals may be confined inside or outside. Because of the large numbers, these animals often aren't cared for properly. The health and safety of the person and the animals are at risk due to unsanitary conditions.

When to see a doctor

If you or a loved one has symptoms of hoarding disorder, talk with a doctor or mental health provider as soon as possible. Some communities have agencies that help with hoarding problems. Check with your local or county government for resources in your area.

As hard as it might be, you may also need to contact local authorities, such as police, fire, public health, child protective services or animal welfare agencies, especially when health or safety is in question.

It's not clear what causes hoarding disorder. Genetics, brain chemistry and stressful life events are being studied as possible causes.

Hoarding disorder can affect anyone, regardless of age, sex or economic status. It's not clear, though, how common hoarding disorder is. That's partly because some people never seek treatment.

Risk factors include:

  • Age. Hoarding usually starts around ages 11 to 15, and it tends to get worse with age. Younger children may start saving items, such as broken toys, pencil nubs, outdated school papers and broken appliances. Hoarding is more common in older adults than in younger adults.
  • Personality. Many people who have hoarding disorder have a temperament that includes indecisiveness.
  • Family history. There is a strong association between having a family member who has hoarding disorder and having the disorder yourself.
  • Stressful life events. Some people develop hoarding disorder after experiencing a stressful life event that they had difficulty coping with, such as the death of a loved one, divorce, eviction or losing possessions in a fire.
  • Social isolation. People with hoarding disorder are typically socially withdrawn and isolated. In many cases, the hoarding leads to social isolation. But, on the other hand, some people may turn to the comfort of hoarding because they're lonely.

Hoarding disorder can cause a variety of complications, including:

  • Unsanitary conditions that pose a risk to health
  • Increased risk of falls
  • Injury or being trapped by shifting or falling items
  • A fire hazard
  • An inability to perform daily tasks, such as bathing or cooking
  • Poor work performance
  • Family conflicts
  • Loneliness and social isolation
  • Financial problems
  • Legal issues, including eviction

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 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 provider to develop an approach for raising your concerns with your loved one. A mental health provider 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 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 compelled to save and why.
  • Key personal information, including traumatic events 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, or other herbal products or supplements you take, and their dosages.

Take a trusted family member or friend along, if possible, for support and to help remember the details discussed at the appointment.

Prepare questions to ask your mental health provider, such as:

  • 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 any 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, the mental health provider may ask:

  • Do you avoid throwing things away because you believe you might need them later or because they have emotional significance or both?
  • How often do you decide to acquire 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, such as cooking, washing dishes or taking a bath?
  • Does clutter prevent you from inviting people to visit your home?
  • How does clutter in your home affect your family members?
  • Does it take you a long time to perform daily tasks because of clutter or because you feel a need to do things perfectly?
  • Do you have so many pets that you can't care for them properly?
  • Have you tried to reduce the clutter on your own or with the help of friends and family? How successful were those attempts?
  • Have others encouraged you to seek professional help?
  • Do you have a close blood relative — a parent or sibling — who is a pack rat?
  • Are you currently being treated for any other medical conditions, including mental illness?

To help diagnose hoarding disorder, mental health providers perform a thorough psychological evaluation. They may ask questions about your acquiring and discarding of items and your emotional well-being. They may also ask your permission to talk with relatives and friends.

Hoarding disorder appears to be more common in people with psychological disorders, such as obsessive-compulsive disorder (OCD), depression or anxiety disorder. So your mental health provider may also ask questions to see if you have symptoms of other mental health disorders.

To be diagnosed with hoarding disorder, you must meet criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. This manual is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

Diagnostic criteria for hoarding disorder include:

  • You have difficulty throwing out or parting with your things, regardless of actual value.
  • You feel a need to save these items, and the thought of discarding them upsets you.
  • Because you don't discard any items, your possessions crowd and clutter your living areas and make the space unusable. If any living areas are uncluttered, it's because someone else cleaned them.
  • Your hoarding causes you significant distress or problems functioning at work, socially or in other important areas, such as keeping yourself and others safe in your home.
  • Your hoarding is not due to another medical condition, such as a brain injury, or another mental disorder symptom, such as decreased energy from major depression.

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 their possessions or animals offer comfort. And people whose possessions or animals are taken away will often quickly collect more to help fulfill emotional needs.

There are two main types of treatment for hoarding disorder — psychotherapy and medications.

Psychotherapy

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

As part of cognitive behavior therapy, you may:

  • Explore why you feel compelled to hoard
  • 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 and practice relaxation skills
  • Attend family or group therapy
  • Have periodic visits or ongoing treatment to help you keep up healthy habits

Medications

Although the primary intervention for hoarding disorder is psychotherapy, research continues on the most effective ways to use medications in the treatment of hoarding disorder. The medications most commonly used are a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs).

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 and reduce your hoarding.
  • 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.
  • 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 see 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.
  • Look out for yourself. Remind yourself that you don't have to live in chaos and distress — that you deserve better.
  • 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.
  • Focus on your goals. To keep motivated to declutter, focus on your goals — living a healthier and more enjoyable life.
  • 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.
  • 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.

Because little is understood about what causes hoarding disorder, there's no known way to prevent it. However, as with many mental conditions, getting treatment at the first sign of a problem may help prevent hoarding from becoming severe.

May 08, 2014