Hoarding Disorder: Symptoms, Causes & Treatment

By Amalia Sirica, LCSW

Hoarding Disorder (HD) is characterized by a tendency to hold onto large quantities of material items. Hoarding should not be confused with collecting, which is more organized and intentional, and less disruptive. Asking someone who struggles with hoarding to part with their belongings can create significant feelings of distress in them. Around 2.6% of the population meets the criteria for hoarding disorder. 

What Is Hoarding Disorder?

Hoarding disorder falls under the “Obsessive-Compulsive and Related Disorders” class in the DSM-5. People with hoarding disorder tend to amass large quantities of material items, often to the point of creating clutter and potential distress in social and familial relationships. 

Hoarding disorder is only diagnosed if it’s causing significant distress and disruption in a person’s life, and if the hoarding behavior was not better explained by the presence of another mental disorder. One study found that HD is most commonly co-occurs in people with major depressive disorder, followed by generalized anxiety disorder, social phobia, and obsessive-compulsive disorder (OCD). 

A person might hoard a variety of different things. Common examples include newspapers, books, clothes, cleaning supplies, food and junk mail. Some people also hoard animals. 

What Causes Hoarding Disorder?

Several different factors can cause hoarding disorder. Some studies have linked hoarding behavior to trauma, finding that people who reported higher levels of trauma had more severe hoarding behavior but not more difficulty discarding their items.

Hoarding behavior has also been linked to early childhood experiences of financial worries or living in poverty. Hoarding might be a learned behavior if a child witnessed a caregiver hoarding. Hoarding behavior may also stem from another mental health disorder such as depression or obsessive-compulsive personality disorder. These other options would have to be considered before someone could receive a diagnosis of hoarding disorder. 

Signs of Hoarding

Some signs of hoarding include: 

• Gathering and keeping items that are not necessary
• Experiencing extreme difficulty or panic when asked to discard those items 
• Gathering items to the point where space in the home is limited and obstructed
• Procrastination and difficulty making decisions

Some studies have also found links between hoarding behaviors and cognitive disorganization, finding that hoarders struggle with sustained attention, working memory, organization and problem-solving.

Levels of Hoarding

According to the Institute For Challenging Disorganization, there are five levels of hoarding, with social impact and disruption increasing from level to level: 

• Level 1: Minimal clutter, all entrances and exits in the house are accessible
• Level 2: Conditions start to become unsanitary, garbage is not being removed, some evidence of household pests
• Level 3: Odors begin to occur throughout the home
• Level 4: Absence of clean dishes or utensils, rotting food, exits start to be blocked 
• Level 5: No usable rooms, noticeable human feces, heavy vermin infestation

Over time, these levels build on each other if the hoarding behavior is not addressed and remedied, leading to increasingly unsafe home environments.

Hoarding Health Risks

One study found that older adults with HD reported a significantly higher number of health conditions compared to their peers, who did not report any psychiatric conditions. People with hoarding disorder often also struggle with sleep apnea, arthritis and blood-related conditions, like anemia.  

Hoarding disorder can contribute to self-neglect or an extreme lack of self-care. Signs of self-neglect can include: 

• Living in unsanitary conditions
• Neglecting doctor’s appointments
• Avoiding a healthy diet and exercise
• Lack of personal hygiene
• Rodents or bugs in the home

After an extended period of time, self-neglect may begin to have health consequences, especially if an individual is avoiding or refusing medical treatment.

Hoarding Disorder Treatment 

The most common treatments for hoarding disorder are: 

• Cognitive-behavioral therapy (CBT): CBT treatment for hoarding disorder includes confronting the person’s beliefs about hoarding and restructuring them. The person may practice sorting and discarding items, and they may be restricted from collecting more items. 
• Motivational Interviewing (MI): This technique attempts to motivate the individual to make positive, lasting changes in their behavior.
• Skills training: The goal of this treatment method is to help the person solve problems and make decisions to remove clutter and keep their environment clean. 
• Medication: Medication for hoarding disorder aims to reduce anxiety or improve mood.

As with all other mental health conditions, hoarding disorder should only be diagnosed by a trained professional. If you or a loved one is struggling with symptoms of hoarding disorder, the Nobu app may be able to supplement your treatment and provide further mental health guidance.