Hoarding disorder

Hoarding disorder is a mental health condition where you gather lots of things over time regardless of their value or usefulness. You then have difficulty getting rid of them even if they are not useful. This leads to extreme clutter and stops you from using your living spaces as they were intended.

Key points about hoarding disorder

  1. The word hoarding is a term used to explain the ongoing build-up of a large number of items, resulting in excessive clutter.
  2. Having hoarding disorder means your living spaces become so cluttered that they become unusable and/or unsafe. 
  3. If you have hoarding disorder, you see your collected things as having immense value. You find it distressing to get rid of these items, even when they affect your daily life.
  4. Treatment for hoarding disorder may include talk therapy, skills training and medicine.
  5. You should be supported to make changes at your own pace.

What is hoarding disorder?

Hoarding is the term used to explain buying or getting a large number of objects or animals over time, resulting in excessive clutter. Your house getting messy and/or cluttered at times is not the same as hoarding disorder. Having hoarding disorder means your living spaces become so cluttered that they become unusable and/or unsafe.

Hoarding disorder can be a condition by itself, as well as sometimes being a symptom of other mental health problems.

Hoarding can also be caused by some other conditions, eg, dementia or brain injury, which are generally diagnosed and treated differently to mental health problems. In these situations, the information in these pages might not apply. See our health topic pages on dementia and brain injury.

What causes hoarding behaviour?

No one knows exactly what causes hoarding.

It can be  triggered by:

  • difficult experiences and painful feelings
  • perfectionism and worrying about making mistakes
  • childhood experiences of losing or not having possessions, or not being cared for
  • trauma and loss
  • family history or habits
  • other mental health problems.

If you hoard, you probably started doing so for good reasons. For example, you may have wanted to avoid wasting things, keep track of important information or be reminded of a significant memory or time.

If you hoard, you might:

  • have very strong positive feelings whenever you get more items
  • feel very upset or anxious at the thought of throwing or giving things away
  • find it very hard to decide what to keep or get rid of.

What harm does hoarding disorder cause?

Severe clutter can become a health and safety risk that can affect you, those living with you or those living near your home.

It can:

  • lead to health problems
  • increase falls risk
  • cause structural damage to your home
  • increase the likelihood of a fire
  • reduce access to utilities, entrances and exits
  • impact the health, wellbeing and safety of children
  • affect relationships with family/whānau and friends
  • lead to social isolation (from avoiding having friends and visitors to your home)
  • if a rental, lead to eviction from your home.

What are the signs of hoarding disorder?

People have very different ideas about what it means to have too much stuff or a cluttered home.

For some people, a pile of items in the corner of a bedroom may seem like clutter. Someone else may have so much stuff in bedrooms and hallways that parts of their home become inaccessible – and to them that is completely normal.

Some of the common signs of hoarding disorder include: 

  • difficulty getting rid of items
  • a large amount of clutter in your office, at home, in your car or in other spaces (eg, storage units) that makes it difficult to use furniture or appliances or move around easily
  • losing important items like money or bills in the clutter
  • feeling overwhelmed by the volume of possessions that have ‘taken over’ your house or workspace
  • being unable to stop taking free items, such as advertising flyers or sugar packets from restaurants
  • buying things because they are a ‘bargain’ or to ‘stock up’
  • not inviting family/whānau or friends into your home due to shame or embarrassment
  • refusing to let people into your home to make repairs. 

Clutter Image Rating Scale

To gain a better understanding of what may be considered hoarding, a Clutter Image Rating Scale (CIRS) has been developed.

The CIRS was developed to help evaluate clutter and hoarding levels in the home.

  • The scale involves a series of 9 pictures in each room of the home, each showing various stages of clutter.
  • This tool is most effective for assessing clutter in standard rooms of a home, eg, your living room, kitchen, bedroom and bathroom.
  • Stages range from (1) completely clutter-free to (9) severely cluttered.
  • In general, if you have clutter that reaches the level of picture number 4 or higher you may need to talk to your doctor about your hoarding behaviour.
  • At a level 5 or above, fire risk is increased.
  • Looking at the images requires some degree of judgment, as no two homes look exactly alike, and clutter is more common in some rooms compared to others.

View images of the different stages from clutter-free to severely cluttered

Where can I get help for hoarding disorder?

People might disagree on what hoarding is and whether it's causing problems for you. Someone else, such as a friend, family member or healthcare professional, might say you are hoarding when you don't think you are.

If hoarding is causing you distress or you are concerned about someone who is affected by hoarding, a good starting point is talking to your GP.

Your GP will discuss your concerns with you to:

  • assess if there are any immediate risks to your health or wellbeing
  • try to understand your particular reasons for collecting
  • decide whether to refer you to a specialist such as a psychologist, counsellor or social worker.

How is hoarding disorder diagnosed?

Simply collecting things is not a hoarding disorder. In collecting, people usually proudly display their collections and keep them well organised. A major feature of hoarding disorder is the disorganised nature of the clutter – in most cases, living spaces can no longer be used for everyday living.

A diagnosis of hoarding disorder requires all 3 of the following:

  1. You collect and keep a lot of items, even things that appear useless or of little value to most people.
  2. These items clutter the living spaces and keep you from using the rooms as they were intended.
  3. Excessive clutter in living spaces can become a health and safety risk.

How is hoarding disorder treated?

A growing number of professionals are aware of hoarding, including the need to help you take things at your own pace and not pressure you to make changes faster than you want to. 

Common strategies for treating hoarding disorder include talking therapy, skills training and medication.

Talking therapies

The main talking therapy used to treat hoarding is cognitive behavioural therapy (CBT), which focuses on how your thoughts, beliefs and attitudes affect your feelings and behaviour. Read more about CBT.

Together with your therapist, you might:

  • examine your beliefs about needing to keep things
  • try to understand why it's hard for you to get rid of things
  • learn skills to help you cope with difficult feelings.

Learning organising and problem-solving skills

Skills training focuses on helping you learn how to organise your belongings, how to problem solve to prevent future clutter building up and how to make decisions about what to keep and what to remove.

Research suggests it can help if your therapist visits you at home, so they can understand more about your situation and help you work out how to make changes. Some people also seem to find it helpful to have treatment in a familiar environment.

Medication  

There aren't any specific medicines for hoarding disorder, but some people find medicine helps with other problems they are experiencing alongside hoarding. For example, you might be offered antidepressants to help lift your mood or reduce anxiety.

Concerned about someone with hoarding disorder?

If you are concerned about a relative, friend or neighbour, your first instinct may be to attempt a large-scale clean-up. However, this can cause great distress to the person who has collected the items, and the clutter will most likely just build up again. If you are concerned, support them to seek help from a healthcare professional, such as their GP.

See also: How to help a hoarder

Learn more

Hoarding disorder Hoarding Disorders UK
Hoarding Mind, UK
Hoarding, a disorder that can be distressing for everyone Carers New Zealand
Hoarding for friends and family Mind, UK 
How to help a loved one with hoarding disorder International OCD Foundation
Children of hoarders Support for adult children of hoarders, US
What is hoarding and squalor? Maroondah Hoarding and Squalor Network, Australia

References

  1. Is it hoarding, clutter, collecting or squalor? International OCD Foundation
  2. What is hoarding and squalor? Maroondah Hoarding and Squalor Network (MHSN), Au
  3. What is compulsive hoarding? International OCD Foundation
  4. Clutter image rating scale International OCD Foundation
  5. Hoarding fact sheet International OCD Foundation
  6. Treatment of Hoarding Disorder International OCD Foundation
  7. About hoarding disorder Mind, UK

Dr Adrienna Ember is a clinical psychologist, coexisting disorders therapist, and personal development strategist in private practice. She supports people with diverse sexual orientations and cultural backgrounds. Adrienna also provides supervision and therapy for those with high public exposure/stressful work conditions (eg, medical professionals, CEOs, lawyers, politicians, police, artists) to avoid burnout and maintain safe practice.
Credits: Health Navigator Editorial Team. Reviewed By: Dr Adrienna Ember, Clinical Psychologist. Last reviewed: 19 Nov 2020