Hoarding Disorder

What Is Hoarding Disorder?

People with hoarding disorder excessively save items that others may view as worthless. They have persistent difficulty getting rid of or parting with possessions, leading to clutter that disrupts their ability to use their living or work spaces.

Hoarding is not the same as collecting. Collectors look for specific items, such as model cars or stamps, and may organize or display them. People with hoarding disorder often save random items and store them haphazardly. In most cases, they save items that they feel they may need in the future, are valuable or have sentimental value. Some may also feel safer surrounded by the things they save.

Hoarding disorder occurs in an estimated 2 to 5 percent of the population and often leads to substantial distress and problems functioning.

Consequences

Hoarding disorder can cause problems in relationships, social and work activitives and other important areas of functioning. Potential consequences of serious hoarding include health and safety concerns, such as fire hazards, tripping hazards and health code violations. It can also lead to family strain and conflicts, isolation and loneliness, unwillingness to have anyone else enter the home and an inability to perform daily tasks such as cooking and bathing in the home.

• Diagnosis

  Diagnosing Hoarding Disorder

  Individuals with hoarding disorder have difficulty discarding items because of strong perceived need to save items and/or distress associated with discarding. The symptoms result in the accumulation of a large number of possessions that congest and clutter living areas of the home or workplace and make them unusable.

  Specific symptoms for a hoarding diagnosis include:

  • Lasting problems with throwing out or giving away possessions, regardless of their actual value.
  • The problems are due to a perceived need to save the items and to distress linked to parting with them.
  • Items fill, block and clutter active living spaces so they cannot be used, or use is hampered by the large amount of items (if living spaces are clear it is due to help from others).

  The hoarding causes major distress or problems in social, work or other important areas of functions (including maintaining a safe environment for self and others).

  An assessment for hoarding may include questions such as:

  • Do you have trouble discarding (or recycling, selling or giving away) things that most other people would get rid of?
  • Because of the clutter or number of possessions, how difficult is it to use the rooms and surfaces in your home?
  • To what extent do you buy items or acquire free things that you do not need or have enough space for?
  • To what extent do your hoarding, saving, acquisition and clutter affect your daily functioning?
  • How much do these symptoms interfere with school, work or your social or family life?
  • How much distress do these symptoms cause you?

  Mental health professionals may also ask permission to speak with friends and family to help make a diagnosis or use rating scales* to help assess level of functioning.

  Some individuals with hoarding disorder may recognize and acknowledge that they have a problem with accumulating possessions; others may not see a problem.

  In addition to the core features of difficulty discarding, excessive saving and clutter, many people with hoarding disorder also have associated problems such as indecisiveness, perfectionism, procrastination, disorganization and distractibility. These associated features can contribute greatly to their problems functioning and overall severity.

  Animal hoarding involves an individual acquiring large numbers (dozens or even hundreds) of animals. The animals may be kept in an inappropriate space, potentially creating unhealthy, unsafe conditions for the animals.

  Many people with hoarding disorder also experience other mental disorders, including depression, anxiety disorders, attention deficit/hyperactivity disorder or alcohol use disorder.

• Causes/Risk Factors

  Causes and Risk Factors

  It is not known what causes hoarding disorder, but researchers have identified a number of risk factors. Hoarding is more common among individuals with a family member who also has a problem with hoarding. Genetic research has begun to identify gene variants that may convey risk for hoarding. Brain injuries have also been found to cause secondary or acquired hoarding symptoms in some patients. A stressful life event, such as the death of a loved one, can also trigger or worsen symptoms of hoarding.

  Hoarding disorder is also associated with distinct abnormalities of brain function and neuropsychological performance, distinct from those seen in people with OCD or other disorders.

  Symptoms of hoarding, such as difficulty discarding items, usually start during the teen years. The average age at onset of first symptoms is 13. If not treated, hoarding disorder tends to be chronic, often becoming more severe over decades, as more and more clutter accumulates, causing more and more dysfunction. Early recognition, diagnosis and treatment are crucial to improving outcomes.

• Treatment

  Treatment

  Treatment can help people with hoarding disorder decrease their saving, acquisition and clutter, and live safer, more enjoyable lives. There are two main types of treatment that help people with hoarding disorder: cognitive-behavioral therapy (CBT) and medication.

  During CBT, individuals gradually learn to discard unnecessary items with less distress, diminishing their exaggerated perceived need or desire to save these possessions. They also learn to improve skills such as organization, decision-making and relaxation. For some people, medications are helpful and may help improve symptoms.

  If you or someone you know is experiencing symptoms of hoarding disorder, contact your doctor or mental health professional. In some communities public health agencies can help address problems of hoarding and getting help for individuals affected. In some instances, it may be necessary for public health or animal welfare agencies to intervene.

References

Physician Review By:

Ranna Parekh, M.D., M.P.H.
November 2015