Learning about the root cause of hoarding can help you understand the symptoms, find support, and dispel misconceptions.

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Most of us think we know what hoarding disorder is. But in truth, unless you’ve been personally affected by it, your perception is likely based on something you’ve seen on TV or in the movies, like the show “Hoarding.” Popular media doesn’t capture the deeper mental aspect of hoarding.

Additionally, the way we see hoarding depicted in the media can stigmatize those with this mental health condition. There’s a lot to know about hoarding that you may not learn from movies or television.

Hoarding disorder is the act of excessively acquiring items, that may have little value, and experiencing distress when faced with the decision to discard or part ways with them.

If you or someone you know shows these signs, becoming aware of the five levels of hoarding disorder can help you find support.

Hoarding is not the same as collecting items. People who hoard tend to gather items impulsively, without much planning, and store them in a disorganized way that clutters the space in and around their home.

People who hoard usually experience embarrassment about their possessions and often avoid allowing others to visit their home. Hoarding disorder may cause problems with health risks, relationships, social activities, and work activities, and can sometimes lead to debt.

Despite historical thinking, hoarding disorder is not the same as obsessive-compulsive disorder (OCD). They’re treated as separate conditions. People can have both OCD and hoarding behaviors, but in hoarding disorder, hoarding is not connected with obsessive thinking.

People with hoarding disorder may seem less distressed by their behavior than people with OCD might be. In OCD, hoarding behavior is generally unwanted, highly distressing, and involves no pleasure or reward.

According to the American Psychiatric Association, the signs and symptoms used to diagnose hoarding disorder are:

  • finding it persistently difficult to part with items, even if they have low actual value
  • holding on to items because you feel you need to save them, and because discarding them would cause distress
  • having a buildup of items that clutters active living spaces, significantly impeding their intended use

For hoarding disorder to be diagnosed, the symptoms must cause major distress or problems in your daily life, such as in your social life, work, or ability to keep yourself and others safe.

Hoarding disorder can lead to problems with your personal life. It can strain family relations and cause you to feel lonely or withdraw from social situations, due to feeling uncomfortable letting people visit.

Depending on your specific circumstances, hoarding can lead to health and safety issues, such as blocked fire exits, pest infestations (insects or rodents), and health hazards from animal excrement. If some living spaces or appliances are blocked or unusable, it can be more difficult to cook or bathe.

The symptoms of hoarding disorder can lead you to have a large amount of clutter in your office, home, car, or other spaces (e.g., storage units). This makes it difficult to use furniture or appliances or move around easily. You might also:

  • find yourself unable to locate important items, like money or bills, due to the clutter
  • feel overwhelmed by the volume of possessions that have “taken over” the house or workspace
  • avoid inviting family or friends into your home due to feelings of shame or embarrassment, and feeling that they wouldn’t understand
  • avoid letting people into the home to make repairs

While some people might collect a range of things, others stick to just one kind of item. This means that hoarding disorder won’t look the same for everyone.

Some common items that people who hoard hold on to are:

  • newspapers and magazines
  • books
  • clothes
  • leaflets and letters, including advertising mail
  • bills and receipts
  • containers, including plastic bags and cardboard boxes
  • household supplies
  • animals, such as dogs, cats, fish, or reptiles

More recently, researchers are looking into digital hoarding — holding on to old emails, photographs, and videos. Some people believe that digital hoarding could be a subtype of hoarding disorder.

The severity of consequences is likely to be lesser than physical hoarding, as digital hoarding does not involve the same health, fire, or safety risks — though it may cause similar psychological distress.

People hoard for a variety of reasons. Sometimes, they believe that an item will be useful or valuable to them in the future. Or, they might feel that an item:

  • has sentimental value
  • is unique or special
  • is too big a bargain to throw away
  • is the only thing reminding them of a certain memory

The Institute for Challenging Disorganization created a scale to better identify the degree of clutter and hoarding behavior one may experience. The five levels include, but are not limited to, the following:

Level 1

  • no excessive clutter or unsanitary conditions
  • all rooms in the residence are being used for intended purposes
  • doorways, windows, and stairways are accessible in case of emergency

Level 2

  • slight congestion or blockage at major exits, hallways, and stairs
  • evidence of inapporpriate animal control or odorous waste
  • plumbing and electrical systems aren’t fully functional

