Hoarding Disorder: Definition, Type, Symptoms, Causes and Treatment

Hoarding disorder is a recurring, chronic mental condition where the person excessively collects but finds it difficult to discard personal items even when they do not have meaningful value. This causes massive cluttering of living spaces and distress to the hoarder. 

Different Types of Hoarding Disorders:

Hoarding disorder presents with symptoms such as persistent inability to discard possessions, severe anxiety, and distress associated with discarding items, indecision about what to keep or where to put things, functional impairments, and comorbid conditions.

Hoarding disorder is caused by several factors, including cognitive processing deficits, genetic factors (heredity), stressful life events such as divorce, and childhood trauma

Treatment for hoarding disorder includes psychotherapy( cognitive behavioral therapy, motivational interviewing, skills training), medication (selective serotonin reuptake inhibitors), and support systems.

What Is Hoarding Disorder?

Hoarding disorder (HD) is a psychological condition in which individuals excessively accumulate items, leading to clutter and difficulty discarding possessions. A 2014 study by Mathews, C. A., “ Hoarding Disorder: More Than Just A Problem Of Too Much Stuff,” published in The Journal of Clinical Psychiatry, defines HD as recurring difficulties in getting rid of personal items even when they do not have meaningful value.

This behavior leads to the accumulation of an excessive amount of items, resulting in cluttered living spaces that compromise the intended use of these areas. People with hoarding disorder often experience significant distress or impairment in social, occupational, or other important areas of functioning due to their hoarding behavior.

The disorder is driven by a perceived need to save items and the distress associated with discarding them. Commonly hoarded items include newspapers, magazines, clothing, and household items. The clutter creates hazardous living conditions, impairing mobility within the home and increasing the risk of falls, fire, and poor sanitation.

Hoarding disorder is distinct from collecting, where items are typically organized and displayed. Rather, HD is often associated with mental health conditions such as anxiety, depression, and obsessive-compulsive disorder (OCD). 

What Are The Different Type Of Hoarding Disorder?

Different types of hoarding disorders include object hoarding, animal hoarding,  and digital hoarding. According to a 2024 article “What You Should Know About Hoarding”, from Verywell Mind, hoarding disorder is categorized into several types, including animal hoarding, where individuals accumulate excessive animals, and object hoarding, which involves accumulating items regardless of value. 

There are also categories based on the type of items hoarded, such as food, clothing, or paper. Each type shares core characteristics like difficulty discarding items, leading to clutter that disrupts living spaces.

1. Object Hoarding

Object hoarding is the most common type of hoarding disorder, where individuals accumulate a wide range of items. These items include newspapers, books, clothing, containers, and even seemingly trivial objects like junk mail. The accumulation becomes so extensive that it clutters living spaces, making areas such as kitchens, bathrooms, and bedrooms virtually unusable. Object hoarders often believe that these items will be useful or valuable in the future, leading to a reluctance to discard anything.

2. Animal Hoarding

Animal hoarding is the practice of keeping a large number of animals without being able to offer adequate care. According to the 2023 article “What is Hoarding Disorder” by the American Psychiatric Association (APA), animal hoarders believe they are rescuing or protecting the animals, but in most circumstances, they fail to provide them with necessities such as food, sanitation, and healthcare. This creates terrible living conditions for both the hoarder and the animals.

3. Digital Hoarding

Digital hoarding is defined as the excessive accumulation of digital files such as emails, images, videos, and papers. This type of hoarding has become more frequent as digital technology has made it easier to store large volumes of data. Individuals with digital hoarding problems feel overwhelmed by the volume of files, which causes major anxiety and issues controlling or organizing their digital spaces.

What are the Symptoms of hoarding disorder?

The symptoms of hoarding disorder are persistent inability to discard possessions, severe anxiety, and distress associated with discarding items, indecision about what to keep or where to put things, functional impairments, and comorbid conditions. According to a 2008 study by Pertusa A et al., “Compulsive Hoarding: OCD Symptom, Distinct Clinical Syndrome or Both”, published in the American Journal of Psychiatry, people with hoarding disorders are usually scared that something bad will happen if they discard the accumulated items, and fear losing the collected items by mistake. 

