Hoarding Disorder

Hoarding disorder is characterized by an ongoing resistance to discarding one’s belongings, even those with no value, like junk mail, old newspapers, and materials that most people would consider to be garbage. Hoarders also hold on to personal possessions that they no longer use, either because they feel emotionally attached to these items or because they believe they will need them in the future.

People with this condition may give in to the urge to acquire excessive amounts of objects that fill up their living space. The accumulation of clutter and lack of order and cleanliness can cause health and safety risks within the home. In this way, hoarding disorder can create social, professional, and functional problems that affect not only the individual but also the people around them.

The hoarding tendency often begins in adolescence and worsens as a person gets older. Unlike a collector (someone who accumulates specific related objects generally recognized as collectibles with some established value), a person with hoarding disorder gathers up random items and is overly attached to personal possessions that may not have any value.

Even when they are convinced to give up or throw away some of the items, doing so causes the hoarder great distress. Ultimately, almost every surface in an individual's home, including floors, furniture, counters, and other fixtures, will be covered in piles of clutter, leaving the hoarder only a narrow path clear for walking through the living space, which for the most part is no longer usable.

Hoarders often experience difficulty with personal hygiene and are at greater risk of falling and their residences become fire risks. The more cluttered and blocked their home becomes, the more stress the individual feels, because of the chaos within the living space and complaints from family members, neighbors, and even local law enforcement.

Symptoms

According to DSM-5, the following symptoms are diagnostic of hoarding disorder:

  • There is persistent difficulty discarding or parting with possessions, regardless of their value or lack thereof.
  • The difficulty in discarding possessions is due to distress associated with getting rid of them.
  • The difficulty in discarding possessions leads to clutter of living spaces and compromises the use of living spaces.
  • The hoarding creates clinically significant distress or impairment in functioning, including the ability to maintain a safe space.

In some cases, the difficulty in discarding items is accompanied by excessive acquisition of items that are not needed or for which there is no available space.

A hoarder may be completely convinced that the hoarding-related activity—difficulty discarding items, excessive acquisition of item—is not problematic despite evidence to the contrary.

Causes

The cause of hoarding disorder has yet to be identified, 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 higher risk of developing the disorder. The majority of people with hoarding disorder also suffer some type of depressive or anxiety disorder.

Hoarding disorder is viewed as a type of obsessive-compulsive disorder, and many OCD disorders are closely linked to anxiety. None of the symptoms of hoarding disorder is due to any other mental health condition or medical problem. One study found that among the reasons people reported for their hoarding, avoiding waste was the most common.

Treatment

Hoarding may persist for a lifetime, but effective treatment can help reduce the need to hold on to unnecessary items; it can also improve decision-making, stress-reducing, and organizational skills.

The primary treatments used to relieve symptoms of hoarding disorder include cognitive-behavioral therapy (CBT) and antidepressant medication, such as selective serotonin reuptake inhibitors (SSRIs). One or the other, or both, may be employed. Early clinical trials suggest that compassion-focused therapy may be more effective than CBT alone.

References

  • American Psychiatric Association. Understanding Mental Disorders: Your Guide to DSM-5. 2015. American Psychiatric Publishing.
  • Anxiety and Depression Association of America website. Hoarding: The Basics. https://www.adaa.org/understanding-anxiety/obsessive-compulsive-disorder-ocd/hoarding-basics Accessed March 28, 2017.
  • Chou C.Y., Tsoh J.Y., Shumway M., et. al. (2019) Treating hoarding disorder with compassion-focused therapy: A pilot study examining treatment feasibility, acceptability, and exploring treatment effects. British Journal of Clinical Psychology. 2019 Jul 4. doi: 10.1111/bjc.12228
  • 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
  • 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

Last reviewed 04/07/2017