We all collect things—whether we think of ourselves as collectors or not. A drawer full of old cables, batteries, and twine. A box of schoolwork from a decade ago. A collection of butter and jam packets from waffle and pancake houses.
None of this is unusual. None of it is necessarily a problem.
So when does ordinary collecting become hoarding?
What is hoarding disorder?
Hoarding disorder involves a strong need to save possessions and significant distress at the thought of parting with them—whether by throwing away, donating, selling, or otherwise letting go.
Hoarding can involve animals as well as objects. Someone with animal hoarding may become deeply attached to the animals they keep and find it extremely difficult to give them up, even when the number of animals has grown beyond what they can safely care for. As a result, both the person and the animals may end up living in unsafe or unhealthy conditions.
When does collecting become hoarding disorder?
Collecting and hoarding disorder can look similar from the outside, and the line between them isn’t always obvious.
A collection can be large without being a sign of hoarding disorder. It can be unusual. It can take up a lot of space. Hoarding disorder is less about what someone collects than about their relationship to the things they keep—and the effect that relationship begins to have on their life.
In practice, that can look like:
- Ongoing difficulty getting rid of possessions, regardless of their monetary or sentimental value.
- A strong need to save things, along with distress at the thought of throwing them away or giving them up.
- Clutter that interferes with the use of a home, such as a bed that can’t be slept in, a kitchen that can’t be cooked in, or hallways that are difficult to navigate.
- Distress or disruption in everyday life, including conflict with family, avoiding having people over, or difficulty keeping up with responsibilities.
- Excessive acquisition, such as buying things or picking up free items despite having little room for them.
What problems can hoarding disorder cause?
As clutter accumulates, it can create serious health and safety risks inside the home, including:
- Falls, especially when walkways are blocked or difficult to navigate.
- Injury from shifting or falling items, particularly when possessions are stacked high or become unstable.
- Fire hazards, including blocked exits or restricted access for emergency responders.
- Unsafe living conditions related to mold, pests, spoiled food, or limited access to kitchens, bathrooms, or other essential parts of the home.
- Housing problems, including code violations or eviction.
The effects can extend well beyond the home, too. Conflict with family members is common, especially when other people try to clean, organize, or remove possessions. Shame or embarrassment about the home can make it harder to invite people over, contributing to loneliness and social isolation. Hoarding can also create financial strain or make it harder to keep up with work and other everyday responsibilities.
Why can’t I just get rid of things?
When getting rid of things feels this hard, it’s easy to blame yourself: are you lazy? Indecisive? Overly sentimental? Maybe you’re just not trying hard enough?
But hoarding disorder isn’t a failure of willpower. Research suggests that people with hoarding problems tend to find more reasons to save an object: it holds a memory, it might be useful someday, throwing it away feels wasteful, or getting rid of it feels like a decision they might regret. With so much to weigh, letting go can become especially difficult.
There’s evidence that the decision itself may feel different, too. In one brain-imaging study, people with hoarding disorder showed unusually high activity in areas involved in emotion and decision-making when deciding whether to keep or discard their own possessions—but lower activity in those same areas when the item wasn’t theirs. In other words, the difference wasn’t about decision-making in general; it was specific to their own belongings. Those differences were also linked with greater indecisiveness and a stronger sense that something didn’t feel “just right.”
People often come in expecting me to tell them to just try harder. But once we look at what’s actually happening—the number of decisions, the distress each one causes—it stops looking like laziness and starts looking like a skill that needs to be rebuilt.
Dr. Patrick McGrath, Chief Clinical Officer at NOCD
And keeping the item works, at least for the moment. You don’t have to make the decision, and you avoid the distress that comes with it. The immediate anxiety goes away, but the larger problem sticks around: the item stays, the clutter builds, and letting go can become harder with each decision.
What causes hoarding disorder?
We don’t know exactly what causes hoarding disorder.
Research suggests that people with hoarding disorder may have difficulty with attention, decision-making, planning, and categorizing possessions, which can make it harder to organize their belongings and decide what to keep. Hoarding disorder also tends to run in families. Research has found higher rates of hoarding symptoms among close family members of people who hoard, and twin studies suggest genetics may play a role.
Stressful experiences can play a role, too. For some people, symptoms may emerge or worsen after a major loss or disruption, such as the death of someone close to them, a divorce, or losing possessions in a fire.
Is hoarding disorder related to OCD?
Yes, but hoarding disorder and obsessive-compulsive disorder (OCD) are not the same condition. Hoarding disorder is classified alongside OCD in the broader category of obsessive-compulsive and related disorders, but it has been recognized as its own diagnosis since the DSM-5 was published in 2013.
There can be overlap between the two. Someone can have both hoarding disorder and OCD, and OCD symptoms can sometimes make it difficult to discard things—for example, if someone fears that throwing something away could cause harm or contamination. But in hoarding disorder, the difficulty discarding is part of the hoarding itself: possessions may feel important, useful, meaningful, or simply too difficult to let go of.
How is hoarding disorder treated?
Hoarding disorder is usually treated with cognitive behavioral therapy (CBT) tailored specifically to hoarding. Treatment focuses not simply on removing clutter, but on helping someone change the thoughts, behaviors, and decision-making patterns that make it so difficult to part with possessions.
CBT for hoarding disorder can involve learning to sort and organize possessions, practicing decisions about what to keep or discard, resisting the urge to acquire more things, and examining beliefs that make possessions feel especially difficult to let go of. The work is usually gradual, with the person making their own decisions about their belongings and building skills they can continue using outside of therapy.
There are currently no medications approved specifically for hoarding disorder. Medication may still be prescribed when someone also has depression, anxiety, or another mental health condition, but research on whether medication directly improves hoarding symptoms remains limited.
Bottom line
Hoarding disorder is more than having a lot of possessions or being especially sentimental. It involves persistent difficulty letting things go that leads to clutter, distress, or disruption in daily life. Cognitive behavioral therapy tailored to hoarding can help people make decisions about their possessions, reduce acquiring, and build skills for managing what they keep.