Persistent Inability To Discard Possessions

One of the primary symptoms of hoarding disorder is the persistent inability to discard possessions. Individuals with this disorder often experience significant distress at the thought of getting rid of items, leading to the accumulation of a large number of possessions, even those that appear to have little or no value. This difficulty is often rooted in a deep emotional attachment to the items or a fear of needing them in the future.​

Severe Anxiety And Distress Associated With Discarding Items

Severe anxiety and distress associated with discarding items are hallmark symptoms of hoarding disorder. This anxiety is so overwhelming that it interferes with daily functioning. The individual usually avoids situations where they must decide what to discard, leading to further accumulation and clutter. This clutter often significantly impacts their ability to use living spaces for their intended purposes, such as cooking in the kitchen or sleeping in the bedroom.

Indecision About What To Keep Or Where To Put Things

Individuals with hoarding disorder are normally unable to decide about what to keep and where to put things. This results in disorganized piles of items, making it difficult to find necessary items when needed. The clutter creates hazardous living conditions, posing risks such as fire hazards, tripping, and falling.

Functional Impairments

People with hoarding disorder experience functional impairments that affect various aspects of life, including social interactions, work performance, and personal health. For instance, the clutter prevents necessary home maintenance, leading to unsanitary living conditions. The individual prefers to withdraw from social interactions to avoid embarrassment or judgment about their living conditions.

Comorbid Conditions

Hoarding disorder usually occurs with other mental health conditions, such as depression and anxiety disorders, including obsessive-compulsive disorder (OCD). These comorbid conditions worsen hoarding symptoms, creating a complex interplay that makes treatment more challenging.

What Are The Causes Of Hoarding Disorder?

Hoarding disorder is caused by several factors, including cognitive processing deficits, genetic factors (heredity), stressful life events such as divorce, and childhood trauma. According to a 2017 study by Dozier, M. E. et al., “The Etiology of Hoarding Disorder: A Review,” hoarding disorder is linked to impairment in cognitive domains, especially executive functioning.

Cognitive Processing Deficits

One of the primary causes of hoarding disorder is related to cognitive processing deficits. Individuals with this condition often have problems with decision-making, planning, and organizing. These cognitive challenges make it difficult for them to categorize and prioritize their possessions, leading to excessive accumulation and the inability to discard items.

Genetics

Genetic factors also play a significant role in hoarding disorder. Research indicates that the disorder tends to run in families, suggesting a hereditary component. People with a family history of hoarding are more likely to develop the condition themselves. Additionally, certain personality traits, such as indecisiveness, perfectionism, and a propensity for procrastination, are commonly observed in individuals with hoarding disorder.

Stressful Life Events

Stressful life events are another critical factor contributing to the onset of hoarding disorder. Traumatic experiences, such as the death of a loved one, divorce, or losing possessions in a fire, can trigger hoarding behaviors. These events lead to emotional distress, and for some individuals, accumulating possessions becomes a coping mechanism to deal with their emotional pain and anxiety.

Childhood Trauma

According to a 2011 study by Frost RO et al., “Comorbidity in Hoarding Disorder. Depress Anxiety”, people with HD usually report incidences of past trauma. Early experiences of deprivation, neglect, or having belongings forcibly taken away can create a strong emotional attachment to possessions in adulthood. This attachment manifests as hoarding behavior, as individuals hold onto items for fear of future loss or as a way to preserve memories and a sense of security​.

What Is The Treatment For Hoarding Disorder?

Treatment for hoarding disorder includes psychotherapy( cognitive behavioral therapy, motivational interviewing, skills training), medication (selective serotonin reuptake inhibitors), and support systems. According to a 2020 study by Weir K et al., “ Treating People With Hoarding Disorder,” published in the American Psychological Association Journal, psychotherapy, especially cognitive behavioral therapy, is beneficial in treating hoarding disorder.

Psychotherapy

  1. Cognitive Behavioral Therapy (CBT): The 2020 study by Weir demonstrates that cognitive Behavioral Therapy is one of the most effective treatments for hoarding disorder. CBT helps individuals understand the underlying thoughts and beliefs that contribute to their hoarding behaviors. Specific CBT techniques for hoarding include exposure to sorting and discarding items, cognitive restructuring to challenge hoarding-related beliefs, and skills training to improve decision-making and organizational skills. Significantly reduce the severity of hoarding symptoms, although it often requires long-term commitment and practice to maintain progress​​.
  2. Motivational Interviewing (MI): Motivational Interviewing is another therapeutic approach used to treat hoarding disorder. MI focuses on enhancing an individual’s motivation to change their behavior. This technique helps individuals align their behaviors with their values and goals, thereby increasing their willingness to engage in treatment. MI is particularly useful at the beginning of treatment to help patients recognize the impact of hoarding on their lives and to build their readiness for further therapeutic interventions​​.
  3. Skills Training: According to the 2020 study by Weir K, skills training is critical in the treatment of hoarding disorder, as many individuals with this condition struggle with organizational skills, problem-solving, and decision-making. Skills training programs teach patients how to effectively organize their belongings, solve everyday problems related to clutter, and make informed decisions about what to keep and what to discard. This practical approach helps individuals manage their living spaces better and reduces the risk of relapse​​.

Medication

There is no FDA-approved medication for hoarding disorder. However, there are medications used to manage co-occurring symptoms and conditions. Selective serotonin reuptake inhibitors (SSRIs), commonly used to treat anxiety and depression, are effective in reducing hoarding behaviors. Medications are particularly helpful when used in conjunction with psychotherapy, as they improve mood and reduce anxiety, making patients more receptive to therapy​​.

Support Systems

  1. Support groups: Support groups are a valuable resource for individuals with hoarding disorder. They offer a safe and non-judgmental environment where individuals share their experiences and receive encouragement from others facing similar challenges. Support groups are led by mental health professionals and incorporate elements of CBT or by peers. Both types of groups are beneficial in reducing feelings of isolation and providing practical tips for managing hoarding behaviors​​.
  2. Family Involvement: Family members and friends play a crucial role in treating hoarding disorder. They provide emotional support, help with decluttering tasks, and encourage the individual to seek and stick with professional treatment. Educating family members about the disorder also helps them understand the challenges their loved one faces and how best to support them without enabling hoarding behaviors​.

What Is The Prognosis For Hoarding Disorder?

The prognosis varies with individuals; while respond well to treatment, while others continue to struggle with hoarding behaviors despite therapy. A 2018 study by Ayers, C. R. et al., “Predictors Of Treatment Outcome And Attrition In Adults With Hoarding Disorder”, published in the Journal Of Obsessive-Compulsive And Related Disorder, demonstrates that treating HD is challenging as some people do not like the changes and adjustments brought on by treatment and recovery.

How Is Hoarding Disorder Diagnosed?

According to the 2013 article from APA, diagnosis is based on persistent difficulty discarding possessions, the accumulation of clutter that impairs living spaces, and significant distress or impairment in social, occupational, or other important areas. 

Can Hoarding Disorder Be Prevented?

According to a 2023 article, “Hoarding Disorder,” from the Mayo Clinic, there is no known way to prevent hoarding disorder, but early intervention and treatment can help manage symptoms and prevent worsening.

What Are The Complications Of Hoarding Disorder?

According to the 2013 article from APA, HD complications include unsanitary living conditions, increased risk of falls, family conflicts, social isolation, and fire hazards. 

What Is The Prevalence Of Hoarding Disorder?

According to a 2009 study by Mueller A, “The Prevalence Of Compulsive Hoarding And Its Association With Compulsive Buying In A German Population-Based Sample”, the prevalence of HD is estimated at 4.6%.

Author: Shantel Sullivan Ed.D., LCSW
Dr. Shantel Sullivan, Ed.D., LCSW, serves as the CEO of Bright Path with a rich background in residential adolescent treatment, adult outpatient services, and academia, leveraging over a decade of licensed social work experience in New York and North Carolina. Her academic credentials include a BA in Sociology, an MSW and a graduate certificate in addictions counseling from the University of New England, culminating in a doctoral degree in Educational Leadership focused on transformational leadership. Beyond her clinical expertise, Dr. Sullivan contributes to the field as a national speaker, educator, and editor of the Bright Path Teen Mental Health Blog, committed to enhancing access to evidence-based mental health care for adolescents and their families.
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