Hoarding disorder

Hoarding disorder is a persistent difficulty discarding or parting with possessions because of a perceived need to save them. A person with hoarding disorder experiences distress at the thought of getting rid of the items. Excessive accumulation of items, regardless of actual value, occurs.

Hoarding often creates such cramped living conditions that homes may be filled to capacity, with only narrow pathways winding through stacks of clutter. Countertops, sinks, stoves, desks, stairways and virtually all other surfaces are usually piled with stuff. And when there's no more room inside, the clutter may spread to the garage, vehicles, yard and other storage facilities.

Hoarding ranges from mild to severe. In some cases, hoarding may not have much impact on your life, while in other cases it seriously affects your functioning on a daily basis.

People with hoarding disorder may not see it as a problem, making treatment challenging. But intensive treatment can help people with hoarding disorder understand how their beliefs and behaviors can be changed so that they can live safer, more enjoyable lives.

Symptoms

Getting and saving an excessive number of items, gradual buildup of clutter in living spaces and difficulty discarding things are usually the first signs and symptoms of hoarding disorder, which often surfaces during the teenage to early adult years.

As the person grows older, he or she typically starts acquiring things for which there is no immediate need or space. By middle age, symptoms are often severe and may be harder to treat.

Problems with hoarding gradually develop over time and tend to be a private behavior. Often, significant clutter has developed by the time it reaches the attention of others.

Signs and symptoms may include:

• Excessively acquiring items that are not needed or for which there's no space
• Persistent difficulty throwing out or parting with your things, regardless of actual value
• Feeling a need to save these items, and being upset by the thought of discarding them
• Building up of clutter to the point where rooms become unusable
• Having a tendency toward indecisiveness, perfectionism, avoidance, procrastination, and problems with planning and organizing

Excessive acquiring and refusing to discard items results in:

• Disorganized piles or stacks of items, such as newspapers, clothes, paperwork, books or sentimental items
• Possessions that crowd and clutter your walking spaces and living areas and make the space unusable for the intended purpose, such as not being able to cook in the kitchen or use the bathroom to bathe
• Buildup of food or trash to unusually excessive, unsanitary levels
• Significant distress or problems functioning or keeping yourself and others safe in your home
• Conflict with others who try to reduce or remove clutter from your home
• Difficulty organizing items, sometimes losing important items in the clutter

People with hoarding disorder typically save items because:

• They believe these items are unique or will be needed at some point in the future
• The items have important emotional significance — serving as a reminder of happier times or representing beloved people or pets
• They feel safer when surrounded by the things they save
• They don't want to waste anything

Hoarding disorder is different from collecting. People who have collections, such as stamps or model cars, deliberately search out specific items, categorize them and carefully display their collections. Although collections can be large, they aren't usually cluttered and they don't cause the distress and impairments that are part of hoarding disorder.

Hoarding animals

People who hoard animals may collect dozens or even hundreds of pets. Animals may be confined inside or outside. Because of the large numbers, these animals often aren't cared for properly. The health and safety of the person and the animals are at risk because of unsanitary conditions.

When to see a doctor

If you or a loved one has symptoms of hoarding disorder, talk with a doctor or mental health professional as soon as possible. Some communities have agencies that help with hoarding problems. Check with the local or county government for resources in your area.

As hard as it might be, if your loved one's hoarding disorder threatens health or safety, you may need to contact local authorities, such as police, fire, public health, child or elder protective services, or animal welfare agencies.

Causes

It's not clear what causes hoarding disorder. Genetics, brain functioning and stressful life events are being studied as possible causes.

Risk factors

Hoarding usually starts around ages 11 to 15, and it tends to get worse with age. Hoarding is more common in older adults than in younger adults.

Risk factors include:

• Personality. Many people who have hoarding disorder have a temperament that includes indecisiveness.
• Family history. There is a strong association between having a family member who has hoarding disorder and having the disorder yourself.
• Stressful life events. Some people develop hoarding disorder after experiencing a stressful life event that they had difficulty coping with, such as the death of a loved one, divorce, eviction or losing possessions in a fire.

Complications

Hoarding disorder can cause a variety of complications, including:

• Increased risk of falls
• Injury or being trapped by shifting or falling items
• Family conflicts
• Loneliness and social isolation
• Unsanitary conditions that pose a risk to health
• A fire hazard
• Poor work performance
• Legal issues, such as eviction

Other mental health disorders

Many people with hoarding disorder also experience other mental health disorders, such as:

• Depression
• Anxiety disorders
• Obsessive-compulsive disorder (OCD)
• Attention-deficit/hyperactivity disorder (ADHD)

Prevention

Because little is understood about what causes hoarding disorder, there's no known way to prevent it. However, as with many mental health conditions, getting treatment at the first sign of a problem may help prevent hoarding from getting worse.

Diagnosis

People often don't seek treatment for hoarding disorder, but rather for other issues, such as depression or anxiety. To help diagnose hoarding disorder, a mental health professional performs a psychological evaluation. In addition to questions about emotional well-being, you may be asked about a habit of acquiring and saving items, leading to a discussion of hoarding.

Your mental health professional may ask your permission to talk with relatives and friends. Pictures and videos of your living spaces and storage areas affected by clutter are often helpful. You also may be asked questions to find out if you have symptoms of other mental health disorders.

For diagnosis, your mental health professional may use the criteria for hoarding disorder listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Treatment

Treatment of hoarding disorder can be challenging because many people don't recognize the negative impact of hoarding on their lives or don't believe they need treatment. This is especially true if the possessions or animals offer comfort. If these possessions or animals are taken away, people will often react with frustration and anger and quickly collect more to help fulfill emotional needs.

The main treatment for hoarding disorder is cognitive behavioral therapy. Medications may be added, particularly if you also have anxiety or depression.

