Hoarding disorder is a persistent difficulty discarding or parting with possessions because of a perceived need to save them. A person with hoarding disorder experiences distress at the thought of getting rid of the items. Excessive accumulation of items, regardless of actual value, occurs.
Hoarding often creates such cramped living conditions that homes may be filled to capacity, with only narrow pathways winding through stacks of clutter. Countertops, sinks, stoves, desks, stairways and virtually all other surfaces are usually piled with stuff. And when there's no more room inside, the clutter may spread to the garage, vehicles, yard and other storage facilities.
Hoarding ranges from mild to severe. In some cases, hoarding may not have much impact on your life, while in other cases it seriously affects your functioning on a daily basis.
People with hoarding disorder may not see it as a problem, making treatment challenging. But intensive treatment can help people with hoarding disorder understand how their beliefs and behaviors can be changed so that they can live safer, more enjoyable lives.
Getting and saving an excessive number of items, gradual buildup of clutter in living spaces and difficulty discarding things are usually the first signs and symptoms of hoarding disorder, which often surfaces during the teenage to early adult years.
As the person grows older, he or she typically starts acquiring things for which there is no immediate need or space. By middle age, symptoms are often severe and may be harder to treat.
Problems with hoarding gradually develop over time and tend to be a private behavior. Often, significant clutter has developed by the time it reaches the attention of others.
Signs and symptoms may include:
Excessive acquiring and refusing to discard items results in:
People with hoarding disorder typically save items because:
Hoarding disorder is different from collecting. People who have collections, such as stamps or model cars, deliberately search out specific items, categorize them and carefully display their collections. Although collections can be large, they aren't usually cluttered and they don't cause the distress and impairments that are part of hoarding disorder.
People who hoard animals may collect dozens or even hundreds of pets. Animals may be confined inside or outside. Because of the large numbers, these animals often aren't cared for properly. The health and safety of the person and the animals are at risk because of unsanitary conditions.
If you or a loved one has symptoms of hoarding disorder, talk with a doctor or mental health professional as soon as possible. Some communities have agencies that help with hoarding problems. Check with the local or county government for resources in your area.
As hard as it might be, if your loved one's hoarding disorder threatens health or safety, you may need to contact local authorities, such as police, fire, public health, child or elder protective services, or animal welfare agencies.
It's not clear what causes hoarding disorder. Genetics, brain functioning and stressful life events are being studied as possible causes.
Hoarding usually starts around ages 11 to 15, and it tends to get worse with age. Hoarding is more common in older adults than in younger adults.
Risk factors include:
Hoarding disorder can cause a variety of complications, including:
Many people with hoarding disorder also experience other mental health disorders, such as:
Because little is understood about what causes hoarding disorder, there's no known way to prevent it. However, as with many mental health conditions, getting treatment at the first sign of a problem may help prevent hoarding from getting worse.
People often don't seek treatment for hoarding disorder, but rather for other issues, such as depression or anxiety. To help diagnose hoarding disorder, a mental health professional performs a psychological evaluation. In addition to questions about emotional well-being, you may be asked about a habit of acquiring and saving items, leading to a discussion of hoarding.
Your mental health professional may ask your permission to talk with relatives and friends. Pictures and videos of your living spaces and storage areas affected by clutter are often helpful. You also may be asked questions to find out if you have symptoms of other mental health disorders.
For diagnosis, your mental health professional may use the criteria for hoarding disorder listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.
Treatment of hoarding disorder can be challenging because many people don't recognize the negative impact of hoarding on their lives or don't believe they need treatment. This is especially true if the possessions or animals offer comfort. If these possessions or animals are taken away, people will often react with frustration and anger and quickly collect more to help fulfill emotional needs.
The main treatment for hoarding disorder is cognitive behavioral therapy. Medications may be added, particularly if you also have anxiety or depression.
Psychotherapy, also called talk therapy, is the primary treatment. Cognitive behavioral therapy is the most common form of psychotherapy used to treat hoarding disorder. Try to find a therapist or other mental health professional with experience in treating hoarding disorder.
As part of cognitive behavioral therapy, you may:
Treatment often involves routine assistance from family, friends and agencies to help remove clutter. This is particularly the case for the elderly or those struggling with medical conditions that may make it difficult to maintain effort and motivation.
For children with hoarding disorder, it's important to have the parents involved in treatment. Sometimes called "family accommodation," over the years, some parents may think that allowing their child to get and save countless items may help lower their child's anxiety. Actually it may do the opposite, increasing anxiety.
So, in addition to therapy for the child, parents need professional guidance to learn how to respond to and help manage their child's hoarding behavior.
There are currently no medications approved by the Food and Drug Administration (FDA) to treat hoarding disorder. Typically, medications are used to treat other disorders such as anxiety and depression that often occur along with hoarding disorder. The medications most commonly used are a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs). Research continues on the most effective ways to use medications in the treatment of hoarding disorder.
In addition to professional treatment, here are some steps you can take to help care for yourself:
If you or a loved one has symptoms of hoarding disorder, your doctor may refer you to a mental health professional, such as a psychiatrist or psychologist, with experience diagnosing and treating hoarding disorder.
Because many people with hoarding disorder symptoms don't recognize that their behavior is a problem, you as a friend or family member may experience more distress over the hoarding than your loved one does.
You may want to first meet alone with a mental health professional to develop an approach for raising your concerns with your loved one. A mental health professional can help you prepare for a conversation to encourage your loved one to seek help.
To consider the possibility of seeking treatment, your loved one will likely need reassurance that no one is going to go into his or her house and start throwing things out. Here's some information to help the person with hoarding disorder symptoms prepare for the first appointment and learn what to expect from the mental health professional.
Before your appointment, make a list of:
Take a trusted family member or friend along, if possible, for support and to help remember the details discussed at the appointment. Bringing pictures and videos of living spaces and storage areas affected by clutter is helpful.
Questions to ask your mental health professional may include:
Don't hesitate to ask other questions during your appointment.
To gain an understanding of how hoarding disorder is affecting your life, your mental health professional may ask:
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