Hoarding disorder is an ongoing difficulty throwing away or parting with possessions because you believe that you need to save them. You may experience distress at the thought of getting rid of the items. You gradually keep or gather a huge number of items, regardless of their actual value.
Hoarding often creates extremely cramped living conditions with only narrow pathways winding through stacks of clutter. Countertops, sinks, stoves, desks, stairways and all other surfaces are usually piled with stuff. You may not be able to use some areas for their intended purpose. For example, you may not be able to cook in the kitchen. When there's no more room inside your home, the clutter may spread to the garage, vehicles, yard and other storage areas.
Hoarding ranges from mild to severe. In some cases, hoarding may not have much impact on your life, while in other cases it seriously affects your daily functioning.
People with hoarding disorder may not see it as a problem, so getting them to take part in treatment can be challenging. But intensive treatment can help you understand how your beliefs and behaviors can be changed so that you can live a safer, more enjoyable life.
The first symptoms of hoarding disorder often appear during the teenage to early adult years. You may get and save too many items, gradually build up clutter in living spaces, and have difficulty getting rid of things.
As you grow older, you may continue getting and holding onto things that you may never use and don't have space for. By middle age, the clutter can become overwhelming as symptoms become more severe and increasingly difficult to treat.
Problems with hoarding gradually develop over time and tend to be a private behavior. You may avoid having family, friends or repair workers in your home. Often, major clutter has developed by the time it reaches the attention of others.
Symptoms of hoarding disorder may include:
Getting too many items and refusing to part with them results in:
With hoarding disorder, items are usually saved because:
Hoarding disorder is different from collecting. People who have collections, such as stamps or model cars, carefully search out specific items, organize them and display their collections. Collections can be large, but they aren't usually cluttered. Also, they don't cause the distress and problems functioning that are part of hoarding disorder.
People who hoard animals may collect dozens or even hundreds of pets. Animals may be confined inside or outside. Because of the large numbers, these animals often aren't cared for properly. The health and safety of the person and the animals are often at risk because of unsanitary conditions.
If you or a loved one has symptoms of hoarding disorder, talk with a health care provider or a mental health provider with expertise in diagnosing and treating hoarding disorder as soon as possible. Some communities have agencies that help with hoarding problems. Check with the local or county government for resources in your area.
As hard as it might be, if your loved one's hoarding disorder threatens health or safety, you may need to contact local authorities, such as police, fire, public health, child or elder protective services, or animal welfare agencies.
It's not clear what causes hoarding disorder. Genetics, brain function and stressful life events are being studied as possible causes.
Hoarding usually starts around ages 15 to 19. It tends to get worse with age. Hoarding is more common in older adults than in younger adults.
Risk factors include:
Hoarding disorder can cause a variety of complications, including:
Hoarding disorder also is linked with other mental health conditions, such as:
Because little is understood about what causes hoarding disorder, there's no known way to prevent it. However, as with many mental health conditions, getting treatment at the first sign of a problem may help prevent hoarding from getting worse. This is especially important because by the time clutter becomes a noticeable problem, hoarding likely has been going on for a while.
People often don't seek treatment for hoarding disorder, but rather for other issues, such as depression, anxiety or relationship problems. To help diagnose hoarding disorder, it's best to see a mental health provider who has expertise in diagnosing and treating the condition. You'll have a mental health exam that includes questions about emotional well-being. You'll likely be asked about your beliefs and behaviors related to getting and saving items and the impact clutter may have on your quality of life.
Your mental health provider may ask your permission to talk with relatives and friends. Pictures and videos of your living spaces and storage areas affected by clutter are often helpful. You also may be asked questions to find out if you have symptoms of other mental health conditions.
Treatment of hoarding disorder can be challenging but effective if you keep working on learning new skills. Some people don't recognize the negative impact of hoarding on their lives or don't believe they need treatment. This is especially true if the possessions or animals offer comfort. If these possessions or animals are taken away, people will often react with frustration and anger. They may quickly collect more to help satisfy emotional needs.
The main treatment for hoarding disorder is cognitive behavioral therapy (CBT), a skills-based approach to therapy. You learn how to better manage beliefs and behaviors that are linked to keeping the clutter. Your provider also may prescribe medicines, especially if you have anxiety or depression along with hoarding disorder.
Cognitive behavioral therapy is the main treatment for hoarding disorder. Try to find a therapist or other mental health provider with expertise in treating hoarding disorder.
As part of CBT, you may:
Treatment often involves regular help from family, friends and agencies to help remove clutter. This is often the case for the elderly or those struggling with medical conditions that may make it difficult to keep up the effort and desire to make changes.
For children with hoarding disorder, it's important to have the parents involved in treatment. Some parents may think that allowing their child to get and save countless items may help lower their child's anxiety and avoid family fights. This is sometimes called "family accommodation." This actually may do the opposite and strengthen the child's tendency to get and save items.
In addition to therapy for their child, parents may find professional guidance helpful to learn how to respond to and help manage their child's hoarding behavior.
Cognitive behavioral therapy is the first treatment recommended for hoarding disorder. There are currently no medicines approved by the Food and Drug Administration (FDA) to treat hoarding disorder. Medicines are used to treat other conditions such as anxiety and depression that often occur along with hoarding disorder. The medicines most commonly used are a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs). Research continues on the most effective ways to use medicines in the treatment of hoarding disorder.
In addition to professional treatment, here are some steps you can take to help care for yourself:
If you or a loved one has symptoms of hoarding disorder, your health care provider may refer you to a mental health provider, such as a psychiatrist or psychologist, with experience diagnosing and treating hoarding disorder.
Because some people with hoarding disorder symptoms don't recognize that their behavior is a problem, you as a friend or family member may experience more distress over the hoarding than your loved one does. If this is the case, you may want to first meet alone with a mental health provider with expertise in treating hoarding disorder. A provider can offer support and help on how to encourage your loved one to seek help.
To consider the possibility of seeking treatment, your loved one will likely need reassurance that no one is going to go into their house and start throwing things out.
Here's some information to help prepare for the first appointment and what to expect from the mental health provider.
Before your appointment, make a list of:
You may want to take a trusted family member or friend along, if possible. They can offer support and help remember the details discussed at the appointment. Bring pictures and videos of living spaces and storage areas affected by clutter.
Questions to ask your mental health provider include:
Feel free to ask other questions during your appointment.
To gain an understanding of how hoarding disorder is affecting your life, your provider may ask:
