Hoarding disorder

Hoarding disorder is an ongoing difficulty throwing away or parting with possessions because you believe that you need to save them. You may experience distress at the thought of getting rid of the items. You gradually keep or gather a huge number of items, regardless of their actual value.

Hoarding often creates extremely cramped living conditions with only narrow pathways winding through stacks of clutter. Countertops, sinks, stoves, desks, stairways and all other surfaces are usually piled with stuff. You may not be able to use some areas for their intended purpose. For example, you may not be able to cook in the kitchen. When there's no more room inside your home, the clutter may spread to the garage, vehicles, yard and other storage areas.

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 daily functioning.

People with hoarding disorder may not see it as a problem, so getting them to take part in treatment can be challenging. But intensive treatment can help you understand how your beliefs and behaviors can be changed so that you can live a safer, more enjoyable life.

The first symptoms of hoarding disorder often appear during the teenage to early adult years. You may get and save too many items, gradually build up clutter in living spaces, and have difficulty getting rid of things.

As you grow older, you may continue getting and holding onto things that you may never use and don't have space for. By middle age, the clutter can become overwhelming as symptoms become more severe and increasingly difficult to treat.

Problems with hoarding gradually develop over time and tend to be a private behavior. You may avoid having family, friends or repair workers in your home. Often, major clutter has developed by the time it reaches the attention of others.

Symptoms of hoarding disorder may include:

• Getting and keeping too many items that you may not have a need for right now and don't have space for.
• Ongoing difficulty throwing out or parting with your things, regardless of their actual value.
• Feeling a need to save these items and being upset by the thought of getting rid of them.
• Building up clutter to the point where you can't use rooms.
• Trying to be perfect and avoiding or delaying decisions.
• Problems with planning and organizing.

Getting too many items and refusing to part with them results in:

• Disorganized piles or stacks of items, such as newspapers, clothes, paperwork, books or sentimental items.
• Items that crowd and clutter your walking spaces and living areas. Rooms can't be used for the intended purpose, such as not being able to sleep in your bed.
• Buildup of food or trash to large, unsanitary levels.
• Distress or problems functioning or keeping yourself, others and pets safe in your home.
• Conflict with others who try to reduce or remove clutter from your home.
• Relationship issues, avoiding social activities and employment problems.
• Difficulty organizing items and sometimes losing important items in the clutter.

With hoarding disorder, items are usually saved because:

• You believe these items are unique or that you'll need them at some point in the future.
• You feel emotionally connected to items that remind you of happier times or represent beloved people or pets.
• You feel safe and comforted when surrounded by things.
• You don't want to waste anything.

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

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

Hoarding usually starts around ages 15 to 19. It tends to get worse with age. Hoarding is more common in older adults than in younger adults.

Risk factors include:

• Personality. Many people who have hoarding disorder have a behavior style that includes trouble making decisions and problems with attention, organization and problem-solving.
• 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 or losing possessions in a fire.

Hoarding disorder can cause a variety of complications, including:

• Increased risk of falls.
• Injury or being trapped by shifting or falling items.
• Family conflicts.
• Loneliness and social isolation.
• Conditions that aren't clean and can be a health risk.
• A fire hazard.
• Poor work performance.
• Legal issues, such as eviction.

Because little is understood about what causes hoarding disorder, there's no known way to prevent it. However, as with many mental health conditions, getting treatment at the first sign of a problem may help prevent hoarding from getting worse. This is especially important because by the time clutter becomes a noticeable problem, hoarding likely has been going on for a while.