Hoarding occurs when someone struggles to discard items and collects unnecessary objects. Over time, the inability to throw things away can overrun the pace of collecting.

The ongoing buildup of collected items can lead to unsafe and unhealthy living spaces. It can also cause tension in personal relationships and severely diminish the quality of daily life.

Hoarding disorder (HD) is the condition associated with hoarding. HD can become worse with time. It most often affects adults, though teenagers may show hoarding tendencies as well.

HD is classified as a disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. This designation makes HD an independent mental health diagnosis. HD can occur simultaneously with other mental health conditions as well.

Treatment requires self-motivation and the desire to change one’s behavior. It also requires the involvement of a doctor. Family support can be helpful, as long as it’s constructive and not accusatory.

HD can occur for several reasons. A person may begin to hoard because they believe an item they’ve collected, or are considering collecting, may be valuable or useful at some point in time. They may also connect the item with a person or significant event that they don’t want to forget.

Hoarders often live with their collected items at the expense of their own needs. For example, they may forego using their refrigerator because their kitchen space has become blocked with items. Or they may choose to live with a broken appliance or without heat rather than let someone into their home to repair the problem.

People who may be more vulnerable to hoarding include those who:

  • live alone
  • grew up in a disorganized space
  • had a difficult, deprived childhood

HD is also associated with other mental health conditions. Some of these include:

Research indicates that HD may also be associated with a lack of executive functioning ability. Deficiencies in this area include, among other symptoms, an inability to:

  • pay attention
  • make decisions
  • categorize things

Executive functioning deficits are often linked with ADHD in childhood.

HD isn’t uncommon. Approximately 2 to 6 percent of people have HD. At least 1 in 50 — possibly even 1 in 20 — people have significant, or compulsive, hoarding tendencies.

HD affects men and women equally. There’s no research-based evidence that culture, race, or ethnicity plays a part in who develops the condition.

Age is a significant factor for HD. Adults aged 55 and older are three times more likely to develop HD than younger adults. The average age for a person seeking help for HD is around 50.

Adolescents can also have HD. In this age group, it’s generally milder and symptoms are less distressing. This is because young people tend to live with parents or roommates who can help manage hoarding behaviors.

HD can begin interfering with daily activities around age 20, but may not become severely problematic until age 30 or later.

HD builds gradually over time, and a person may not be aware that they’re exhibiting symptoms of HD. These symptoms and signs include:

  • being unable to part with items, including both valuable and invaluable objects
  • having an excessive amount of clutter in the home, office, or another space
  • being unable to find important items amid excessive clutter
  • being unable to let items go for fear that they’ll be needed “someday”
  • holding onto an excessive number of items because they’re reminders of a person or a life event
  • stockpiling free items or other unnecessary items
  • feeling distressed but helpless about the amount of stuff in their space
  • blaming excessive clutter on their space’s size or lack of organization
  • losing rooms to clutter, making them unable to function for their intended purposes
  • avoiding hosting people in the space because of shame or embarrassment
  • putting off home repairs because of clutter and not wanting to let a person into their home to fix whatever is broken
  • having conflict with loved ones because of excessive clutter

Diagnosis and treatment of HD is possible. However, it may be difficult to persuade a person with HD to recognize the condition. Loved ones or outsiders may recognize signs and symptoms of HD long before the person with the condition comes to terms with it.

Treatment for HD must focus on the individual and not solely on the spaces that have become overrun with clutter. A person must first be receptive to treatment options in order to change their hoarding behavior.

Diagnosis

Someone seeking treatment for HD should first see their doctor. A doctor can evaluate HD through interviews with the person as well as their loved ones. They may also visit the person’s space to determine the severity and risk of the situation.

A thorough medical evaluation may also help diagnose any other underlying mental health conditions.

Cognitive behavioral therapy (CBT)

Individual and group cognitive behavioral therapy (CBT) may be the most successful way to treat HD. This should be directed by a medical professional.

Research has shown that this type of treatment can be useful. A review of literature indicated that younger women who went to several CBT sessions and received several home visits had the most success with this line of treatment.

CBT can be done in an individual or group setting. The therapy focuses on why someone may have a hard time discarding items and why they desire to bring more items into a space. The goal of CBT is to alter behavior and the thought processes that contribute to hoarding.

CBT sessions may include creating decluttering strategies as well as discussing ways to prevent bringing in new items to the space.

Peer-led groups

Peer-led groups can also help treat HD. These groups can be friendly and less intimidating to someone with HD. They often meet weekly and involve regular check-ins to provide support and evaluate progress.

Medications

No medications exist specifically to treat HD. Some may help with symptoms. A doctor may prescribe a selective serotonin reuptake inhibitor or serotonin-norepinephrine reuptake inhibitor to help with the condition.

These medications are typically used to treat other mental health conditions. However, it’s not clear whether these medications are useful for HD. Some research has indicated that medications for ADHD may also be helpful for HD.

Helpful support

Supporting a person affected by HD can be challenging. HD can cause strain between the affected person and loved ones. It’s important to let the person with HD become self-motivated to get help.

As an outsider, it’s tempting to believe that cleaning out the cluttered spaces will solve the problem. But the hoarding will likely continue without proper guidance and intervention.

Here are some ways you can support a person with HD:

  • Stop accommodating or assisting the person with hoarding tendencies.
  • Encourage them to seek professional help.
  • Support without criticizing.
  • Discuss ways they could make their space safer.
  • Suggest how treatments may positively impact their life.

Hoarding disorder is a diagnosable condition that requires the help of a medical professional. With professional help and time, a person may be able to move on from their hoarding behaviors and reduce dangerous and tension-inducing clutter in their personal space.