An Overview of Hoarding Disorder

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Hoarding disorder is a mental illness that makes it hard for someone to get rid of possessions—even those of little or no value. As items accumulate over time, they clutter a person's home to the point where living spaces can't be used as intended. When extreme, hoarding can put a person (and others in their home) in danger.

Symptoms

A person with hoarding disorder is primarily unable to part with objects, items, or possessions, but the disorder can also include what is known as excessive acquisition. With this behavior, a person actively seeks to acquire more unneeded items.

People who hoard have varying levels of insight into their behavior. Some are able to recognize their maladaptive thoughts and understand how they contribute to hoarding, while others fail to acknowledge that they hoard and don't connect how they think and feel with the behavior.

People with poor insight may not recognize the severity of their hoarding despite being in uninhabitable living conditions as a result of it.

When extreme, hoarding can put the person and anyone else in their home, including pets, in danger. Piles of items create fire hazards and may make some areas of the home inaccessible (or inescapable). Rotting food, garbage, and pet waste increase the risk of infectious disease, especially if it attracts insects and rodents.

Other risks are specific to what a person hoards. For example, a person who hoards animals may have exotic pets who are more likely to carry pathogens. The risk of illness is increased further if a person who hoards cannot properly care for their animals. Pets that are not groomed or are unvaccinated are vulnerable to disease, which may be passed to their owners or other pets.

Causes

Around 2% to 6% of the general population in the United States is estimated to have a hoarding disorder. Hoarding behaviors often start in childhood or adolescence and progressively worsen as a person gets older.

Over time, a person's level of daily functioning and living conditions become more impaired by hoarding, which is often exacerbated by a significant or traumatic life event (e.g., death of a spouse, loss of a job, children moving away to college).

There isn't a single factor that predisposes someone to hoard or causes the disorder to start. As with other mental illnesses, it's more likely that factors come together to create the right circumstances internally and externally for the disorder to flourish.

Some aspects of hoarding may be inherited, as several studies have proposed genetic variables in people who hoard. Research also indicates that an inherent tendency toward generalized indecisiveness is common in people who hoard as well as in their first-degree relatives.

Environmental factors, including traumatic or significant life stressors and changes, may occur prior to when the hoarding starts and can make the behavior worse.

Hoarding is often complicated by mental health conditions such as depression and anxiety, which co-occur in approximately 75% of individuals with the disorder.

Interpersonal conflict, social isolation, impaired ability to prepare food or maintain personal hygiene, poor sanitation, and other health and safety hazards are major concerns for people with hoarding disorder and those who live with them.

It's also not uncommon for people with hoarding disorder to run into problems with utilities and housing authorities. They also have a high rate of utilization of social service agencies.

Diagnosis

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), classifies hoarding disorder in the category of "Obsessive-Compulsive and Related Disorders."

The DSM-5 outlines the following diagnostic criteria for hoarding disorder:

  • 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 (e.g., cognitive impairment)
  • Symptoms are not better accounted for by another psychiatric disorder (e.g., major depressive disorder, schizophrenia, or OCD)

Treatment

Many people who hoard do not get treatment, often because of poor insight, a lack of resources, or shame. Those who do seek treatment are usually 50 years of age or older.

Hoarding-specific cognitive behavioral therapy, which involves assisting people to change the way they think and make decisions about their belongings, has been demonstrated to be an effective treatment for the disorder.

Treating hoarding disorder is a process. It can take time and may require more than one type of intervention, including:

  • Psychoeducation to improve a person's insight and help them better understand the disorder
  • A clinical interview and functional assessment of a person's behavior
  • Collaborative goal-setting between the person who hoards and the mental health professionals (like a social worker or psychologist) working with them
  • Cognitive therapy to identify a person's cognitive distortions and assist them with developing cognitive flexibility and adaptive cognitive restructuring
  • Acquiring organizational and problem-solving skills through training
  • Exposure and response prevention to acquisition opportunities, as well as other types of behavioral experiments
  • Excavation exposure to guide a person through the process of de-cluttering, which can involve sorting through possessions while utilizing and practicing their newly acquired decision-making skills

There is currently no FDA-approved pharmacological (with medication) treatment for hoarding disorder.

Antidepressant medications (including SSRIs and SNRIs) may have limited potential as a treatment for hoarding, particularly when a person has another mental health condition such as obsessive-compulsive disorder (OCD). Psychostimulants and cognitive enhancers are also being investigated as possible treatments.

A Word From Verywell

Hoarding is a mental illness that makes it difficult, if not impossible, for someone to part with possessions, regardless of their monetary value or sentimental worth or lack thereof. The accumulation of items over time often renders a person's home and living space uninhabitable, and may even put them (and others in the home) in danger.

As with most mental illnesses, the cause of hoarding is complex, and while effective treatment for hoarding disorders takes time and may require more than one approach, such as psychotherapy and medication, help is available.

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Article Sources

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