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Hoarding
By Mayo Clinic staffMayo Clinic Health Manager
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Definition
Hoarding is the excessive collection of items, along with the inability to discard them. Hoarding often creates such cramped living conditions that homes may be filled to capacity, with only narrow pathways winding through stacks of clutter. Some people also collect animals, keeping dozens or hundreds of pets in unsanitary conditions.
Hoarding, also called compulsive hoarding and compulsive hoarding syndrome, can be a symptom of obsessive-compulsive disorder (OCD). But many people who hoard don't have other OCD-related symptoms, and researchers are working to better understand hoarding as a distinct mental health problem.
People who hoard often don't see it as a problem, making treatment challenging. But intensive treatment can help people who hoard understand their compulsions and live a safer, more enjoyable life.
Symptoms
In the homes of people who engage in compulsive hoarding, countertops, sinks, stoves, desks, stairways and virtually all other surfaces are usually stacked with stuff. And when there's no more room inside, the clutter may spread to the garage, vehicles and yard.
Hoarding affects emotions, thoughts and behavior. Signs and symptoms of hoarding may include:
- Cluttered living spaces
- Inability to discard items
- Keeping stacks of newspapers, magazines or junk mail
- Moving items from one pile to another, without discarding anything
- Acquiring unneeded or seemingly useless items, including trash
- Difficulty managing daily activities, including procrastination and trouble making decisions
- Difficulty organizing items
- Perfectionism
- Excessive attachment to possessions, and discomfort letting others touch or borrow possessions
- Limited or no social interactions
People who engage in hoarding typically collect items because they believe these items will be needed or have value in the future. A person also may hoard items that he or she feels have important emotional significance — serving as a reminder of happier times, for example, or representing beloved people or pets. People who hoard may report feeling safer when surrounded by the things they collect.
Hoarding animals
People who hoard animals may collect dozens or even hundreds of pets. They usually hoard animals that can be confined inside and concealed more easily. Because of their sheer numbers, these animals often aren't cared for properly. Veterinarians may be the first to notice signs of animal hoarding when owners seek help for a steady stream of sick or injured pets.
When to see a doctor
Hoarding ranges from mild to severe. In some cases, hoarding may not have much effect on your life, while in other cases it affects you on a daily basis.
Clutter and difficulty discarding things are usually the first symptoms of hoarding. These early indications of a problem usually surface during the teenage years. As an affected person grows older, he or she typically starts acquiring things for which there is no need or space. By middle age — when the condition is usually diagnosed — symptoms are often severe and difficult to treat.
If you or a loved one has symptoms of hoarding, talk with a doctor or mental health provider as soon as possible. Some communities have agencies that help with hoarding problems. Check with your local or county government for resources in your area.
As hard as it might be, you may also need to contact local authorities, such as police, fire, public health or animal welfare agencies, especially when health or safety is at stake.
Causes
It's not clear what causes hoarding. Some researchers believe that hoarding occurs on a continuum — some people may simply be considered harmless pack rats, while others have a much more severe form of collecting that is life-threatening. The condition is more likely to affect those with a family history of hoarding, so genetics and upbringing are likely among the triggering factors.
Hoarding is currently considered a subtype of obsessive-compulsive disorder (OCD), but this classification is under debate. Many mental health researchers argue that, while some people with OCD have hoarding behavior, hoarding is not specific to OCD. In fact, one study found that hoarding was no more likely to be associated with OCD than with other anxiety disorders.
Ongoing research is aimed at understanding the biological and environmental factors that seem to play a role in hoarding. The findings from these studies may lead to the classification of hoarding as a new and separate mental health disorder.
Risk factors
Hoarding can affect anyone, regardless of age, sex or economic status. It's not clear how common hoarding is, though. That's partly because researchers have only recently begun to study it and partly because some people never seek treatment.
Here are some risk factors and features about hoarding that researchers have come to understand:
- Age. Hoarding usually starts in early adolescence, around age 12, and it tends to get worse with age.
- Family history. People are more likely to hoard if they have close family members who engage in compulsive hoarding.
- Stressful life events. Some people develop hoarding 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.
- Social isolation. People who hoard are typically socially withdrawn and isolated. In many cases, the hoarding leads to social isolation. But, on the other hand, some people may turn to the comfort of hoarding because they're lonely.
- Perfectionism. People who compulsively hoard are often perfectionists. They worry about making the right decision about what to do with each possession — should they keep it or discard it? Trying to decide causes distress, so they avoid making a decision and simply keep everything.
Complications
Hoarding can cause a variety of complications, including:
- Unsanitary conditions that pose a risk to health
- An inability to perform daily tasks, such as bathing or cooking
- Poor work performance
- Loneliness and social isolation
- A fire hazard
Preparing for your appointment
If you or a loved one has symptoms of hoarding, call your doctor. He or she may immediately refer you to a mental health provider, such as a psychiatrist, with experience diagnosing and treating hoarding.
If you are calling on behalf of a friend or relative with symptoms, the mental health provider may ask to first meet alone with you to develop an approach for raising your concerns with your loved one. Many people with hoarding symptoms don't recognize that their behavior is problematic and are not motivated to seek treatment. A mental health provider can help you prepare for a conversation in which you encourage your loved one to seek help.
In order 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.
The information below can help the person with hoarding symptoms prepare for the first appointment and learn what to expect from the mental health provider.
