Hoarding disorder is characterized by persistent difficulty getting rid of possessions due to a perceived need to save them. Individuals with hoarding disorder experience considerable distress when trying to part with their possessions, and will often decide to keep them as a result.

Over time, this pattern of behavior can cause significant amounts of clutter to accumulate, which can create safety hazards and disrupt peoples’ ability to use their living spaces. This can prevent them from performing normal day-to-day tasks and put strain on their relationships.

According to the American Psychiatric Association, the overall prevalence of hoarding disorder is 2.6%, and evidence suggests that it occurs with equal frequency in men and women. The rate of hoarding disorder is higher for people over 60 years old and those with other psychiatric conditions, particularly anxiety and depression.

Hoarding behavior tends to increase in severity with age, and can often become more difficult to manage if it isn’t properly addressed. You can help protect yourself and your loved ones by learning all you can about how to recognize hoarding disorder and how it is treated.

Recognizing hoarding disorders  

Recognizing hoarding disorder is often the first step toward a successful recovery, but this can be difficult, as not everyone who displays hoarding symptoms will meet the criteria for diagnosis. According to the American Psychiatric Association, the specific symptoms needed to support a hoarding disorder diagnosis include: 

• Persistent difficulty discarding or parting with possessions, regardless of their actual value.
• Feeling a need to save items, and experiencing distress when trying to discard them. 
• An accumulation of clutter in the home that compromises the intended use of active living areas, and an inability to remove clutter without third-party intervention.

Other symptoms that may or may not present with hoarding disorder include indecisiveness, procrastination, perfectionism, distractibility, anxiety about running out of certain items and attributing emotion to inanimate objects.

Unlike collectors, who target specific types of items in a planned way, people with hoarding disorder select objects impulsively and don’t follow any consistent theme. Additionally, they do not store or display their possessions in an organized fashion, and will often have random piles of assorted clutter throughout their living space.

This clutter can create health and safety hazards, and prevent people from using the rooms in their home. As a result, people who have untreated hoarding disorders may struggle with normal daily functions like cooking, bathing and doing laundry. This can lead to serious issues like employment problems and social isolation.

In many cases, people with hoarding disorders will avoid having any guests in their homes to protect their privacy. This can put additional strain on personal relationships and allow the problem to progress unchecked.

Some individuals with hoarding disorders will acknowledge that they have a problem, while others may not seem to recognize the issue. Healthcare professionals may try to speak with a patient’s friends or family in order to help with their diagnosis.

What causes hoarding disorder?

More research is likely necessary to identify the underlying biological factors that cause hoarding disorder. However, there are some possible contributing factors to consider, such as genetics and personal history.

Existing research has shown that hoarding disorder is more common in people who have first-degree relatives with the condition, such as parents or siblings. This is likely due to a combination of genetics and environmental influence.

People may also develop hoarding behaviors as an unhelpful coping mechanism after experiencing stressful or traumatic events, particularly those that involve loss, such as the death of a loved one or the theft of a prized possession, although the exact relationship between hoarding and these types of events is not completely clear.

What are the most common co-occurring mental health disorders with hoarding?

While hoarding disorder can occur by itself, individuals with certain mental health conditions are at greater risk of developing hoarding behaviors. The most common co-occurring mental health disorders with hoarding include:

• Obsessive-compulsive personality disorder (OCPD) 
• Obsessive-compulsive disorder (OCD) 
• Attention-deficit/hyperactivity disorder (ADHD)
• Depression

Other conditions that may be associated with hoarding include eating disorders, psychosis, dementia and pica (compulsive swallowing of non-food items), though these are not known to co-occur as frequently.

Practical strategies for overcoming hoarding disorders

Even with the right professional help, overcoming a hoarding disorder requires a significant amount of dedication and personal effort, which can be a daunting proposition. However, you can make the process more manageable and increase your chances of success by employing the right strategies.

Decluttering and organizing techniques

Decluttering your home and getting organized after living with a hoarding disorder can seem impossible, and thinking about the mess in front of you may leave you feeling discouraged. Fortunately, you can make decluttering easier on yourself by breaking the process down into smaller steps and tackling them one at a time. Some helpful techniques for doing this may include:

• Break up the work: Divide up your decluttering workload by planning separate cleanups for individual rooms or areas of your home. For example, you may dedicate one day to cleaning dirty dishes and removing rotten food from your kitchen, and spend the next day organizing your refrigerator and pantry.  
• Prioritize high-impact areas: Start by cleaning the areas of your home where you spend the most time, such as your kitchen or bedroom. This will ensure that the work you do makes a more noticeable impact on your daily life, which can help you get motivated to keep cleaning.  
• Divide your possessions into categories: Another way to break the cleaning process down is by sorting the items in your home into different categories based on what you want to do with them. This can be done by designating items as either “keep,” “donate,” or “discard.”  
• Implement a decision-making strategy: Choosing what to do with possessions is often difficult for people with hoarding disorder, but you can make it easier by following a decision-making strategy. This may involve setting criteria for the items in each category, or asking yourself the same series of questions about each item (“Is this a health or safety hazard? Does this have any practical uses?”).

