Hoarding Disorder: Information, Symptoms, Treatment and More

Hoarding Disorder is a condition that is characterised by an individual having a persistent difficulty in discarding or parting with items, which normally results in unmanageable amounts of clutter being amassed. The items will normally have little monetary or sentimental value.

Hoarding Disorder normally results in an individual being surrounded by clutter – which will often interfere with their living arrangements.

While the individual involved won’t always see anything wrong with their behaviour, those around them will commonly be concerned or even distressed. The person involved may be too embarrassed or ashamed to seek help.

The condition is considered to be part of the Obsessive-Compulsive Spectrum. The condition can lead to many problems, making accessing treatment important. But by accessing treatment, it should lead to an individual adopting healthier behaviours.

What are the symptoms of Hoarding Disorder?

An individual with Hoarding Disorder will normally be unable to discard or part with a range of items. Many items can be hoarded – with newspapers, magazines, clothes, promotional products, and worn out cooking equipment all common things to hoard.

The disorder is linked to the Obsessive-Compulsive spectrum due to the appearance of obsessions (need to keep items) and compulsions (keeping the item). A range of symptoms may be present.

Signs and symptoms

• Primarily, the individual will be unable to discard or part with items that are normally of very little monetary or sentimental value
• When attempting or contemplating discarding an item, the individual becomes distressed and overwhelmed – ultimately deciding against discarding the item.
• The house of the individual will typically be very untidy and contain a lot of things that appear to be of no value
• Many areas of the house will be taken over and become unusable due to hoarding – such as a sink or stove.
• Activities like cooking, cleaning and even mobility around the house can become difficult
• They may believe that one day the item will come into use
• Get attached to items easily
• Have poor social relationships
• Typically feels guilty or ashamed about their hoard

These symptoms cause a range of behavioural changes. The person may not want anyone to visit them due to their shame about a hoard. They will also be at heightened risk of developing a physical condition, due to the health hazard that hoards become.

Symptoms typically begin in childhood and get worse over time. It is common for Hoarding Disorder to co-occur with other mental health conditions like Anxiety, Depression or Schizophrenia.

There is a very pronounced difference between collecting and hoarding. Collecting is typically done in a methodical way, with only the bare essentials kept. Hoarding however is seldom organised, and will typically cause a range of problems.

What are the causes of Hoarding Disorder?

It isn’t entirely known what causes Hoarding Disorder, or why people act in this manner. However, a range of factors have been identified as probable causes, and certainly act as risk factors. It is likely that many factors are responsible for the onset of the condition. 

The condition often appears as a result of self-neglect. Additionally, certain traits appear to be linked to Hoarding Disorder. Someone who lives alone, is unmarried, and has poor relations with others, are at higher risk of hoarding.

Those who had a difficult upbringing that involved having few possessions, may also be at risk. They may relish the opportunity to keep and treasure items – something they were deprived from doing in their youth.

Another potential cause is that some people – normally those who have had a past trauma – feel that by creating a hoard, it gives them a different problem to focus on as opposed to the more prominent issue [1].

Moreover, Hoarding Disorder can appear as a complication of a different mental health condition, such as Anxiety or Depression. Someone who is depressed will often feel lonely, and may choose to hoard items as a way of being kept company. For example, one study found that in a sample of patients with Hoarding Disorder, 36% of them had Depression [2].

It is also possible that people with a physical condition that makes it difficult to move may believe it is easier to keep items, rather than to risk further injury and clear their hoard.

Finally, genetics may also be involved – as Obsessive-Compulsive spectrum disorders often run in families.

Diagnosis of Hoarding Disorder

One of the complications of Hoarding Disorder is that the person rarely wishes to seek treatment. When a person does seek help, it is normally due to a friend or family member instigating their treatment.

The individual involved will normally either not realise a problem exists, or will be ashamed of their habit. Providing the individual with reassurances about their hoard is an important step.  

Seeing a doctor is important. At an appointment, a Doctor will have a discussion with the person and try to understand why they hoard, what impact this has, potential causes, and discuss the wider topic of mental health.

In terms of the criteria that needs to be met in order for Hoarding Disorder to be diagnosed, the following should be satisfied:

• The individual has a persistent and long-standing difficulty in discarding or parting with possessions and items – irrespective of their monetary or sentimental value.
• This difficulty can be explained by an individual’s distress that is caused by the contemplation of discarding items
• The individual has developed a large hoard which makes the living environment not fit for purpose
• Any efforts to clean up the hoard are instigated by someone else
• The symptoms displayed cause emotional distress for the individual
• The symptoms cannot be attributed to substance abuse
• The symptoms aren’t better explained by an alternate mental health condition

How is Hoarding Disorder treated?

Treatment is available for Hoarding Disorder. The aim is for full recovery and at the very least for an individual to feel they have more control over their action.

Therefore, this hopefully leads to their hoard being cleared and maintained properly. Treatment typically involves talking therapy and in some cases, medication.

Talking Therapy

Talking therapy is the predominant treatment for Hoarding Disorder. Therapy can help an individual create better coping mechanisms, learn organisational skills, declutter their home and more.

A therapy like Cognitive-Behavioural Therapy is especially useful – due to its focus on the effect of thoughts.

Cognitive Behavioural Therapy (CBT): CBT is a type of therapy that is used to treat a range of mental health conditions. CBT involves an individual talking face-to-face with a therapist, although sometimes CBT can be conducted in a group setting. CBT attempts to improve an individual’s wellbeing and mood. The therapy focuses on the link between thoughts, feelings and actions. This can be useful for those with low self-esteem, anxiety, unhelpful personality traits or intrusive thoughts. CBT can help an individual understand their feelings more, and in the long run should lead to an improvement in quality of life.

If desired, there are many other types of talking therapy available. For further information, you can see our dedicated Therapy section.

Medication

In cases where necessary, medication can be prescribed. The medication Clomipramine (Anafranil) – which is a Tricyclic antidepressant – can help treat Hoarding Disorder. The more modern SSRI antidepressants could be prescribed.

Antidepressants: Antidepressants can help to improve and regulate mood. They should improve motivation and restore energy. SSRI Antidepressants are the most commonly prescribed. They act on the brain chemical serotonin – which is thought to help in regulating mood and emotion. They may include side-effects such as a dry mouth, sexual problems and nausea, though these should hopefully be short-term. Other classes of antidepressants are available in the event of an inadequate reaction.

Summary

Hoarding Disorder is a very difficult condition to live with and can lead to several complications. However, treatment is available – which should lead to an individual having a better quality of life, and healthier behavioural traits.

Therefore, seeking help is a very important step to take. For more information on mental health, our website has plenty of content!

See Also

• Obsessive-Compulsive Spectrum Section
• What is the Prognosis for Obsessive-Compulsive Spectrum Disorders?
• Therapy Homepage
• Medicine Homepage