What you can do
- Write down any symptoms you're experiencing, and for how long. It will help the mental health provider to know what kinds of items you feel compelled to save, and why.
- Write down key personal information, including traumatic events in your past, such as divorce or the death of a loved one.
- Make a list of your medical information, including other physical or mental health conditions with which you've been diagnosed. Also write down the names of any medications or supplements you are taking.
- Take a trusted family member or friend along, if possible. It can be difficult to soak up everything your mental health provider says, and a loved one can help remember the details. In addition, someone who has known you for a long time may be able to ask questions or share information with the mental health provider that you don't remember to bring up.
- Write down questions to ask your mental health provider in advance, so that you can make the most of your appointment.
For hoarding, some basic 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 do I stand to gain from 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 frequently will I need therapy sessions, and for how long?
- Are there medications that can help?
In addition to the questions that you've prepared to ask your mental health provider, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your mental health provider
The mental health provider is likely to ask you a number of questions and may also talk with your close friends and family members to gain an understanding of how hoarding is affecting your life. The mental health provider may ask:
- Do you avoid throwing things away because you believe you might need them later, or because they have emotional significance?
- How often do you decide to acquire 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, such as cooking, washing dishes or taking a bath?
- Does clutter prevent you from inviting people to visit your home?
- How does clutter in your home affect your family members?
- Does it take you a long time to perform daily tasks because of clutter or because you feel a need to do things perfectly?
- Do you have so many pets that you can't care for them properly?
- Have others encouraged you to seek professional help?
- Do you have a first-degree relative — a parent or sibling — who is a "pack rat"?
- Are you currently being treated for any other medical conditions, including mental illness?
Because other mental health disorders often go hand in hand with hoarding, your mental health provider may also ask questions to see if you may have symptoms of depression, social phobia, anxiety or other problems.
Tests and diagnosis
Hoarding isn't yet considered an official, distinct disorder. However, it can be diagnosed as a subtype or symptom of obsessive-compulsive disorder or obsessive-compulsive personality disorder.
To help diagnose obsessive-compulsive disorder, mental health providers perform a thorough psychological evaluation. They ask many questions about your obsessions, compulsions and emotional well-being and may also ask your permission to talk with your relatives and friends.
If your mental health provider believes you have symptoms of compulsive hoarding, he or she will perform a similar evaluation, with additional questions that focus on your collecting habits. You may also fill out psychological questionnaires.
To diagnose hoarding, mental health providers check for three main characteristics:
- Acquisition of a large number of possessions that others would consider useless, along with an inability to discard them
- Having an overly cluttered home or living spaces — so cluttered that living spaces can't be used as intended, such as not being able to sleep in your bed, take a bath in your tub, or prepare food in your kitchen
- Having significant distress over your hoarding or an impaired ability to accomplish your daily activities
Treatments and drugs
Treatment of hoarding is often a challenge that meets with mixed success. For one thing, many people who hoard don't recognize the negative impact of hoarding on their lives or don't believe they need treatment. This is especially true if their possessions or animals offer comfort. And people whose animals are taken away will often quickly collect more to help fulfill emotional needs.
Treatment of hoarding is also difficult because researchers aren't yet sure which treatment is best. Try to find a therapist or other mental health provider who has experience in treating hoarding. While therapy can be intense and time-consuming, perhaps taking many months or even years, it can pay off in the long run.
There are two main types of treatment for hoarding — psychotherapy and medications.
Psychotherapy
Cognitive behavior therapy is the most common form of psychotherapy used to treat hoarding. As part of cognitive behavior therapy, you may:
- Explore why you feel compelled to hoard
- Learn to organize and categorize possessions to help you decide which ones to discard
- Improve your decision-making skills
- Declutter your home during in-home visits by a therapist or professional organizer
- Learn and practice relaxation skills
- Attend family or group therapy
- Be encouraged to consider psychiatric hospitalization if your hoarding is severe
- Have periodic visits or ongoing treatment to help you keep up healthy habits
Medications
Research continues on the most effective ways to use medications in the treatment of hoarding. The medications most commonly used for hoarding are selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant.
These medications often work well for obsessive-compulsive disorder. However, studies of SSRIs as a treatment for hoarding symptoms have produced varied results. Although some research suggests that people with hoarding symptoms are less likely to respond to SSRIs, other research has found that the SSRI drug paroxetine (Paxil) may improve hoarding symptoms as well as other symptoms associated with OCD.
Prevention
Because little is understood about what causes hoarding, there's no known way to prevent it. However, as with many mental conditions, getting treatment at the first sign of a problem may help prevent hoarding from becoming severe and impairing your life.
Lifestyle and home remedies
Hoarding can cause many difficulties in treatment and self-care, especially for people who don't feel that hoarding is a problem in their lives. Whether or not you believe you need treatment for hoarding, here are some steps you can take to try to care for yourself:
- Stick to your treatment plan if you're receiving treatment. It's hard work, and it's normal to have some setbacks over time. But treatment can help you feel better about yourself and understand what's driving your hoarding.
- 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.
- 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 see friends and family.
- Look out for yourself. Remind yourself that you don't have to live in squalor and chaos — that you deserve better.
- Take small steps. If you feel overwhelmed by the volume of your possessions and the decluttering task that lies ahead, remember that you can 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.
- Focus on your goals. To keep motivated to declutter, focus on your goals — living a healthier and more enjoyable life.
- 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 you aren't doing them any favors. They also 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.
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