Even if you start with good intentions, sticking with your decluttering goals can be difficult if you try to take on too much at once. Using these strategies to segment your workload can help keep you on-task and lighten the physical and emotional burden of decluttering.

Time management: Set realistic goals and timelines for decluttering

When cleaning your home, it’s important not to push yourself too far in the beginning, as this may be harmful and counterproductive in the long run. To avoid burning yourself out, you should create a timeline that corresponds with your decluttering strategy and needs. Here’s an example of a reasonable decluttering timeline:

• Day 1: Assess the situation; including the total amount of clutter, any hazards that may be present, and any areas that may take longer to clean.
• Day 2: Gather any supplies you’ll need for cleaning/decluttering; including cleaning products, protective equipment, and waste bins/bags.
• Day 3 and 4: Remove any trash and odor-producing waste from the home.
• Day 5: Take a break.
• Day 6: Clean out and organize refrigerator and pantry.
• Day 7: Clear any exits blocked by clutter.
• Day 8 and 9: Sort out any items that you want to sell or donate
• Day 10: Sort out any items that have legitimate practical uses.

Throughout this process, it may be helpful to set different deadlines for different tasks, such as cleaning individual rooms or areas. Additionally, you should allow yourself more time to clean the areas of your home that have more clutter.

While you may want to see major results quickly, even small steps represent progress, and working against tight deadlines can make the decluttering process even more stressful. By setting realistic goals and making incremental progress toward your recovery, you can give yourself a compounding sense of accomplishment without becoming overwhelmed.

Creating a supportive living environment

Cleaning your house is only part of overcoming a hoarding disorder. To maximize your chance of long-term success, it’s also critical to make sure that your living space is a supportive environment for your recovery.

One effective way to do this is by establishing an organizational and storage system in your home. This may involve designating particular storage areas or containers for specific items or categories of items to ensure that you always know where to put them.

Individuals with hoarding disorder often have great difficulty determining what to do with possessions, and may end up keeping them as a result. Establishing a uniform set of protocols for handling items can help you avoid this indecision and the stress it causes.

Developing and maintaining healthy habits

Along with modifying your home environment to support recovery, it’s also important to develop and maintain habits that will help you avoid relapse. Establishing a regular cleaning routine is an effective way to do this, as it can help you adjust to the discomfort of sorting through your possessions and ensure that new clutter does not accumulate in your home.

Understanding the possibility of relapse

Even with proper treatment and a supportive living environment, people recovering from hoarding disorders can still experience relapses. While this can seem discouraging, it’s important to recognize that recovery is a gradual process and that relapses are possible, but they can be remedied and even avoided with the right steps.

One of the most effective ways to prevent relapses is to identify the factors that trigger hoarding behavior and develop healthier ways to cope with the stress of these triggers, such as using sensory experiences to manage anxiety, rather than acquiring new items.

If you don’t already know what your triggers are, it may be helpful to keep a journal of the times when you feel compelled to acquire items, and look for patterns that connect these instances. However, if identifying and/or managing triggers becomes too difficult, it may be prudent to seek professional care, rather than trying to handle it alone.

Seeking professional help

Though it may be uncomfortable at first, seeking professional help is often critical for successful hoarding recovery. Overcoming hoarding disorder can be very difficult, and healthcare professionals who specialize in hoarding can help by providing accurate assessments of your condition and determining the best course of treatment. Healthcare professionals who can assist in hoarding treatment include:

• Psychologists: Psychologists specialize in the study of behaviors and mental processes, including the way that people interact with their environment. Psychologists are not medical doctors, and cannot prescribe medication. However, they can use psychotherapy to help you manage the feelings and behaviors associated with hoarding.  
• Psychiatrists: Psychiatrists are medical doctors who specialize in the diagnosis, treatment and prevention of mental, emotional and behavioral disorders. While they may utilize some of the same techniques as psychologists to treat hoarding, such as psychotherapy, they are also able to prescribe medication.
• Therapists/Counselors: Therapists and counselors can diagnose hoarding and help you develop a treatment plan. Like psychologists, therapists and counselors do not have the power to prescribe medication, although they may refer you to a psychiatrist for further evaluation and treatment.

While it can be difficult to find a qualified and experienced professional to treat hoarding, asking for a referral from a trusted source such as your primary care physician is often a great place to start. It may also be helpful to research doctors who specialize in hoarding disorder treatment in your area.

