Obsessive compulsive disorder - OCD treatment and therapy from NOCD

Is my home just cluttered, or am I a hoarder? What experts say

By Jessica Migala

Jul 24, 20238 min read minute read

Reviewed byPatrick McGrath, PhD

Compared to the clutter-free homes you see on social media, having countertops littered with items, a garage full of stuff, and a dining table repurposed as a storage area can make any home look particularly packed. 

But what if your clutter is causing particular stress? What if your clutter is preventing you from living in your home well? When does “normal” clutter turn into hoarding? If you’re asking yourself that question, this article can help you determine if your stuff has taken over, if that’s a problem, and how to get help.

What’s the difference between hoarding disorder (HD) and clutter?

People may offhandedly remark that they’re “such a hoarder,” but it’s not as simple as having a lot of stuff. Hoarding disorder is a mental health disorder marked by a need to save items and extreme distress at the thought of getting rid of them, according to the American Psychiatric Association. For that reason, someone with hoarding disorder accumulates a lot of stuff, to the point that it impacts their day to day life. 

Clutter, on the other hand, refers to things around the home that are disorganized and don’t have a place, notes the International OCD Foundation. It’s the junk mail on your countertops that you’re avoiding, the toys scattered on the floor, or the clothes you haven’t yet folded and put away. 

There is a definitive line between clutter and hoarding, says Patrick McGrath, PhD, Chief Clinical Officer at NOCD. And you can find out if you’ve crossed that line with one simple question: “Is your home able to be used for its purpose?” he asks. In other words, you can have a lot of clutter but you still have chairs to sit on, places to eat, and a bed to sleep on. Your bookshelves may be full of books and knick knacks, but it doesn’t impinge on your ability to live in your home. 

With hoarding, on the other hand, areas of the home are not able to be used for their intended purpose. Your bedroom has become a storage closet, so you sleep on your couch; there are three bathrooms in the house but you can only use one because they’re all full of extraneous stuff; your kitchen is so crammed that you had to plug in a microwave in your living room to heat up food, Dr. McGrath explains. “Both clutter and hoarding can look messy, but you can still use a cluttered home.”

ADHD and hoarding: What’s the connection?

People who have hoarding disorder often have symptoms of inattention in attention-deficit/hyperactivity disorder (ADHD), notes a 2021 UK study. That research found that symptoms of hoarding were present in about 20% of those with ADHD compared to just 2% in a control group. Other research has found rates even higher, with nearly 30% of those with hoarding disorder having ADHD.

For someone who has ADHD, there’s a difficulty with overall executive function, including issues with focus, attention, organization, planning, and decision making, says Dr. McGrath. If you have ADHD, you may find that it’s difficult to do things “in a string” or step-by-step, making it difficult to appropriately organize or put away items. Distraction may come in when you’re looking for one thing and instead focus on another. “I wouldn’t say ADHD is necessarily a precursor to hoarding, but you might see more people who have hoarding who also have ADHD compared to the general population,” he explains.

The burden of clutter: More than just a messy house

Clutter, which contributes to a chaotic living environment, has been shown to be a source of stress and decreased well-being, according to a 2016 study. Clutter, say researchers, “can undermine the comfortable everyday experience of at-homeness people take for granted until clutter and disorganization erode their ability to find things, move safely throughout their home, and use spaces as intended.” 

Practically speaking, clutter can also create distress if it impairs your ability to find things around the home, and it can be a source of financial strain if you continually buy multiple things after losing one in your home, Dr. McGrath says.

If you’re bothered by clutter but don’t meet the criteria for hoarding, setting up good behavioral strategies can help you stay more organized, says Dr. McGrath. For example, determine where you are going to put your wallet and keys when you step inside your home, and commit to putting them  there every day. When starting to organize, working all at once on your entire home or room can be extremely difficult—it’s easy to lose motivation. Instead, choose one small space—a specific corner in the room, a drawer in your kitchen, a shelf in your closet—to focus on decluttering.

