Hoarding disorder

Overview

Hoarding disorder is an ongoing difficulty throwing away or parting with possessions because you believe that you need to save them. You may experience distress at the thought of getting rid of the items. You gradually keep or gather a huge number of items, regardless of their actual value.

Hoarding often creates extremely cramped living conditions with only narrow pathways winding through stacks of clutter. Countertops, sinks, stoves, desks, stairways and all other surfaces are usually piled with stuff. You may not be able to use some areas for their intended purpose. For example, you may not be able to cook in the kitchen. When there's no more room inside your home, the clutter may spread to the garage, vehicles, yard and other storage areas.

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 daily functioning.

People with hoarding disorder may not see it as a problem, so getting them to take part in treatment can be challenging. But intensive treatment can help you understand how your beliefs and behaviors can be changed so that you can live a safer, more enjoyable life.

Symptoms

The first symptoms of hoarding disorder often appear during the teenage to early adult years. You may get and save too many items, gradually build up clutter in living spaces, and have difficulty getting rid of things.

As you grow older, you may continue getting and holding onto things that you may never use and don't have space for. By middle age, the clutter can become overwhelming as symptoms become more severe and increasingly difficult to treat.

Problems with hoarding gradually develop over time and tend to be a private behavior. You may avoid having family, friends or repair workers in your home. Often, major clutter has developed by the time it reaches the attention of others.

Symptoms of hoarding disorder may include:

• Getting and keeping too many items that you may not have a need for right now and don't have space for.
• Ongoing difficulty throwing out or parting with your things, regardless of their actual value.
• Feeling a need to save these items and being upset by the thought of getting rid of them.
• Building up clutter to the point where you can't use rooms.
• Trying to be perfect and avoiding or delaying decisions.
• Problems with planning and organizing.

Getting too many items and refusing to part with them results in:

• Disorganized piles or stacks of items, such as newspapers, clothes, paperwork, books or sentimental items.
• Items that crowd and clutter your walking spaces and living areas. Rooms can't be used for the intended purpose, such as not being able to sleep in your bed.
• Buildup of food or trash to large, unsanitary levels.
• Distress or problems functioning or keeping yourself, others and pets safe in your home.
• Conflict with others who try to reduce or remove clutter from your home.
• Relationship issues, avoiding social activities and employment problems.
• Difficulty organizing items and sometimes losing important items in the clutter.

With hoarding disorder, items are usually saved because:

• You believe these items are unique or that you'll need them at some point in the future.
• You feel emotionally connected to items that remind you of happier times or represent beloved people or pets.
• You feel safe and comforted when surrounded by things.
• You don't want to waste anything.

Hoarding disorder is different from collecting. People who have collections, such as stamps or model cars, carefully search out specific items, organize them and display their collections. Collections can be large, but they aren't usually cluttered. Also, they don't cause the distress and problems functioning 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 often 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 health care provider or a mental health provider with expertise in diagnosing and treating hoarding disorder 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 function and stressful life events are being studied as possible causes.

Risk factors

Hoarding usually starts around ages 15 to 19. 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 behavior style that includes trouble making decisions and problems with attention, organization and problem-solving.
• 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 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.
• Conditions that aren't clean and can be a health risk.
• A fire hazard.
• Poor work performance.
• Legal issues, such as eviction.

Other mental health disorders

Hoarding disorder also is linked with other mental health conditions, 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. This is especially important because by the time clutter becomes a noticeable problem, hoarding likely has been going on for a while.

Diagnosis

People often don't seek treatment for hoarding disorder, but rather for other issues, such as depression, anxiety or relationship problems. To help diagnose hoarding disorder, it's best to see a mental health provider who has expertise in diagnosing and treating the condition. You'll have a mental health exam that includes questions about emotional well-being. You'll likely be asked about your beliefs and behaviors related to getting and saving items and the impact clutter may have on your quality of life.

Your mental health provider 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 conditions.

Treatment

Treatment of hoarding disorder can be challenging but effective if you keep working on learning new skills. Some 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. They may quickly collect more to help satisfy emotional needs.

The main treatment for hoarding disorder is cognitive behavioral therapy (CBT), a skills-based approach to therapy. You learn how to better manage beliefs and behaviors that are linked to keeping the clutter. Your provider also may prescribe medicines, especially if you have anxiety or depression along with hoarding disorder.

CBT

Cognitive behavioral therapy is the main treatment for hoarding disorder. Try to find a therapist or other mental health provider with expertise in treating hoarding disorder.

As part of CBT, you may:

• Learn to identify and challenge thoughts and beliefs related to getting and saving items.
• Learn to resist the urge to get more items.
• Learn to organize and group things to help you decide which ones to get rid of, including which items can be donated.
• Improve your decision-making and coping skills.
• Remove clutter in your home during in-home visits by a therapist or professional organizer.
• Learn to reduce isolation and increase opportunities to join in meaningful social activities and supports.
• Learn ways to increase your desire for change.
• Attend family or group therapy.
• Have occasional visits or ongoing treatment to help you keep up healthy habits.

Treatment often involves regular help from family, friends and agencies to help remove clutter. This is often the case for the elderly or those struggling with medical conditions that may make it difficult to keep up the effort and desire to make changes.

Children with hoarding disorder

For children with hoarding disorder, it's important to have the parents involved in treatment. Some parents may think that allowing their child to get and save countless items may help lower their child's anxiety and avoid family fights. This is sometimes called "family accommodation." This actually may do the opposite and strengthen the child's tendency to get and save items.

In addition to therapy for their child, parents may find professional guidance helpful to learn how to respond to and help manage their child's hoarding behavior.

Medicines

Cognitive behavioral therapy is the first treatment recommended for hoarding disorder. There are currently no medicines approved by the Food and Drug Administration (FDA) to treat hoarding disorder. Medicines are used to treat other conditions such as anxiety and depression that often occur along with hoarding disorder. The medicines most commonly used are a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs). Research continues on the most effective ways to use medicines 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:

• Follow your treatment plan. It's hard work, and it's common to have some setbacks over time. But treatment can help you feel better about yourself, improve your desire to change and reduce your hoarding. Have a daily schedule to work on reducing your clutter. Do this during times of the day when you have the most energy.
• 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. Help is often needed to stay organized 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. Joining a support group for people with hoarding disorder can let you know that you are not alone. These groups can help you learn about your behavior and available resources.
• Try to keep yourself clean and neat. If you have possessions piled in your tub or shower, resolve to move them so that you can bathe or shower.
• 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 healthy 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 can gain by reducing clutter in your home.
• Take small steps. With a professional's help, you can tackle one area at a time. Small and consistent 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. That's not possible if you can't provide them with proper nutrition, clean living conditions and veterinary care.

Preparing for an appointment

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

Because some 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. If this is the case, you may want to first meet alone with a mental health provider with expertise in treating hoarding disorder. A provider can offer support and help on how 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 their house and start throwing things out.

Here's some information to help prepare for the first appointment and what to expect from the mental health provider.

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 provider to know what kinds of items you feel you have to save and your personal beliefs about getting and keeping 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.
• Any medicines, vitamins, herbal products or other supplements you take, and their doses.
• Questions to ask your mental health provider.

You may want to take a trusted family member or friend along, if possible. They can offer support and help remember the details discussed at the appointment. Bring pictures and videos of living spaces and storage areas affected by clutter.

Questions to ask your mental health provider 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 medicines that can help?

Feel free to ask other questions during your appointment.

What to expect from your mental health provider

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

• What types of things do you tend to get and save?
• 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 get rid of some 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 proper 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?