Hoarding Disorder

What Is Hoarding?

Hoarding was previously considered a subtype of obsessive-compulsive disorder (OCD); however, hoarding refers to a disorder in which someone has difficulty getting rid of items, regardless of actual value. The hoarding definition provided by the American Psychiatric Association further clarifies that it is a persistent problem of getting rid of possessions that can lead to clutter and disrupt someone’s ability to use their living or work spaces.

Compulsive hoarding is different from collecting because the items are not displayed, nor do they necessarily have any value. Hoarding can lead to the excessive accumulation of items. Eventually, a person with hoarding disorder may not be able to move freely through their space.

Until recently, hoarding disorder did not receive much attention. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) previously listed hoarding disorder as a subtype or feature of other disorders. The most recent update of the DSM-5 placed hoarding disorder as its own category.

Common Types of Hoarding

Hoarding may take many forms and can lead to different outcomes based on what types of items someone is hoarding. The motivations behind hoarding may also differ between various types of hoarding. Some common types include animal hoarding, book hoarding and food hoarding.

Animal Hoarding

Animal hoarding most often begins with good intentions of rescuing animals from shelters or bringing in stray animals. Someone who hoards animals is likely to accumulate more animals than they can properly take care of. Instead of giving away some of their animals, they continue to acquire new animals. Two of the most common forms are cat hoarding and dog hoarding. However, a person can hoard any animal.

Book Hoarding

People who engage in book hoarding justify their hoarding by expressing a need to have the information on hand. People with this type of hoarding, sometimes called bibliomania, save books, papers and files, even if it’s highly unlikely that they will ever use them again.

Shopper Hoarding

Shopper or shopping hoarding occurs when someone keeps every item they’ve purchased even if they don’t use it. The objects shopper hoarders may have can be anything — food, clothing, photos, televisions, collectibles, etc. These purchases typically remain unopened and still in their packages with price tags attached.

Food Hoarding

This kind of hoarding is particularly wasteful. Food hoarding is when someone brings home bags of groceries or excessive amounts of food when their refrigerator and cupboards are already full. The food may rot, attract rodents and bugs, and breed viruses or germs. In addition to buying excessive amounts of food, people with food hoarding disorders usually don’t throw away the food either. It’s not uncommon for food hoarders to have rotted food in piles around their house.

Trash Hoarding

People with trash hoarding disorders not only save or keep piles of garbage, but they often go through other people’s trash to find their own treasures that they’ll bring back to their house. Rodents and other pests will most likely appear because of the rotting trash. Pests and vermin can create additional problems for someone with trash hoarding because of the diseases they carry or breed from their waste.

Paper Hoarding

People living with a paper hoarding disorder keep all types of paper like bills, invoices, books, magazines, coupons, junk mail, photos, report cards, receipts, recipes, etc. Hoarding paper can be a fire hazard, and if a pile becomes large enough, a dangerous hazard that could fall on someone.

Symptoms of Hoarding

Hoarding symptoms include the inability to discard possessions and experiencing significant anxiety at the thought or attempt to discard items. A person with hoarding disorder likely has difficulty keeping their possessions organized and may feel embarrassed over the disorder of their living spaces.

Obsessive thoughts and compulsions are sometimes present, like when a person compulsively stockpiles items with the fear of running out or refuses to throw away any trash for fear it will be needed one day.

How Is Hoarding Disorder Diagnosed?

Hoarding disorder is an official mental health diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), meaning that a licensed mental health professional will diagnose the condition. This could be a psychologist, psychiatrist, clinical social worker or professional counselor.

Diagnostic criteria for hoarding disorder include:

• Ongoing difficulty with getting rid of possessions, even when they are not valuable.
• Belief that items need to be saved, leading to distress over parting with them.
• Distress over getting rid of possessions leads to clutter and congestion that makes living areas unusable.
• Hoarding results in significant distress and leads to difficulty functioning in daily life, such as in social situations, at work or regarding their personal safety.
• The hoarding is not a consequence of another medical problem, such as a brain injury, and it is not a direct result of a mental health condition, such as low energy with depression.

About 80–90% of individuals with hoarding disorder will meet the criteria for “excessive acquisition.” This means they will hoard an unreasonable amount of items that are unneeded or that they don’t have space for.

There are also various levels of insight associated with hoarding disorder. For instance, some hoarders may have good insight, meaning they recognize their hoarding behaviors are problematic. Others will have poor insight; they’ll mostly deny that hoarding is a problem, despite mounting evidence. In the worst case, someone may have delusional or absent insight, in which they are entirely sure that their hoarding behavior is not a problem.

