Like many severe mental health conditions, hoarding disorder is highly stigmatized. Those suffering from it can be seen as lazy, “dirty,” “crazy,” and other words that imply a mental health condition is a personal failure or character flaw. In reality, hoarding disorder is a painful, complicated condition that affects an estimated 2.5% of the population.
Notice I am not using the word “hoarder.” This is an intentional choice to use person-first language, something that many in the health and social work fields urge for. Saying “someone with hoarding disorder” centers the person before the disorder.
Keep this in mind as you think about people who experience the condition. Hoarding is not the only aspect of who they are—some would argue that it’s not who they are at all, but rather something they have. If you have someone in your life who you think might be experiencing hoarding, it’s important to remain compassionate, respectful, and build/maintain trust.
It’s also imperative that you’re familiar with the telltale signs that someone may need to find help for hoarding disorder—that way, you can know where you can go to help them get better. Let’s start with establishing what hoarding disorder actually is.
What is hoarding disorder?
Hoarding disorder entered the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) under the category “obsessive-compulsive and related disorders.”
Dr. Patrick McGrath, clinical psychologist and NOCD’s Chief Clinical Officer, says that hoarding, at its core, is “a problem with discarding things, and with acquiring more of them.” He goes on to say that “when you stop being able to use your space as it’s intended,” this indicates that hoarding disorder may be at play.
When that happens, the disorder can become dangerous. The person may trip over their things, have a limited ability to exit the home quickly (such as in the case of a fire), create serious fire hazards, and cause dust, dirt, mold, and pests to accumulate, which can lead to severe health problems.
Hoarding disorder is characterized by a chronic difficulty parting with possessions due to a perceived need to save them, as well as excessive acquisition of items. Thinking about or attempting to get rid of the items creates significant distress, which reinforces the habit of saving them and accumulating others. Most often, one is not so much concerned with the usefulness or monetary value of an object, but rather with its meaning.
It’s crucial to distinguish hoarding from collecting. Those who collect are typically interested in a specific item or theme, and they plan for when and where they’ll add to their collection. They display their items and keep them for the purpose of being admired, enjoyed, used, or studied. Those with hoarding disorder amass items impulsively, seemingly at random, and the items end up characteristically disorganized.
Hoarding behaviors tend to begin earlier in life, but they usually get progressively worse as people get older, and they often attach more and more emotional value to their possessions over time.
As we all evolve technologically, there is also a type of hoarding known as digital hoarding, which isn’t about acquiring physical items in excess and having difficulty getting rid of them, but about information in our computers, external hard drives, and the cloud. This can take up time and cause impairment in similar ways as physical hoarding can.
What are the symptoms of hoarding disorder?
Because hoarding, unlike many mental health conditions, has such a tangible outcome, it’s often easier to spot—especially by others who are close to people who experience it. Of course, that doesn’t make it easier to live with or treat, but it does mean there are concrete signs you can look out for, whether for yourself or someone else.
Diagnostic criteria for hoarding disorder according to the DSM-5 include:
- Persistent difficulty discarding or parting with possessions, regardless of actual value
- That difficulty is due to a perceived need to save the items and the distress associated with discarding them
- The difficulty discarding things leads to an accumulation of possessions that congest and clutter active living areas and compromise their intended use. If living areas are uncluttered, it is only because of the interventions of a third party (family members, cleaners, etc.)
- Hoarding causes significant distress or impairment in social, occupational, or other areas of functioning (including maintaining a safe environment)
The DSM-5 also notes that 80-90% of those with hoarding disorder display the trait of “excessive acquisition,” meaning they not only have difficulty parting with items, but they also excessively acquire items for which there is no space or which are not needed.
Dr. McGrath says that people with hoarding disorder also tend to have poor insight into their condition, meaning they are unable to recognize its severity. They may not think they need any intervention. In some cases, however, the individual may acknowledge that they have a serious problem—or are on their way to developing one.
He also says that those with hoarding disorder commonly miss or are late to work, whether it’s because they can’t find their work materials, they’ve tripped on something, or they don’t have a clear path from which to exit their home.
Also worth noting is that hoarding disorder has a high comorbidity rate with depression—it’s been found to occur in nearly 50% of cases. Depression can make it all the more challenging for someone with hoarding disorder to find the motivation and will to part with items and declutter their space, or to go about their daily activities in a fulfilling way.
Some signs of depression to look out for include:
- Loss of interest in activities that the person once enjoyed
- Having low energy levels, even being chronically fatigued
- Loss of appetite
- Feelings of hopelessness or pessimism
- Low self-esteem
- Feelings of irritability, frustration, or restlessness
Note that although hoarding disorder is classified under the category of “obsessive-compulsive and related disorders,” it is distinct from obsessive-compulsive disorder (OCD). While hoarding behaviors may be accurately described as compulsive, people with hoarding disorder do not tend to experience the recurring, distressing, intrusive triggers that cause obsessions in OCD.
How can you help someone you think might have hoarding disorder?
Hoarding disorder is best treated using a combination of tactics. A licensed mental health professional can help you assess which course of action is best, as well as if medication might be right for your loved one.
The typical first line of treatment is cognitive behavioral therapy (CBT), a type of therapy that helps its clients learn the relationship between their thoughts, feelings, and behavior, with the end goal of altering harmful behaviors. CBT is widely practiced for a variety of disorders, but training that is specific to hoarding disorder is not as widespread. When assessing clinicians to help your loved one with hoarding, it’s crucial to learn if they have specific training in treating hoarding disorder, and what kind of experience they have treating the condition.
Skills training is another tool for treating hoarding disorder. This might include a focus on attentional skills (in order to help the client maintain focus enough to be able to sort and organize), categorization skills (as in categorizing possessions into logical groupings), and decision-making skills (so they can more easily decide what to discard).
Dr. McGrath says that it’s imperative to develop rapport and trust when working with a client with hoarding disorder, as “they are afraid that other people won’t respect their stuff like they do.” Furthermore, they may feel extreme shame or embarrassment about their behaviors and living situation, making it difficult to trust others and open up.
If you have a loved one with the disorder, it might be tempting to take charge and begin discarding their things on your own. While well-intentioned, this can lead to anger, resentment, and does not treat the root of the problem. If their home is cleared by someone else without their mental health being addressed, they will most likely return to acquiring more and more items again.
Instead, it’s crucial to seek help from a mental health professional who has specialized training and experience treating hoarding. They can help treat the person suffering, while also guiding you as you assist in decluttering, identify physical or medical resources your loved one may need, and help you address any ways you may be accommodating your loved one’s condition.
Remember to remain loving, compassionate, calm, and non-judgemental when expressing concerns to someone with hoarding disorder. They are more likely to be receptive to help if it’s clear that you respect them and prioritize your relationship.
Recovering from hoarding disorder can be a long road, but there is hope. Behaviors won’t change overnight, but the right treatment approach, with the help of loved ones like yourself and qualified professionals, can make a huge impact on one’s quality of life and the functionality of their home.
Where to turn for hoarding treatment
If you believe your loved one may be struggling with hoarding disorder, I encourage you to learn more about NOCD’s effective, evidence-based approach to treatment. Many NOCD Therapists have received specialty training in treating hoarding disorder from leading experts, and have experience helping many people—just like your loved one—recover their lives from hoarding.