Hoarding Therapy

What Is Hoarding Disorder?

According to the American Psychiatric Association (APA, 2024), people with hoarding disorder have “persistent difficulty getting rid of or parting with possessions due to a perceived need to save the items.” 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 hoarded possessions. However, hoarding disorder is a mental health condition in its own right. Since 2013, it has been grouped with obsessive-compulsive disorder (OCD) and related disorders (APA, 2013).

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

Some cases of hoarding can be severe, and others mild. It becomes a problem when hoarding impacts your life and affects your functioning and health.

Almost everyone knows someone who has trouble letting go of possessions they no longer use. There is no known cause for hoarding disorder, although studies have shown that there may be links between hoarding and depression, anxiety disorders, social isolation, stress, and alcohol use disorder (APA, 2024; Mayo Clinic, 2023). How common hoarding is has helped bring attention to it as a serious mental health condition. Until the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) was released in 2013, it wasn’t a separate diagnosis, and people who hoarded were usually diagnosed with other conditions, such as OCD (APA, 2013).

About 2.6% of people have hoarding disorder, with higher rates in adults over 60. Symptoms usually begin between ages 15 and 19 and tend to get worse with each decade (APA, 2024).

Hoarding often occurs alongside depression, anxiety, and attention deficit hyperactivity disorder (ADHD). For some people, hoarding begins or gets worse after stressful or traumatic events involving loss, such as a death in the family, loss of a job, divorce, or abuse (Fontenelle et al., 2021; Mayo Clinic, 2023). Hoarding is also more common in people who have other mental health conditions (APA, 2024).

Many people who hoard are private and may withdraw from others. 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. Mold, dust, and ammonia from human or pet waste can harm health, and clutter raises the risk of falls and of injury from shifting or collapsing piles (Mayo Clinic, 2023). In addition, the increasing weight of accumulated possessions can cause structural damage or even the collapse of otherwise strong structures.

Symptoms of Hoarding

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

Signs of hoarding include (Mayo Clinic, 2023):

• Buying or taking donated items that the person doesn’t need or have space for
• Having a tough time throwing away or giving away things, even if they have little monetary value
• Having the compulsion to save items and becoming upset when thinking of having to give them away
• Clutter that makes rooms, such as bedrooms or bathrooms, unusable
• 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
• Trouble organizing, planning, and making decisions

Hoarding can be confused with collecting, but the two are different. 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 (APA, 2024). They also do not create health risks to the individual.

Methods Used in Therapy for Hoarding

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

Hoarding disorder can be treated in several ways. Cognitive behavioral therapy (CBT) designed for hoarding has the strongest research support. It helps people make decisions about their things, let go of items with less distress, and build organizing skills. Research on medication is limited, so it is usually considered only after therapy has been tried (APA, 2024). In a review of CBT studies, symptoms improved a great deal, especially difficulty discarding, and more sessions and more home visits were linked to better results. Many people still had some symptoms after treatment, which is one reason ongoing support matters (Tolin et al., 2015).

The treatment program is often long and relatively slow-moving, as people who hoard often feel intense anxiety about letting go of things. Moving slowly and altering behaviors at a speed they are comfortable with is often the most effective way to overcome hoarding disorder.

The complications when treating hoarding disorder are often magnified by the person not believing that the behavior is a problem. Therapists typically work to address the problem by earning the patient’s trust, then slowly working to help them see how hoarding is affecting their life before working out a step-by-step plan to change the behaviors at their core. Addressing the issue and then slowly working to address the behavior, instead of just getting rid of the hoarded possessions, helps to keep it from happening again once the patient is finally ready to discard items.

How Family and Friends Can Help

Cleaning out a loved one’s home without their agreement can be very upsetting and rarely helps in the long run (International OCD Foundation [IOCDF], 2024). Instead, start by talking about safety, pointing to specific risks such as blocked exits or fire hazards, rather than focusing on the clutter itself. You also should not enable the hoarding, for example, by paying for extra storage. Speak with respect and without judgment. Remember, change often comes in small steps, so look for overall progress rather than day-to-day changes (IOCDF, 2024).

Why Hire a Therapist?

Hoarding is a compulsion that primarily affects people who don’t necessarily see it as a problem. Cleaning out someone’s home or forcing them to remove particular 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 critical.

People who hoard 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 hoarding disorder for help. They can help your loved one with any underlying psychological conditions and understand the root of the behavior instead of just addressing the visible symptoms. Remember, removing extraneous items doesn’t relieve the underlying problem.

If clutter is creating an immediate danger, such as a fire hazard or blocked exits, call 911 or your local emergency number. If you’re in crisis or thinking about suicide, call or text 988 (US and Canada), or see our crisis helplines for other countries.

What to Look for When Finding a Therapist

When looking for a therapist, finding one with experience in hoarding is ideal, but since hoarding disorder has only been a separate diagnosis since 2013, a therapist with expertise in obsessive-compulsive behavior, or anxiety disorders, is often qualified to handle most hoarding cases. Search TherapyTribe for a therapist who treats hoarding today. Don’t wait to get the help you need.

References

American Psychiatric Association. (2013). Obsessive-compulsive and related disorders [Fact sheet]. https://web.archive.org/web/20260204115557/https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM-5-Obsessive-Compulsive-Disorder.pdf

American Psychiatric Association. (2024). What is hoarding disorder? https://www.psychiatry.org/patients-families/hoarding-disorder/what-is-hoarding-disorder

Fontenelle, L. F., Muhlbauer, J. E., Albertella, L., & Eppingstall, J. (2021). Traumatic and stressful life events in hoarding: The role of loss and deprivation. European Journal of Psychotraumatology, 12(1), Article 1947002. https://doi.org/10.1080/20008198.2021.1947002

International OCD Foundation. (2024). How to help a loved one with HD. https://hoarding.iocdf.org/for-families/how-to-help-a-loved-one-with-hd/

Mayo Clinic. (2023, January 26). Hoarding disorder: Symptoms and causes. https://www.mayoclinic.org/diseases-conditions/hoarding-disorder/symptoms-causes/syc-20356056

Tolin, D. F., Frost, R. O., Steketee, G., & Muroff, J. (2015). Cognitive behavioral therapy for hoarding disorder: A meta-analysis. Depression and Anxiety, 32(3), 158–166. https://doi.org/10.1002/da.22327