TV shows have raised awareness of the devastating impact hoarding behaviors can have on the individual and their loved ones. It is important for people to understand that TV shows, by their nature, may not capture all the time, effort and hard work that is a necessary part of any mental health treatment program. Hoarding disorder, which became a new diagnostic entry in the DSM-5 in 2013, affects about 2-3 percent of the population. People with hoarding disorder have difficulty parting with possessions, clutter that interferes with normal functioning and marked distress and impairment.

The initial start of hoarding symptoms is thought to happen in childhood or adolescence (typical onset is around age 16) and it is chronic and progressive. Hoarding is more common in older age groups than younger age groups.

Below are some early signs that an individual may have hoarding behaviors. These behaviors are typically mild and progress over years. They may develop into a severe problem in adults around their 50s. However, not every person with hoarding symptoms has hoarding disorder.

• Difficulty letting go of things (throwing away, selling, recycling, giving away)
• Clutter that makes it difficult to move easily throughout the home
• Piles of items that keep tipping over (newspapers, magazines, mail)
• Sleeping with items on the bed
• Difficulty organizing and categorizing
• Difficulty making decisions
• Spending time moving things from pile to pile without letting go of items
• Problems with attention
• Excessive shopping or collecting free things
• Not realizing the seriousness of the problem

It is difficult to watch a family member struggle with clutter; especially when they do not see how it is impacting their lives. Those who want to help often feel helpless and overwhelmed. The first step to help a loved one is to get information. The International OCD Foundation (IOCDF) has information about hoarding and practical resources and referrals. The second step is to listen to your loved one and try to understand why they have problems with clutter. For example, letting go of possessions is difficult for a variety of reasons: sentimentality, aesthetics, or an object’s future usefulness. Those with hoarding behaviors are often highly creative individuals who can think of multiple uses for items; however, these grand ideas rarely materialize, resulting in clutter. More often than not, your loved one can recognize at least one issue (limited space, not able to have family over) that makes them unhappy, and that will serve as a good shared starting point.

In the United States, a person’s civil liberties are protected; going into someone’s house (depending on the situation) may be a civil rights violation. Because there are strong attachments to the clutter, and the clutter is a result of a disorder which causes excessive acquisition and decisions to save possessions, simply removing the clutter may not help. Only changing the amount of acquisitions and decisions to save will keep the clutter manageable. Imagine treating a person with alcoholism by throwing away their wine bottles—this would not likely work as a long-term solution, and the person would likely go back to drinking if they did not get professional help to treat their underlying problems. In addition, if a family member “just went in and removed the clutter,” it would most likely result in disastrous consequences, including: rupture of trust, alienating the family member, increasing the family member’s anxiety, depression/suicidality, thus potentially delaying their willingness to receive care and treatment.

Yes, hoarding disorder is more common among people who have a family member who has hoarding disorder. The cause of hoarding disorder remains unknown. Genetics is likely only one part of why hoarding disorder affects a particular individual; environment and traumatic life events play a role as well.

Animal hoarding is a heartbreaking cycle for the pets, the individuals who keep these pets, families and the government agencies involved (animal control, social services). In severe cases, individuals often display rigid beliefs that they are saving and protecting animals despite the fact that they are not providing adequate care. In these cases, animals in the home may be sick, dying, or dead, but the individual denies any problems and actively resists intervention. In less serious cases, the individual may have a history of adequate care for a large number of animals, but when stressful events occur—such as illness, loss of income, or death of a spouse—they struggle to properly care for the animals; and at the same time, they are fearful or lack the skills to seek help. In these cases, the individual is more cooperative, and intervention is usually more successful.

Animal hoarding is defined in DSM-5-TR as the accumulation of a large number of animals and a failure to provide minimal standards of nutrition, sanitation and veterinary care and to act on the deteriorating condition of the animals (including disease, starvation or death) and the environment (e.g., severe overcrowding, extremely unsanitary conditions).

There are multiple types of help for individuals with hoarding disorder, including self-help books, support groups, individual talk therapy, medications and group therapy. New studies are underway examining internet-based treatments. Emerging evidence supports peer-facilitated group treatments.

Hoarding disorder can be treated, and there is hope for returning to a normal life. Typically, individuals will continue to face challenges throughout their lives; staying in treatment may decrease chances that hoarding symptoms and clutter will return.