The Five Stages of Hoarding

The Institute for Challenging Disorganization (ICD) categorizes hoarding into five stages based on the hoarding behaviors’ severity. 

Stage 1:

The first stage of hoarding is the least severe. The residence of a stage one hoarder may include:

• Light amounts of clutter and no noticeable odors
• Accessible doors, windows and stairways
• Safe and sanitary conditions with no odors

Hoarding level one involves few signs that an individual has a hoarding disorder. The lack of clutter might hide the condition, but the individual may still have difficulty discarding items and shop excessively for objects they do not need.

Stage 2:

Hoarding stage two is slightly more severe, with at least one household appliance, such as a stove, not functioning and at least one major exit to the house blocked. Compared to level one hoarding, stage two hoarding occurs when clutter begins to build up in the home. Housekeeping becomes inconsistent, involving an odor from dirty dishes and a lack of cleaning. Additional signs of hoarding stage two include:

• Visible animal waste or odor from waste
• Some evidence of household pests
• Congestion in household entrances, exits, hallways and stairways
• Carbon monoxide detectors non-functional
• Some presence of mildew

People within hoarding level two may avoid inviting people to their house or feel embarrassed by their home’s state. This stage of hoarding may cause anxiety or a depressed state and lead to the person withdrawing from social interaction.

Stage 3:

Residences within hoarding stage three have visible clutter outside their home because items that are usually indoors have made their way outdoors. Multiple household appliances are non-functional, and one area of the house has light structural damage. The number of pets exceeds regulations, and animal control and sanitation are inadequate. Other characteristics include:

• Clutter makes certain areas of the home unusable, and at least one space in the home, such as a bathroom, is not functional
• Heating and air-conditioning devices unusable for more than one season
• Evidence of improper sanitation, such as overflowing garbage cans, dirt and debris throughout the house, and obvious, irritating odors
• A light bug infestation and/or moderate evidence of spiders in the home

A person within this stage often has poor personal hygiene and weight issues due to an unhealthy diet. An individual in this level of hoarding may become dismissive or angry when approached by friends or family members about the state of their home.

Stage 4:

Residences within hoarding level four have noticeable mold and mildew throughout the building, structural damage that is at least six months old, odors and sewage buildup, and evidence of water damage, damaged walls or broken windows. The number of pets in the home exceeds regulations, and animal sanitation is poor. There is so much clutter in the home that doorways, hallways and stairs are inaccessible. The following are additional indicators of hoarding stage four:

• Rotting food in the home
• Expired cans and bottles
• No usable dishes and utensils
• Infestation of beds and furniture
• Excessive presence of spiders and webs
• Hearing bats and other rodents in the attic and walls
• Flammable substances stored in the living room

People within hoarding level four tend to have poor hygiene and may not bathe for weeks. These individuals often have worsening mental health and focus their emotional energy on grandiose plans or nostalgic memories.

A 2015 study published by the American Psychiatric Association found that mental health conditions like depression, ADHD and generalized anxiety disorder are common among individuals with hoarding disorder. Study results showed that obsessive-compulsive disorder (OCD) and social anxiety were common among men with hoarding disorder. In general, those who rise to hoarding stage four are likely to experience another mental disorder.

Stage 5:

Hoarding stage five, the most severe type of hoarding disorder, involves severe structural damage to the residence. Broken walls, no electricity or running water, fire hazards, and visible rodents and other non-pet animals are a few of the characteristics of homes within hoarding stage five. Other signs include:

• Clutter filling bathrooms and kitchen, to the point that no rooms are usable
• Animals at the property present a risk to people due to their poor health and behavior
• Heavy infestation of spiders, rodents, bed bugs, fleas, cockroaches, etc.
• Noticeable human feces
• Rotting food on surfaces and inside a non-working refrigerator

People within hoarding level five often do not live at their residence because of the clutter. Instead, they may stay at a friend or family member’s house. They may also discharge their waste into bottles or buckets that remain inside the home. Individuals within this stage of hoarding usually have noticeable symptoms of depression. At this stage of hoarding, people often find themselves involved in legal proceedings to condemn their properties.

Measuring Hoarding Severity

The ICD ranks the severity of a person’s hoarding disorder by evaluating factors such as:

• Whether household appliances are functioning
• The accessibility of windows and doors
• The level of animal control
• The level of clutter in the home, including whether it blocks living areas
• Whether rooms in the house are usable
• The degree of bug infestation in the home
• Whether there are health hazards in the home, such as mold and mildew, rotting food, improperly stored medications and feces/urine
• The degree of clutter present outside of the home

What the ICD hoarding levels chart does not capture is the degree of anxiety associated with hoarding. Research suggests that hoarding is linked to low tolerance for distress and high anxiety sensitivity. Individuals who engage in severe hoarding behavior may do so to manage distress and anxiety.

