Hoarding Disorder: Cutting Through the Clutter

No one wants to throw away something that might later prove to be useful or valuable. But a person who lives in excessive clutter and can’t discard often worthless possessions without experiencing distress may suffer from hoarding disorder. Hoarding can be difficult to overcome, but research has led to a better understanding of the disorder.

Creating a health hazard

A chronic disorder, hoarding appears to be common across the lifespan, according to a study in the March 2017 American Journal of Geriatric Psychiatry. People with hoarding disorder compulsively buy or acquire possessions, some seemingly useless. They’re unwilling or unable to discard items. They experience anxiety and stress about throwing things away, usually because they fear the item may someday be useful or valuable or it helps them remember an important person or event. They may have difficulty organizing things, preferring to keep an item until they can decide where it belongs.

What distinguishes this disorder from collecting is that in hoarding, possessions accumulate until they reduce the person’s functional living space. A hoarder may not be able to use his or her kitchen, bathroom, or even bedroom because it’s filled with clutter that can increase the risk of falls, fire, and illness owing to poor sanitation. Hoarding often causes problems with spouses, families, and friends.

Individuals who hoard are often unable to see that their behavior is a problem, which can make it difficult for others to help them. Previously, experts viewed hoarding as a symptom or subtype of obsessive-compulsive disorder (OCD). But most experts now agree that hoarding is a distinct disorder.

People with hoarding disorder may be prone to developing other psychiatric problems, including depression, generalized anxiety disorder, phobias, and OCD. It’s unclear if animal hoarding—acquiring and keeping dozens of animals in unsanitary conditions—is a type of hoarding disorder.

Why people hoard

Researchers aren’t sure what causes hoarding, but many people who develop the disorder report they experienced a stressful or traumatic event as a child or an adult, such as the death of a loved one or a divorce, around the time the disorder began.

People who hoard may have had a parent who was depressed, manic, or a heavy drinker. They may have endured excessive abuse or experienced a home break-in. Or they may have financial problems.

Research on hoarding suggests that people who develop the disorder might have differences in how their brain functions. People who hoard may have abnormal activity in the anterior cingulate cortex and insula—areas of the brain linked to making decisions and identifying the emotional significance of items. Together these difficulties could make it hard for them to throw things away.

A treatment challenge

Hoarding disorder can be difficult to treat. The two primary treatments are cognitive behavioral therapy (CBT) and medication. In CBT for hoarding, a person typically meets with a therapist once or twice a week to learn how to gradually discard unnecessary possessions with less distress, which can help change the perceived need to acquire and save useless items.

This treatment also involves teaching people to improve their ability to organize, make decisions, solve problems, and relax. Therapy can take seven to 19 months or more and typically includes home visits. CBT appears to decrease hoarding severity, but only by 14 to 20 percent.

Medications used to treat hoarding include antidepressants known as selective serotonin reuptake inhibitors (SSRIs). Although SSRIs are a standard treatment for OCD, they appear to be less effective for people with hoarding disorder.

Hoarding in older adults

Hoarding is more common in older adults, and some research suggests the disorder might get worse with increasing age, although the evidence is mixed.

Because of physical and cognitive limitations, older adults may be more prone to hoarding-related health risks, including falling, fire, poor hygiene, poor nutrition, difficulty taking medications, and insect infestations.

One study found that in older adults, the severity of hoarding symptoms was strongly linked to a set of mental processes such as working memory and concentration that people use to plan, organize, and manage their time and attention. These deficits may also make it difficult for older adults to take part in or be helped by cognitive behavioral therapy.

How to find help

If you’re concerned that someone you know might have hoarding disorder, seek the advice of a mental health professional, preferably someone who has experience with the disorder. A therapist might ask:

Do you have trouble getting rid of things most people would throw away?

Does the clutter in your home make it difficult to use rooms and surfaces?

How often do you buy or acquire items you don’t need or have space for?

To what extent does your clutter affect your daily functioning and your work, social, or family life?

How much distress do these symptoms cause you?

The International OCD Foundation offers a searchable online database of therapists, including those who specialize in hoarding.