Hoarding Disorder

Definition

Hoarding is a disorder characterized by an ongoing resistance to discarding unnecessary items like junk mail, old newspapers, and materials that most people would consider to be garbage. People with hoarding disorder also hold on to personal possessions that are no longer needed, either because they feel personally attached to the items or because they believe they will need them in the future. The accumulation of clutter and lack of order and cleanliness can cause health and safety risks within the home and create social, professional, and functional problems for a person with hoarding disorder. The disorder also affects the people around the hoarder.

Symptoms

Hoarding can begin in adolescence and not only continue but worsen as the person gets older. Unlike someone who is a collector of objects generally recognized as collectable with some known value, a person with hoarding disorder collects random items and is overly attached to personal possessions that may or may not have any value. Although they may be convinced to give up or throw away some of the items, doing so causes the person great distress. Ultimately, almost every surface in the home of a hoarder, including floors, furniture, counters and other fixtures, is covered in growing piles of clutter. The hoarder has only a narrow path left clear for walking through the living space which, for the most part, is no longer usable. The more cluttered and blocked the home becomes, the more stress the person feels, because of the chaos within the living space and often because of complaints from family members and neighbors.

Causes

The cause of hoarding disorder has yet to be found, although there are known risk factors. People who experience a traumatic event, have difficulty making decisions, or have a family member who hoards, are at risk of developing the disorder. The majority of people with hoarding disorder also suffer some type of depressive or anxiety disorder. Some also have obsessive-compulsive disorder (OCD). In fact, hoarding disorder was once thought to be a symptom of OCD, and there are some similarities between the two, however, hoarding is now recognized as a separate condition. None of the symptoms of hoarding disorder are due to any other mental health condition, nor are they due to a medical problem. One study found that, among the reasons people gave for hoarding, avoiding waste was the most common.

Treatments

Although hoarding may persist for a lifetime, treatment can help reduce the need to hold on to unnecessary items and improve decision-making, stress reducing, and organizational skills. Cognitive-behavioral therapy and antidepressant medication (selective serotonin reuptake inhibitors or SSRIs) are the primary treatments used to relieve symptoms of hoarding disorder. One or the other, or both, may be employed.

References

Anxiety and Depression Association of America website. Hoarding: The Basics. https://www.adaa.org/understanding-anxiety/obsessive-compulsive-disorder... Accessed March 28, 2017.

Morein-Zamir S, Papmeyer M, Pertusa A. et al. The profile of executive function in OCD hoarders and hoarding disorder. Psychiatry Research. 30 March 2014;215(3):659-667. http://www.sciencedirect.com/science/article/pii/S0165178113008196

Frost RO, Steketee G, Tolin DF, Sinopli N, Ruby D. Motives for acquiring and saving in hoarding disorder, OCD and community controls. Journal of Obsessive-Compulsive and Related Disorders. January 2015;4:54-59. http://www.sciencedirect.com/science/article/pii/S0165178113008196

American Psychiatric Association. Understanding Mental Disorders: Your Guide to DSM-5. 2015. American Psychiatric Publishing.

Last reviewed 06/08/2017