Understanding Hoarding Disorders

Hoarding Disorder. Getty Images

Hoarding Disorder is a psychiatric disorder that involves difficulty with the disposition of personal possessions, resulting in the accumulation of items, which clutter living spaces, rendering them unable to be used in the manner in which they were intended.

Classified among the "Obsessive Compulsive and Related Disorders" in the Diagnostic and Statistical Manual of Metal Disorders, Fifth Edition (DSM-5), Hoarding disorder is not uncommon; it is estimated that Hoarding Disorder affects 2% - 6% of the population.

The DSM-5 diagnostic criteria include:

  • Persistent difficulty discarding or parting with possessions which may be seen by others as having limited value or utility
  • Perceived need to save items and distress associated with discarding them
  • Symptoms result in the accumulation of a large number of possessions that clutter the living areas and compromise their intended use
  • Clinically significant distress or impairment in an important aspect of functioning, including maintaining a safe living environment
  • Symptoms are not due to a general medical condition (i.e., cognitive impairment)
  • Symptoms are not better accounted for my another psychiatric disorder (i.e., major depressive disorder, schizophrenia)

Hoarding Disorder symptoms may include “excessive acquisition” in which individuals actively seek to acquire items that are not needed and contribute to the clutter. The level of insight varies greatly in individuals who struggle with hoarding, ranging from those who recognize maladaptive thoughts and behaviors which contribute to the maintenance of the problem, to those who have poor insight, failing to see their cognitions and behaviors as problematic, despite their living environment.

The onset of hoarding symptoms typically occurs in early adolescence and become increasingly problematic as the individuals age. Impairment of one’s daily functioning typically increases with age and is commonly exacerbated by a significant life event (e.g., death of a spouse, children moving away to college). Most commonly, those who present to treatment or other service due to Hoarding Disorder are 50 years of age or older.

Factors that contribute to the onset and maintenance of the disorder are varied. There is evidence of genetic variables in the epidemiology of Hoarding Disorder. An inherent tendency toward generalized indecisiveness is common among those with Hoarding Disorder and their first-degree relatives. Environmental factors, including traumatic or significant life stressors and changes, can precede the onset or exacerbation of hoarding behavior. Furthermore, Hoarding Disorder is often complicated by comorbid mood or anxiety disorder, which occurs in approximately 75% of individuals with the diagnosis.

Hoarding disorder has the potential to have a very significant impact on the lives of those who struggle with the disorder as well as others in their lives. Interpersonal conflict, social isolation, impaired ability to prepare food or maintain personal hygiene, poor sanitation and other health and safety hazards may be of concern. High utilization of social service agencies, problems with utilities, and housing authorities are not uncommon.

Hoarding-specific cognitive behavioral therapy has been demonstrated to be effective in the treatment of Hoarding Disorder. This treatment involves assisting individuals to change the way they think and make decisions about their belongings. The treatment process includes psychoeducation to improve insight and understanding of the disorder, clinical interview and functional assessment of the behavior, collaborative establishment of goals between psychologist and client, cognitive therapy to identify cognitive distortions and assist in the development of cognitive flexibility and adaptive cognitive restructuring, organizational skills training and problem solving, exposure and response prevention to acquisition opportunities, behavioral experiments, and excavation exposure to guide the client through the process of de-cluttering by sorting through possessions while utilizing and practicing newly acquired decision-making skills.

There is no FDA-approved pharmacological treatment for Hoarding Disorder. Limited data shows some potential efficacy for SSRIs and SNRIs. Current pharmacological investigations seek to explore the use of psychostimulants and cognitive enhancers in the treatment of Hoarding Disorder.


American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 5thed. Washington, DC: American Psychiatric Association; 2013:251-4.

Steketee, Gail; Frost, Randy (2011). Stuff: Compulsive Hoarding and the Meaning of Things. Oxford: Oxford University Press.

Tolin, David; Frost, Randy; Steketee, Gail (2007). Buried in Treasures: Help for Acquiring, Saving, and Hoarding. Oxford: Oxford University Press. 

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