Hoarding Therapy

Hoarders are often unaware that they even have a problem until loved ones discover the conditions they are living in.
Hoarding Therapy
Changing pathological behaviors at a speed that is comfortable for the hoarding individual is often the most effective way to combat compulsive hoarding.

What Is Hoarding Disorder?

According to the Mayo Clinic, hoarding is defined as “a persistent difficulty discarding or parting with possessions because of a perceived need to save them.” And while this is an adequate definition, it often leads friends and loved ones, to believe that treating the condition is as simple as getting rid of the hoarded possessions. However, hoarding is typically a symptom of a larger mental health condition, related to anxiety disorders such as obsessive-compulsive disorder (OCD).

An individual with hoarding disorder doesn’t just have a shopping problem, they experience severe anxiety at the thought of getting rid of any of their possessions. Excessive amounts of items, no matter what the monetary value, is accumulated over time. Tabletops, kitchen counters, floors, bathrooms, closets, and most surfaces are just piled with random items. If the hoarder runs out of space for their items in their home, they may fill up their cars, backyard and even pay for storage units.

Some cases of hoarding can be severe and others mild. It becomes a problem when hoarding has an impact on your life and affects your functioning and health.

There is no known cause for compulsive hoarding, although studies have shown that there may be links between hoarding and depression, anxiety disorders, social isolation, stress, and/or chemical dependency. Until the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) was released in 2013, it wasn’t even a defined condition, but rather a listed symptom of other mental health conditions, such as OCD. The relatively high prevalence rate of hoarders has brought attention to it as a serious mental health condition. Almost everyone knows someone that has trouble letting go of possessions that they no longer use.

Currently, estimates state that two to five percent of adults are compulsive hoarders, with most of these instances manifesting in childhood and then worsening as a person ages.

Due to the link between hoarding with depression, anxiety, and attention deficit hyperactivity disorder (ADHD), there is some reason to believe that compulsive hoarding might be triggered by traumatic events such as a death in the family, loss of a job, divorce, and/or abuse. The occurrence rate in well-functioning individuals is markedly lower than those with co-occurring psychological disorders.

Most hoarders are secretive and prefer to keep to themselves, however, the conditions that they live in can be unsanitary to the extent that they are prime environments for disease, accidents, house fires, mold, and pest infestations. Many hoarders suffer from chronic respiratory dysfunction or cardiac issues due to large amounts of ammonia (from human or pet urine or feces), mold, dust, and other allergens. In addition, the increasing weight from the possessions that a hoarder keeps can cause structural damage or even complete collapse of otherwise strong structures.

Symptoms of Hoarding

Hoarding can slowly develop over time and it may be hard to see because it is a very private behavior. By the time others notice their loved one has a problem, it has usually gotten pretty severe.

Signs of hoarding are:

  • Buying or taking donated items that the person doesn’t need or have space for
  • Having a very hard time throwing away or giving away things, even if it has no monetary value
  • Having a compulsion to save items, and becoming upset when thinking of having to give them away
  • Bedrooms and bathrooms being unusable due to clutter
  • The belief that their possessions will be needed in the future
  • The feeling of safety when surrounded by their things
  • The desire to not waste anything

Hoarders can be confused with people that collect items, however, hoarding is different from collecting. Collectors of stamps or baseball cards, deliberately search for specific items and take care of their collections by organizing them. Although collections may seem to take up a lot of room, they do not appear as clutter. They also do not create health risks for the individual.

Methods Used in Therapy for Hoarding?

Hoarding is a difficult problem to treat. When friends and loved ones make an attempt to help, this is often characterized by a gentle or forceful coaxing of the hoarder to release unneeded or unwanted possessions. While this may bring temporary relief, it certainly isn’t a permanent solution, as the hoarder will continue to accumulate possessions until the problem resurfaces. In addition, this often makes the problem worse by increasing anxiety levels in an individual who may already be dealing with an underlying mental health condition.

Compulsive hoarding has various types of treatment. While both medicine and therapy are key aspects to helping compulsive hoarders, the addition of cognitive behavioral therapy (or behavior modification therapy) to treat the underlying cause of the behavior are often the best course of action.

The treatment program is often long, and fairly slow moving, as hoarders are typically quite anxious by nature. Moving slowly and altering behaviors at a speed that they are comfortable with is often the most effective way to combat compulsive hoarding.

Therapists typically work to address the problem by earning the trust of the patient, and then slowly working to make them realize how hoarding is harmful, before ultimately working out a step-by-step program to modify the behaviors’ at its core. The complications when treating compulsive hoarders are often magnified by the hoarder not believing that the behavior itself is a problem. Addressing the issue and then slowly working to address the behavior, as opposed to just getting rid of the hoarded possessions, helps to keep it from happening again once the patient is finally ready to discard items.

Why Hire a Therapist?

Hoarding is a compulsion that mostly affects individuals that don’t necessarily see it as a problem. The act of cleaning a hoarder’s house or forcing them to remove certain objects often causes undue stress and ultimately becomes counterproductive. Once hoarded items are gone, the behavior or underlying psychological condition can remain unaddressed, making ongoing therapy sessions more important.

Hoarders are often unaware that they have a problem until loved ones discover what kind of conditions they are living in. Once this happens, it’s best to contact a mental health professional – with experience in compulsive hoarding – for help. Only he or she can properly help your loved one with any underlying psychological conditions as well as understand the root of the behavior, instead of just addressing the visible symptoms. Remember, getting rid of the extraneous items doesn’t relieve the underlying problem.

What to Look for When Finding a Therapist.

When looking for a therapist, finding one with experience in hoarding is ideal, but since this is a rather new condition, a therapist with experience in obsessive-compulsive behavior, or anxiety disorders, is often qualified to handle most hoarding cases. Search TherapyTribe.com to find your therapist.


Mayo Clinic Staff (2018). Hoarding Disorder. Retrieved on June 13, 2019, from https://www.mayoclinic.org/diseases-conditions/hoarding-disorder/symptoms-causes/syc-20356056

Hoarding disorder. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. http://www.psychiatryonline.org. Accessed June 13, 2019.

Tolin DF, et al (2015). Cognitive behavioral therapy for hoarding disorder: A meta-analysis. Depression and Anxiety. 32:158.