How hoarding affects your life

If you have hoarding disorder, the condition can seep into and destroy every aspect of your life. First, there’s the health and safety risk: these homes leave people at risk for food contamination, falls, pest infestation, fire hazards, and eviction, points out a 2020 review in Current Psychiatry Reports

There are also the relationship strains from hoarding. “You’ll see spousal divorce or people living completely separately in a home,” Dr. McGrath says. One person may live in a clean and organized space in the home, where the one who has hoarding disorder will stay in their area filled with stuff—and they simply won’t cross paths. “This can be a significant source of strife in relationships,” he says. The conflict doesn’t just stop at romantic relationships, often impacting family relationships, other cohabiting relationships, and friendships, as people try to step in and help—or refuse to come into their home altogether.

In addition, people with hoarding disorder tend to experience a lower overall quality of life, as things break in their home and they’re unwilling or unable to get them fixed for fear of an outsider coming into the home, leaving them living without necessities, such as heat or air conditioning. When conditions become especially extreme, authorities may even remove children from the home. 

Hoarding disorder is considered an OCD-related disorder. It’s an extremely common misconception that just because you have obsessive-compulsive disorder (OCD) you’re automatically a clean person, Dr. McGrath says. In fact, it can be quite the opposite.

Though it’s considered an OCD-related disorder, there are distinct differences between OCD and hoarding, and they should be treated as two separate disorders. People with OCD “don’t like their growing mess, and want it to go away. In hoarding, people aren’t typically troubled by it,” Dr. McGrath says. Someone may be forced to address their hoarding disorder if the authorities knock on their door or a family member threatens to keep grandkids home until the home is cleaned up. It’s often an outside force that prompts them to seek help. 

Hoarding can be linked to OCD in a couple of ways. For instance, “plenty of people with OCD have an amazingly clean house—an inch above the floor,” Dr. McGrath describes. This is to illustrate that due to a fear of contamination, anything that falls on the floor is considered contaminated, and so nothing is picked up and cleaned, creating a very messy, chaotic, and—ironically—contaminated environment. 

In addition, people have also had fears that when they touch something, the object becomes contaminated. In turn, they’ll avoid throwing away things they’ve touched out of rather extreme worries. Dr. McGrath describes a somewhat far-fetched—but no less distressing or common—concern that contaminated trash could “wind up in a landfill where a seagull comes and plucks it out and then drops it in the yard of someone else, thereby contaminating them.” However, in those instances, OCD may look similar to hoarding, but OCD is in the driver’s seat. That means that the two conditions shouldn’t be conflated. 

How to treat hoarding disorder

When discussing treatment with your provider, treatment is most successful when it addresses both hoarding disorder and a co-occuring underlying disorder, such as depression, ADHD, or OCD.

Treatment for hoarding will involve a significant behavioral component, with a therapist providing active ways to combat your hoarding behavior. This may involve psychoeducation about one’s mental processes and exposure and response prevention therapy (ERP), a form of cognitive behavioral therapy (CBT) that is commonly a primary component of hoarding treatment. By intentionally exposing yourself to the anxiety and distress of discarding items, your brain can learn to recognize that you are safe and can withstand this discomfort without hoarding.

Your clinician should also work with you to understand the emotional reasons behind your hoarding, says Dr. McGrath. Are you hoarding to build a wall of stuff around yourself as protection? If you get rid of something, do you worry that you’ll lose the memory otherwise? Are you worried about things going into a landfill, so you keep buying things from yard sales and dumpster diving?

It’s also important to work with someone to help them get rid of hoarded items with a structured approach, such as Dr. McGrath’s “four box” method, where you maintain a Keep, Donate, Recycle, and Trash box. You have to fill up each box before you can get new ones. Bringing in family and friends to help you sort through all of your stuff is also key, since there can be so much stuff that it’d take years to go through it otherwise.

“This is treatable, it really is. The hardest part, I think, is the guilt and shame that can go along with hoarding,” says Dr. McGrath. Working through the emotions associated with letting go of hoarding is critical.

How NOCD can help

The therapists at NOCD receive specialized training in treatment for OCD-related disorders, including hoarding disorder. When you work with a therapist with NOCD, you’ll meet for virtual, live face-to-face sessions. When you need support between sessions, you’ll be able to message your therapist, engage with virtual support groups, or connect with member advocates who are there for you in your treatment journey. Schedule a free 15-minute call with the NOCD Care team today.

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