Hoarding disorder is a pattern of behaviour that is characterised by excessive acquisition and an inability or unwillingness to discard large quantities of objects that cover the living areas of the home and cause significant distress or impairment.
Signs and Symptoms:
- They hold onto a large number of items that most people would consider useless or worthless, such as:
- Advertising mail, old catalogues, magazines, and newspapers
- Worn out cooking equipment
- Things that might be useful for making crafts
- Clothes that might be worn one day
- Broken things or trash
- “Freebies” or other promotional products
- Their home is cluttered to the point where many parts are inaccessible and can no longer be used for intended purposes. For example:
- Beds that cannot be slept in
- Kitchens that cannot be used for food preparation
- Tables, chairs, or sofas that cannot be used for dining or sitting
- Unsanitary bathrooms
- Tubs, showers, and sinks filled with items and can no longer be used for washing or bathing
- Their clutter and mess are at a point where it can cause illness, distress, and impairment. As a result, they:
- Do not allow visitors in, such as family and friends, or repair and maintenance professionals, because the clutter embarrasses them
- Are reluctant or unable to return borrowed items
- Keep the shades drawn so that no one can look inside
- Get into a lot of arguments with family members regarding the clutter
- Are at risk of fire, falling, infestation, or eviction
- Often feel depressed or anxious due to the clutter
The DSM-5 diagnostic criteria for hoarding disorder are:
- Persistent difficulty discarding or parting with possessions, regardless of the value others may attribute to these possessions. (The Work Group is considering alternative wording: “…, regardless of their actual value.”)
- This difficulty is due to strong urges to save items and/or distress associated with discarding.
- The symptoms result in the accumulation of a large number of possessions that fill up and clutter active living areas of the home or workplace to the extent that their intended use is no longer possible. If all living areas become decluttered, it is only because of the interventions of third parties (e.g., family members, cleaners, authorities).
- The symptoms cause clinically significant distress or impairment in social, occupational, or other critical areas of functioning (including maintaining a safe environment for self and others).
- The hoarding symptoms are not due to a general medical condition (e.g., brain injury, cerebrovascular disease).
- The hoarding symptoms are not restricted to the symptoms of another mental disorder (e.g., hoarding due to obsessions in Obsessive-Compulsive Disorder, decreased energy in Major Depressive Disorder, delusions in Schizophrenia or another Psychotic Disorder, cognitive deficits in Dementia, restricted interests in Autism Spectrum Disorder, food storing in Prader–Willi syndrome).
People hoard because they believe that an item will be useful or valuable in the future. Or they feel it has sentimental value, is unique and irreplaceable, or too big a bargain to throw away. They may also consider an item a reminder that will jog their memory, thinking that without it they won’t remember an important person or event. Or because they can’t decide where something belongs, it’s better just to keep it.
Hoarding is a disorder that may be present on its own or as a symptom of another disorder. Those most often associated with hoarding are obsessive-compulsive personality disorder (OCPD), obsessive-compulsive disorder (OCD), attention-deficit/hyperactivity disorder (ADHD), and depression.
Those who have suffered a traumatic loss may be more likely to become hoarders than those who haven’t. Some people develop hoarding tendencies after experiencing a stressful life event that they had difficulty coping with, such as the death of a loved one, divorce, eviction or losing their possessions in a fire.
Cognitive behavioural therapy (CBT) is the most effective psychological treatment. It can help you to change the thoughts and feelings that drive you to hoard.
The therapist will help you understand what makes it difficult for you to throw things away. You then agree to not hoard more items during the treatment. There is no point clearing things away if you replace them with others. You and your therapist start clearing out items together. You will find that the longer you spend thinking about it, the more difficult it becomes. The therapist helps you to look at your thoughts and feelings about possessions. As hoarding has often been going on for years, treatment can take a long time. The aim is to use the 3 Rs – Reduce, Recycle and Reuse.
SSRIs are also used to help people who hoard. Selective serotonin reuptake inhibitors (SSRIs) are antidepressant medications which are used to help anxiety and obsessional problems. Improvement usually happens slowly over weeks or even months.
Research continues into other medications which might be helpful in hoarding disorder. One group of drugs blocks the action of dopamine, a chemical in the brain. They can be used with SSRI medication if the SSRI alone does not seem to be helping enough.