Level 3

  • visible clutter outside of home
  • at least one room in the home is unusable due to clutter
  • light insect infestation and audible evidence of pests

Level 4

  • odor or evidence of sewer backup
  • visible moisture or standing water posing health hazards due to mold or mildew
  • rotting food and organic contamination

Level 5

  • extreme outdoor/indoor clutter and inadequate ventilation
  • bed inaccessible due to clutter or infestation
  • unrepairable damage to the interior and exterior foundation of residence

For many people, knowing that they’re not alone in their condition can bring them a sense of comfort. This can also bring comfort to friends and family seeking guidance on how to help their loved ones get treatment.

Data suggests that the prevalence of hoarding is around 2% to 6%. This is higher among adults over 70 years old. The severity of hoarding behaviors increases with each decade.

Although 2% may seem like a low number, remember that it still accounts for millions of people. There are many people who can relate to you.

Mental health professionals are unsure about the exact cause of hoarding disorder. Several factors may make it more likely for someone to develop the condition.

Possible causes and risk factors for hoarding disorder include:

  • having a family history of hoarding disorder
  • experiencing trauma, such as the loss of a loved one or a serious illness
  • having problems with information processing, such as planning, attention, memory, and organization

Hoarding disorder can also be a symptom of another condition, like attention deficit hyperactivity disorder (ADHD) or depression.

Less commonly, it can be associated with:

  • pica, in which a person consumes nonfood items
  • psychosis
  • major neurocognitive disorder, formerly known as dementia
  • a brain injury
  • Prader–Willi syndrome, a genetic condition

If your friend or family member is hoarding, try to keep in mind that simply decluttering and clearing out their living space doesn’t constitute full treatment. In other words, the simple act of cleaning someone’s space doesn’t guarantee that they will avoid hoarding in the future.

With that being said, it can be useful for a person who hoards to learn strategies for avoiding clutter, as it models the kind of behaviors that will be beneficial to them:

Decluttering strategies

Here are some tips you might want to offer your loved one:

  • Make immediate decisions about when to keep or throw something away, instead of keeping it so you can decide later.
  • Think twice about what you allow in your home instead of acquiring items on impulse.
  • Set aside 15 minutes a day to declutter, starting small and building up.

Emotional support

Just the thought of discussing someone’s hoarding habits might provoke anxiety. That’s completely understandable. When you do decide to talk to a loved one, try to make sure you give the emotional support they need.

Emotional tools you can use are:

  • Respect. Remember that, ultimately, the process and decision are theirs.
  • Sympathy. Try to understand where they’re coming from.
  • Encouragement. Come up with ideas to make their home safer, such as moving clutter from doorways and halls.

Also, given the nature of hoarding disorder, try not to take it personally if your attempts to help your loved one aren’t well received. Keep in mind that until the person is internally motivated to change, they might not be ready to accept your help.

Various treatment options can help reduce hoarding habits, make the home safer, improve quality of life, and reduce the distress that comes with saving or discarding items. These include:

  • Cognitive behavioral therapy (CBT). CBT can support the person to restrict the number of items they acquire, help them to practice sorting and discarding items, and apply cognitive restructuring to challenge thoughts and beliefs about attachment to items.
  • Motivational interviewing (MI). MI can increase motivation by helping the person connect their values and goals with their behaviors and brainstorming ways to change behaviors that aren’t in line with their values and goals.
  • Skills training. This can help people learn how to organize their belongings within their homes, use problem-solving methods to address common issues that arise in working on their clutter, and make decisions about keeping needed items and removing objects that contribute to clutter.
  • Medication. Antidepressant or anti-anxiety medications can help some people to engage with treatment by resolving difficult feeling states.

Hoarding disorder is a condition that can exist in and of itself, but it can also coexist with other mental health conditions. It can feel difficult to find the right tools for support, but try to keep in mind that the right tools are out there, and conversation is necessary.

If you’re looking for more resources, you may want to visit the following websites:

  • The American Psychiatric Association offers helpful resources, including education, Q&As, and personal perspectives of people affected by hoarding disorder.
  • International OCD Foundation offers information for finding support groups and help for hoarding disorder.
  • If you’re looking for mental health support, but not sure where to start, you can check out our Find a Therapist resource.