What Causes Hoarding?

While what causes hoarding is not known, it appears to have a genetic component. People with indecisive temperaments may develop a hoarding disorder due to the difficulty of deciding what items to get rid of and which items to keep. Hoarding disorders begin to develop in adolescence but generally stay in the less severe of the five stages of hoarding during this time. Later stages of hoarding are rare in young people. Hoarding may intensify following stressful life events and continue to worsen if coping and acceptance of the stressor do not occur.

The Psychology of Hoarding

Different theories within the field of psychology have developed their own understanding of hoarding. 

Psychological Ownership Theory

Within psychological ownership theory, an individual who hoards wants to have control, express themselves and have a space that is theirs. These individuals are hyper-sentimental, meaning they have a strong emotional attachment to their possessions. They view their things as part of who they are and what they need to be safe. 

Attachment Theory

Those who follow attachment theory believe that individuals who hoard typically had relationship issues with their early primary caregivers, leading to anxious or avoidant attachment styles. These individuals go on to avoid relationships and instead seek out objects for comfort and security. They have a harder time dealing with their emotions and stress and use hoarding behaviors as a way to cope with their emotions. 

Constructivist Approach

Within the constructivist approach, individuals who hoard assign values to their items. They believe that all of their possessions serve an important purpose, such as preserving history or the memory of a loved one, providing protection and security, relieving anxiety or avoiding loneliness. 

Who Is at Risk for Hoarding?

Risk factors for hoarding disorders may include a history of brain injuries, spending significant amounts of time with people who hoard and stressful life events.

Hoarding Statistics

Researchers have concluded that hoarding is more common in older adults, though it may begin to develop in adolescence. Hoarding statistics indicate a prevalence of almost four percent of the general population. Hoarding disorders are often more common in males than females. The severity of hoarding appears to be inversely related to household income. Thus, people with lower incomes may be more likely to engage in hoarding.

What Are the Consequences of Hoarding?

Hoarding can have severe consequences for the individual and their loved ones. Excessive shopping that fuels the hoarding commonly leads to financial strain. Relationships become strained. People with hoarding disorder also risk possible loss of housing due to eviction or condemnation, depending on the severity of the disorder.

Children of people with a hoarding disorder may experience depression or another mental condition due to their living situation. Adolescents and teenagers may avoid inviting peers to their house out of embarrassment. Some children become resentful of their parents, unhappy with the unhealthy lifestyle the hoarding creates. Others may be removed from the home to escape health hazards.

Diseases Caused by Hoarding

The trash, clutter, and animal or human waste built up from hoarding can severely impact the air quality, causing respiratory problems for the residents. High levels of ammonia from the waste can also lead to respiratory distress or failure and impact brain functioning. Lack of sanitation increases the risk of infectious diseases, diarrhea and allergic reactions.

Hoarding Disorder Treatment

Hoarding disorder is a diagnosable mental health condition, and treatment is necessary to help people recover from hoarding behaviors. Individuals who hoard may be resistant to treatment, especially if they have poor or absent insight. In some cases, their capacity to refuse treatment may be limited if they are a hazard to themselves or others.

If a person refuses help for hoarding, family members and friends may consider making repeated attempts to convince them to get help, and over time, they may accept treatment. Loved ones may also decide to work with a mental health professional to learn how to best support the hoarder.

A person’s decision-making capacity is often limited in severe hoarding cases, so a family member may take guardianship and accept services on behalf of the person. This can include help with cleaning the home and mental health treatment.

Regardless of whether treatment is voluntary or the result of guardians making decisions on a hoarder’s behalf, therapy is typically needed to help people process the reasons behind their emotional connection to items. A specific type of therapy called cognitive behavioral therapy can reduce the severity of hoarding. Certain medications may also be beneficial.

If you or someone you know is struggling with a substance use disorder and a co-occurring disorder like hoarding, help is available. At The Recovery Village, a team of professionals provides treatment programs for substance use and co-occurring disorders to suit your individualized needs. Call and speak with a representative to learn more about which program could work for you.

Editor – Abby Doty

Abby Doty graduated from Hamline University in 2021 with a Bachelor's in English and Psychology. She has written and edited creative and literary work as well as academic pieces focused primarily on psychology and mental health. Read more

Medically Reviewed By – Taylor Cameron, LPC

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