Psychotherapy

Psychotherapy, also called talk therapy, is the primary treatment. Cognitive behavioral therapy is the most common form of psychotherapy used to treat hoarding disorder. Try to find a therapist or other mental health professional with experience in treating hoarding disorder.

As part of cognitive behavioral therapy, you may:

• Learn to identify and challenge thoughts and beliefs related to acquiring and saving items
• Learn to resist the urge to acquire more items
• Learn to organize and categorize possessions to help you decide which ones to discard
• Improve your decision-making and coping skills
• Declutter your home during in-home visits by a therapist or professional organizer
• Learn to reduce isolation and increase social involvement with more meaningful activities
• Learn ways to enhance motivation for change
• Attend family or group therapy
• Have periodic visits or ongoing treatment to help you keep up healthy habits

Treatment often involves routine assistance from family, friends and agencies to help remove clutter. This is particularly the case for the elderly or those struggling with medical conditions that may make it difficult to maintain effort and motivation.

Children with hoarding disorder

For children with hoarding disorder, it's important to have the parents involved in treatment. Sometimes called "family accommodation," over the years, some parents may think that allowing their child to get and save countless items may help lower their child's anxiety. Actually it may do the opposite, increasing anxiety.

So, in addition to therapy for the child, parents need professional guidance to learn how to respond to and help manage their child's hoarding behavior.

Medications

There are currently no medications approved by the Food and Drug Administration (FDA) to treat hoarding disorder. Typically, medications are used to treat other disorders such as anxiety and depression that often occur along with hoarding disorder. The medications most commonly used are a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs). Research continues on the most effective ways to use medications in the treatment of hoarding disorder.

Lifestyle and home remedies

In addition to professional treatment, here are some steps you can take to help care for yourself:

• Stick to your treatment plan. It's hard work, and it's normal to have some setbacks over time. But treatment can help you feel better about yourself, improve your motivation and reduce your hoarding.
• Accept assistance. Local resources, professional organizers and loved ones can work with you to make decisions about how best to organize and unclutter your home and to stay safe and healthy. It may take time to get back to a safe home environment, and help is often needed to maintain organization around the home.
• Reach out to others. Hoarding can lead to isolation and loneliness, which in turn can lead to more hoarding. If you don't want visitors in your house, try to get out to visit friends and family. Support groups for people with hoarding disorder can let you know that you are not alone and help you learn about your behavior and resources.
• Try to keep up personal hygiene and bathing. If you have possessions piled in your tub or shower, resolve to move them so that you can bathe.
• Make sure you're getting proper nutrition. If you can't use your stove or reach your refrigerator, you may not be eating properly. Try to clear those areas so that you can prepare nutritious meals.
• Look out for yourself. Remind yourself that you don't have to live in chaos and distress — that you deserve better. Focus on your goals and what you stand to gain by reducing clutter in your home.
• Take small steps. With a professional's help, you can tackle one area at a time. Small wins like this can lead to big wins.
• Do what's best for your pets. If the number of pets you have has grown beyond your ability to care for them properly, remind yourself that they deserve to live healthy and happy lives — and that's not possible if you can't provide them with proper nutrition, sanitation and veterinary care.

Preparing for an appointment

If you or a loved one has symptoms of hoarding disorder, your doctor may refer you to a mental health professional, such as a psychiatrist or psychologist, with experience diagnosing and treating hoarding disorder.

Because many people with hoarding disorder symptoms don't recognize that their behavior is a problem, you as a friend or family member may experience more distress over the hoarding than your loved one does.

You may want to first meet alone with a mental health professional to develop an approach for raising your concerns with your loved one. A mental health professional can help you prepare for a conversation to encourage your loved one to seek help.

To consider the possibility of seeking treatment, your loved one will likely need reassurance that no one is going to go into his or her house and start throwing things out. Here's some information to help the person with hoarding disorder symptoms prepare for the first appointment and learn what to expect from the mental health professional.

What you can do

Before your appointment, make a list of:

• Any symptoms you're experiencing, and for how long. It will help the mental health professional to know what kinds of items you feel compelled to save and personal beliefs about acquiring and retaining items.
• Challenges you have experienced in the past when trying to manage your clutter.
• Key personal information, including traumatic events or losses in your past, such as divorce or the death of a loved one.
• Your medical information, including other physical or mental health conditions with which you've been diagnosed.
• Any medications, vitamins, supplements or other herbal products you take, and their dosages.
• Questions to ask your mental health professional.

Take a trusted family member or friend along, if possible, for support and to help remember the details discussed at the appointment. Bringing pictures and videos of living spaces and storage areas affected by clutter is helpful.

Questions to ask your mental health professional may include:

• Do you think my symptoms are cause for concern? Why?
• Do you think I need treatment?
• What treatments are most likely to be effective?
• How much can I expect my symptoms to improve with treatment?
• How much time will it take before my symptoms begin to improve?
• How often will I need therapy sessions, and for how long?
• Are there medications that can help?

Don't hesitate to ask other questions during your appointment.

What to expect from your mental health professional

To gain an understanding of how hoarding disorder is affecting your life, your mental health professional may ask:

• What types of things do you tend to acquire?
• Do you avoid throwing things away?
• Do you avoid making decisions about your clutter?
• How often do you decide to get or keep things you don't have space or use for?
• How would it make you feel if you had to discard some of your things?
• Does the clutter in your home keep you from using rooms for their intended purpose?
• Does clutter prevent you from inviting people to visit your home?
• How many pets do you have? Are you able to provide appropriate care for them?
• Have you tried to reduce the clutter on your own or with the help of friends and family? How successful were those attempts?
• Have your family members expressed concern about the clutter?
• Are you currently being treated for any mental health conditions?

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