Hoarding Disorder

What is hoarding disorder?

Hoarding disorder is a mental health condition in which a person feels a strong need to save a large number of items, whether they have monetary value or not, and experiences significant distress when attempting to get rid of the items. The hoarding impairs their daily life.

Typical hoarded items include newspapers, magazines, household goods and clothing. Sometimes, people with hoarding disorder accumulate a large number of animals, which are often not properly cared for.

Hoarding disorder can lead to dangerous clutter. The condition can interfere with your quality of life in many ways. It can cause people stress and shame in their social, family and work lives. It can also create unhealthy and unsafe living conditions.

Is hoarding an anxiety disorder?

While hoarding disorder is classified as being part of the obsessive-compulsive disorder (OCD) spectrum, which is an anxiety disorder, hoarding disorder is a distinct condition.

Previously, the Diagnostic and Statistical Manual of Mental Disorders (DSM), the standard classification of mental disorders produced by the American Psychiatric Association, classified hoarding as a subtype of OCD.

However, healthcare providers were encountering people with hoarding behaviors who didn’t have any other mental health conditions. After more research, hoarding disorder was included as an isolated condition, in the OCD spectrum, in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), which is the most recent edition.

What is the difference between hoarding and collecting?

Hoarding items and collecting items are distinct behaviors.

Collecting normally involves saving certain types of items, such as comic books, currency or stamps. You’d carefully choose these items and typically organize them in a certain way. Collecting items in this way doesn’t negatively impact your daily life.

Hoarding doesn't involve organization of the items in a way that makes them easy to access or use. People with hoarding disorder often hoard items that have little or no monetary value, such as pieces of paper or broken toys. The hoarding also negatively impacts their daily life.

Who does hoarding disorder affect?

Hoarding disorder often begins during adolescence and gradually worsens with age, causing significant issues by the mid-30s.

Hoarding disorder is more likely to affect people over 60 years old and people with other mental health conditions, especially anxiety and depression.

How common is hoarding disorder?

Approximately 2% to 6% of people in the United States have hoarding disorder.

What are the symptoms of hoarding disorder?

Some people with hoarding disorder recognize that their hoarding-related beliefs and behaviors are problematic, but many don’t. In many cases, stressful or traumatic events, such as divorce or the death of a loved one, are associated with the onset of hoarding symptoms.

People with hoarding disorder feel a strong need to save their possessions. Other symptoms include:

• Inability to get rid of possessions.
• Experiencing extreme stress when attempting to throw out items.
• Anxiety about needing items in the future.
• Uncertainty about where to put things.
• Distrust of other people touching possessions.
• Living in unusable spaces due to clutter.
• Withdrawing from friends and family.

People with hoarding disorder may hoard items for any of the following reasons:

• They believe that an item will be useful or valuable in the future.
• They feel an item has sentimental value, is unique and/or irreplaceable.
• They think an item is too great of a bargain to throw away.
• They think an item will help them remember an important person or event.
• They can’t decide where an item belongs, so they keep it instead of throwing it away.

Many people with hoarding disorder also have associated issues with cognitive functioning, including:

• Indecisiveness.
• Perfectionism.
• Procrastination.
• Disorganization.
• Distractibility.

These issues can greatly affect their functioning and the overall severity of hoarding disorder.

What causes hoarding disorder?

Researchers don’t yet know the exact cause of hoarding disorder. So far, they’ve identified several information (mental) processing deficits associated with hoarding, including issues with:

• Planning.
• Problem-solving.
• Visuospatial learning and memory.
• Sustained attention.
• Working memory.
• Organization.

Hoarding disorder may exist on its own or may be part of another condition. Mental health conditions most often associated with hoarding disorder include:

• Obsessive-compulsive personality disorder (OCPD).
• Obsessive-compulsive disorder (OCD).
• Attention-deficit/hyperactivity disorder (ADHD).
• Depression.

Researchers have identified other risk factors associated with hoarding disorder that may make it more likely that you’ll develop the condition, including:

• Having a relative with hoarding disorder.
• Brain injury.
• Traumatic life event.
• Impulsive buying habits.
• Inability to pass up free items, such as coupons and flyers.
• Substance use disorder or alcohol use disorder.
• Prader-Willi syndrome.

How is hoarding disorder diagnosed?

People with hoarding disorder rarely seek help on their own. Concerned friends or family members often reach out to a professional to help a loved one with the condition.

Contact a healthcare provider or mental health professional if hoarding makes a living situation unhealthy or unsafe for you or someone you know. If someone you know is hoarding animals, it’s important to contact the correct authorities, such as Animal Control Services, to safely acquire and care for the animals.

To diagnose hoarding disorder, your healthcare provider will ask about your collecting and saving habits. To confirm a diagnosis, the following symptoms must be present:

• Ongoing difficulty getting rid of possessions whether they have value or not.
• Feeling a strong need to save items and feelings of distress associated with discarding items.
• Living spaces that are so filled with possessions that they’re unusable and/or unsafe.

How is hoarding disorder treated?

Healthcare providers use two main types of therapies to treat hoarding disorder:

• Cognitive behavioral therapy, a type of talk therapy (psychotherapy).
• Antidepressant medications, which are usually selective serotonin reuptake inhibitors (SSRIs).

Cognitive behavioral therapy (CBT) is a common treatment for hoarding disorder. With the help of a licensed mental health professional, such as a psychologist, people learn to understand why they hoard and how to feel less anxiety when throwing away items. Specialists also teach organization and decision-making skills. These skills can help you better manage your possessions.

Some providers prescribe medications called antidepressants to help treat hoarding disorder. These medicines can improve the symptoms of the condition for some people.

Can hoarding disorder be prevented?

There’s no known way to prevent hoarding disorder. However, hoarding behaviors appear relatively early in life (usually between the ages of 15 and 19 years) and then follow a chronic course. If you notice signs of hoarding in your child or someone you know, early recognition, diagnosis and treatment are essential to improving outcomes.

What is the prognosis (outlook) for hoarding disorder?

The prognosis (outlook) for hoarding disorder is often poor. While some people with the condition greatly improve after treatment with cognitive behavioral therapy, many people still have symptoms after treatment that impact their day-to-day life.

People with hoarding disorder often have a lack of functional living space, which can prevent them from performing important daily tasks, such as cooking, cleaning, sleeping and bathing. They may also live in unhealthy or unsafe conditions. Serious hoarding can lead to fire hazards, tripping hazards and health code violations.

Hoarding disorder can also cause problems in relationships and social and work activities. It often leads to family strain and conflicts, isolation and loneliness.

Hoarding can affect the social development of children. Unlivable conditions may lead to separation or divorce, eviction and even loss of child custody. People who hoard animals that are in unsafe living conditions may also face prosecution under state animal cruelty laws.

When should I see my healthcare provider about hoarding disorder?

If you or someone you know is experiencing symptoms of hoarding disorder, contact your healthcare provider or a mental health professional.

In some communities, public health agencies can assist in addressing hoarding problems. In some cases, it may be necessary for animal welfare agencies to intervene.

A note from Cleveland Clinic

It’s important to remember that hoarding disorder is a mental health condition — it’s not a matter of laziness or willpower. As with all mental health conditions, seeking professional help as soon as symptoms appear can help decrease the disruptions to your life. Mental health professionals can offer treatment plans that can help you manage your thoughts and behaviors related to hoarding.

The family members of people with hoarding disorder often experience stress, depression, grief and isolation. It’s important to take care of your mental health and seek help if you’re experiencing these symptoms.