Therapeutic approaches and treatment options

Mental health professionals have several tools at their disposal for treating hoarding disorders. These can involve behavioral therapy, medication, or a combination of the two. Some of the most commonly recommended treatments for hoarding include:

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) is the most well-studied treatment for hoarding disorder. It is a type of psychotherapy based on the principle that our thoughts, feelings, and behaviors are all closely connected.

Using CBT to treat hoarding disorder will likely involve identifying the unhealthy thoughts and beliefs that contribute to hoarding behavior, and using practical strategies to address them. You may also work on developing skills for organization, decision-making and coping with negative feelings.

Exposure and response prevention therapy

Exposure and response prevention (ERP) therapy is a subtype of cognitive behavioral therapy that involves exposing people to their obsessive thoughts without letting them engage in compulsive behaviors.

Using ERP to treat hoarding may involve removing an item from your home in the presence of a therapist, in order to trigger your compulsion, and then working to manage this compulsion with your therapist instead of acting on it.

ERP can allow patients with hoarding disorders to practice coping with triggering situations in a safe environment, while developing skills and learning techniques to control their compulsions during these situations.

Medication options for managing hoarding symptoms

Currently, there are no medications approved by the FDA for the treatment of hoarding disorder. However, doctors may prescribe medications used to manage conditions associated with hoarding, such as anxiety and depression.

Some studies have found that antidepressants like SSRIs and SNRIs may be beneficial for treating hoarding disorder, though these medicines are more commonly prescribed to patients who have co-occurring conditions like OCD.

SSRIs can be prescribed for non-OCD hoarding disorder, but your doctor will want to closely monitor their effects, as existing research is so limited. After starting treatment, you and your doctor will look for side effects and/or signs that your antidepressants are working, and possibly change your medicines if no positive changes are noted.

Additionally, some research has shown that stimulants like methylphenidate (Ritalin®), which is commonly used to treat attention-deficit/hyperactivity disorder (ADHD), can also help reduce hoarding symptoms. However, these findings are not conclusive, and different people may have different experiences when taking ADHD medication.

Resources for further education and assistance

Whether it’s you or someone you care about, managing a hoarding disorder can be a variable process, and it’s important to arm yourself with the right information. Check out these resources to learn more about hoarding and find support from others who have had similar experiences:

• Clutterers Anonymous: An organization that practices a 12-step program for people who have problems with clutter. On their website, you can find a variety of informational resources, connect with decluttering helplines, and join in-person or virtual recovery meetings.
• International OCD Foundation: The International OCD Foundation offers a variety of online resources for those affected by hoarding, including articles, videos and directories that can help you locate treatment programs, therapists, support groups and professional organizers.
• Children of Hoarders: A non-profit organization operated by former children of hoarders. Here, current children of hoarders can join support groups, learn management strategies and get advice from people who understand their experiences.
• NAPO: The National Association of Productivity and Organizing Professionals (NAPO) operates a massive directory of certified cleaning and organization pros. Here, you can search for service providers in your area that specialize in hoarding behavior.
• The Schulman Center: A treatment center specializing in compulsive theft, spending and hoarding behaviors. On their website, you can find helpful articles and videos about hoarding, and connect with support groups in your area.

Online research is no substitute for medical care, but it can be a good way to figure out your next steps. With guidance from these resources, you can be sure that you’re taking the right approach to treating and managing hoarding.

Helplines for immediate assistance

If you or someone you care about is being affected by hoarding, it’s important to address the issue before it can progress, and it’s often beneficial to seek firsthand help from an experienced professional. These resources can provide 24/7 emotional support and help with hoarding cleanup:

• NAMI HelpLine: Support service operated by the National Alliance on Mental Illness (NAMI). It is open for calls, emails and text messages Monday through Friday from 10 a.m. to 10 p.m. On their website, you can also locate support groups and access a variety of informational resources about hoarding.
• 1-800-HOARDERS: A 24/7 hoarding support hotline operated by Hoarders.com. They can provide emotional support and help connect you with support groups, counselors, therapists and hoarding remediation companies.
• 988 Suicide and Crisis Lifeline: A free, 24/7 hotline specializing in crisis services and suicide prevention. Here, those affected by hoarding can receive confidential support and advice during times of extreme distress. 
• SAMHSA National Helpline: A free information and treatment referral service run by the Substance Abuse and Mental Health Services Administration (SAMHSA). The hotline is open to calls and text messages 24 hours a day, seven days a week.
• MentalHealthHotline: A free, 24/7 hotline for people with mental health concerns and their families. Here, those affected by hoarding can receive emotional support and practical guidance from trained professionals.

Overcoming and managing hoarding behaviors is an ongoing struggle, but simply acknowledging the problem can be a major first step. By employing the right strategies and seeking appropriate medical care when necessary, people with hoarding disorders can develop healthy behaviors, learn to cope with triggers and gradually reverse the impact that hoarding has had on their lives.

Need a doctor? Find one on Zocdoc.