Hoarding Disorder

Hoarding symptoms may differ between individuals and, as with most mental health disorders, occur on a spectrum of type and severity. The following are some key features to look for when determining if someone is experiencing hoarding disorder:

• The individual has difficulty discarding possessions, even if they are no longer needed or have no practical value.
• They have a strong compulsion to acquire and collect items excessively, even if they are not essential or useful.
• Their homes become cluttered so that living areas cannot be used for their intended purposes.
• They develop intense emotional attachments to their possessions, seeing them as extensions of themselves or valuable sources of comfort.
• They experience significant distress, impairment in daily functioning, and strained relationships with family and friends.
• They have an all-or-nothing mindset such that if they can’t be perfect in their organization, they will avoid decision-making altogether, including avoiding deciding to declutter.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides the following additional criteria:

• The hoarding behavior is not attributable to a medical condition, such as a brain injury or neurovascular disease.
• The hoarding behavior is not better attributed to the symptoms of another mental disorder, such as delusions² associated with schizophrenia or lethargy associated with major depressive disorder.

When determining an individual prognosis, mental health professionals often note if the patient's difficulty with discarding items is accompanied by excessive acquisition of new belongings, particularly if they procure things they don't need or acquire them despite having nowhere to put them. 

They may also note the person’s degree of self-awareness. Some individuals may be completely aware of the distress caused by their hoarding behaviors and experience anxiety and depression as a result. Others may be convinced there is no problem with their behaviors despite evidence to the contrary and may possibly become combative when confronted or asked to change. 

Studies on hoarding disorder indicate symptoms typically begin to appear between 10 and 20 years old and become more severe with age.

Research on the etiology of hoarding disorder (HD) is still relatively limited, and more current studies are necessary to determine a cause. Still, experts believe that brain structure and function, heredity, life experiences, and childhood environment may contribute to risk factors for developing HD.

Physiology

According to the American Psychiatric Association, various information processing deficits may be related to hoarding, including planning, attention, organization, visuospatial learning and memory, problem-solving, and working memory. However, a study from 2023 only found a difference in categorization skills in individuals living with hoarding disorder. More research may be needed to elucidate the potential role of cognitive impairment in hoarding disorder.

Heredity

While more current quantitative studies may shed more light on heritability, research on twins and hoarding behavior suggests there may be a strong genetic link to HD, particularly among women. A 2015 study on geriatric hoarding patients found that in a sample of 71 participants, an average of half of the individuals reported having a mother with hoarding symptoms.

Environment

Individuals with PTSD³ or who have experienced a stressful life event, such as the death of a loved one or the loss of a job, appear to be more susceptible to hoarding disorder. Though perhaps unassociated with a cause, risk factors such as age, gender, and socioeconomic status may play a role in developing hoarding tendencies. Childhood experiences in homes with a chaotic environment, where the family moved frequently or there was childhood trauma,⁴ may also contribute to HD.

The goal of HD treatment is typically two-fold: 1) Professionals work to assist the individual in resolving the underlying physical/psychological challenges contributing to their behavior. 2) The therapist may recruit a case worker or organization within the community to help make the individual's home safe for living, ensure it isn't breaking any code violations, and reduce the risk of legal eviction.

Medication

Currently, there is no established pharmacological treatment approved specifically for HD. However, medication may be prescribed to manage co-occuring conditions and symptoms related to HD (for example, anxiety, depression, and symptoms surrounding the act of parting with belongings).

Also, a 2014 clinical trial shows promise for treating HD using venlafaxine, a serotonin-norepinephrine reuptake inhibitor (SNRI). Upon completion of the trial, 70% of the 23 participants who completed the trial had an above-average response to the medication. 

While preliminary studies on such medications indicate they may help treat people with HD, more controlled, quantified research is needed to definitively establish them as viable treatment options.

It is important to consult with a doctor or medical professional before beginning or changing any medication plan. 

Other treatment options

Therapists often recommend that treatment for HD include psychoeducation for family members. This may help them understand hoarding, its potential causes, the treatment process, and how they can help. This can encourage empathy and support among loved ones.

Treatment for HD also sometimes requires a coordinated community effort due to the consequences of hoarding behaviors. For this reason, many therapists work closely with a "hoarding task force" composed of multiple public agencies. 

For example, some communities work with therapists to coordinate efforts between the local police, the public health department, the fire department, housing inspection services, and the local social services department to help people in the community with HD. 

While some task forces work within the local government, others may coordinate to assist a specific population, such as older adults. Some cases may require more resources than others, such as those of people with animal hoarding behaviors. 

Self-care

Self-care for HD may help treat the sometimes emotionally distressing symptoms associated with changing hoarding behavior. It may also help alleviate symptoms of common co-occurring disorders, such as depression and anxiety. People with HD are encouraged to eat well, exercise, spend time with supportive people, and participate in activities that increase mindfulness, such as yoga or meditation, as a supplement to therapy. 

Treatment for HD tends to be firmly rooted in CBT. While in-person therapy may be the most conventional option, due to the nature of the symptoms, people with HD may be socially isolated and reluctant to seek therapy in an office environment. In these cases, online platforms offering virtual therapy can be significantly helpful. 

If you or someone you know is experiencing difficulty with hoarding behavior, it may help to educate yourself and seek attention from a mental health professional experienced in treating HD. The following resources may help: 

• International OCD Foundation (IOCDF) - Hoarding Fact Sheet
• IOCDF - Local support group list  
• Hoarding Clean Up Service Directory
• Directory for local HD task force resources

For help with substance use, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357). Please see our Get Help Now page for more immediate resources.

Although more data is required for a more complete portrait of HD and how to best treat it, studies of the disorder reveal some insights that may be helpful. For example, much research has been done on the relationship between hoarding and emotion regulation. In a 2018 analysis, 11 adults ages 39-68 diagnosed with hoarding disorder were surveyed about their experience of emotions connected with their hoarding behaviors. The researchers found that individuals with HD may have more difficulty identifying emotional states than those without the disorder. 

In addition to research on psychotherapeutic treatment methods, some studies indicate that serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SRNIs) may successfully minimize hoarding symptoms. 

Here are some key statistics on hoarding disorder:

• An estimated 2%-6% of the adult population experiences hoarding disorder. 
• People ages 55 to 94 are three times more affected by hoarding disorder than those ages 34 to 44.
• Roughly 75% of people with HD have other mental illnesses, such as social anxiety disorder, anxiety, depression, and OCD.
• Studies suggest that 70%-80% of people undergoing CBT methods designed to treat HD showed notable improvements after 9 to 12 months of treatment. Some individuals report long-term improvement of symptoms after therapy.