Key facts

• Hoarding disorder is when you find it difficult and distressing to get rid of material possessions.
• It results in cluttered, disorganised living spaces.
• Hoarded items tend to be of low financial value and in poor condition.
• Collecting things and having hoarding disorder are not the same.
• Cognitive behavioural therapy (CBT) can help with the hoarding behaviour and the distress associated with this.

What is hoarding disorder?

Hoarding disorder is when you have significant and often irrational difficulty letting go of things or throwing things out, regardless of their value. You may want to save the items for future use, and there is a lot of distress associated with discarding them.

This leads to an accumulation of possessions and rubbish that clutter your living areas.

Hoarding disorder is a recognised mental illness, which progressively gets worse.

People with hoarding disorder may have a lack of insight into their condition and often have a lot of shame related to their situation.

If you have hoarding disorder, you may not be able to recognise that:

• you have a problem or if you do you may not know what to do about it
• you cannot use your surroundings due to the clutter

What’s the difference between collecting and hoarding?

Many people collect things as a hobby — from stamps to magazines to teacups. But there are differences between collecting and hoarding.

People who collect things are more likely to display or store their collection in a specific place. Collectors are also more likely to use or enjoy their collection.

By comparison hoarders tend to:

• keep things because they believe they have a use in the future — but often these things aren’t used
• keep things in a disorganised way, with no specific way of storing them

With hoarding, your belongings tend to take over large areas of your home.

People with hoarding disorder accumulate possessions because it is upsetting to get rid of them.

There is little association between collecting and hoarding disorder.

The reasons why people begin to hoard are not fully understood. It can be a symptom of another condition. Sometimes hoarding may be due to:

• mobility problems
• intellectual impairment or the development of dementia
• mental health problems

Hoarding disorder often starts early in life. It is associated with some personality traits, such as:

• perfectionism
• difficulty being able to make decisions
• procrastination (delaying tasks until later, often by finding distractions)

Perfectionism in hoarding is associated with fear of making mistakes, losing or misplacing a specific item and of later regret.

Related conditions

People with hoarding disorder may have another illness, such as:

• acquired brain injury
• autism spectrum disorder
• attention deficit hyperactivity disorder
• obsessive-compulsive disorder
• schizophrenia

Almost anything can be hoarded. However, items hoarded are often:

• of low financial value such as newspapers
• in poor condition, such as take away containers
• relatively easy to get if needed
• unlikely to be seen as meaningful by other people

What sort of things do people hoard?

Someone with hoarding disorder may accumulate anything, but common items include:

• clothing
• ornaments
• broken items — for spare parts or to repair them
• kitchenware
• car parts
• old bills
• newspapers
• magazines, books and brochures

Items inherited from a deceased estate may be especially problematic. This is because they can be numerous, sentimental, and associated with grief and loss.

Animal hoarding

Animals can be hoarded too, especially small domestic ones, such as:

• cats
• rabbits
• dogs
• birds

Animal hoarding can easily lead to squalor. Both animal food and animal waste easily mount up. People in the house can be at risk of:

• parasites
• zoonotic disease — diseases that can be caught from the animals

The person may believe they are caring for the animals. But in reality, they may not be doing this very well.

When should I see my doctor?

See a doctor or mental health professional if you think that you or a family member has signs of hoarding disorder.

Your doctor should be able to refer you to a psychologist with experience in hoarding disorders. They can also advise you on other services that may be able to help.

Your doctor will also be able to check that any other physical health conditions are recognised and being treated.

Cognitive behavioural therapy (CBT) is the recommended treatment for hoarding disorder.

CBT encourages you to talk about how you think about:

• yourself
• the world
• other people

It also explores the relationship between your behaviour, thoughts and feelings.

CBT can help reduce how bad the hoarding disorder is. It will help you to work on:

• goal setting
• organising and problem solving skills
• sorting and getting rid of things
• reality checking

At the end of treatment, you will have a better understanding of the problem.

Some antidepressants have shown some benefits in hoarding disorder, but the evidence for their use isn’t strong.

How to help someone with hoarding disorder

Helping someone with hoarding disorder is stressful and takes patience and understanding.

It's usually not a good idea to:

• criticise the person
• use blunt, negative language — such as this place is a dump
• clear the rubbish away

This won't solve the problem and the clutter often builds up quickly again.

You can encourage them to seek help and offer support. SANE Australia has useful tips to help someone who hoards.

Hoarding can make it hard to move around your home.

This can make it hard to:

• clean your home
• maintain your personal hygiene — because you can’t get to the toilet or washing facilities
• have visitors
• allow trades people in for essential repairs

You may not be able to sleep in your bed, because it is covered in things.

Hoarding can also lead to safety risks. Hoarding can:

• be a fire risk
• attract insects and rodents
• cause trips and falls

If the piles of things collapse, you may become trapped.

Hoarding disorder can lead to squalor — which is living in an unsanitary environment.

You may have seen reality TV shows about people who hoard mail, gadgets, cats, and even trash. Or, maybe for you, the reality is a little closer. It could be a neighbor or a family member.

When people aren’t able to throw things away, piles can grow to the ceiling. These piles can make it impossible to use bathrooms, bedrooms, and kitchens.

The piles may fall over, trap, and injure people. They can catch on fire. Cluttered homes and yards may attract pests. Neighbors may call the police. Parents may lose custody of children.

People don’t choose to be hoarders. And they aren’t being sloppy or lazy. “This is a very real mental disorder,” says hoarding disorder expert Dr. David F. Tolin of Hartford Hospital’s Institute of Living. “It is important to recognize that people with hoarding disorder have lost control of their decision-making abilities.”

Tolin’s NIH-funded research suggests why it’s hard for people with this disorder to part with items, even things with no real-world value. He found that brain activity was different between people with hoarding disorder and healthy people.

“We’re always puzzled by the fact that many people with hoarding disorder often don’t seem terribly bothered by their circumstance,” he says. “If they don’t have to make a decision, the parts of their brain that are largely in charge of becoming bothered are underactive.”

But if they are forced to decide about whether to discard something, that part of the brain becomes overactive. “And so, the brain is essentially screaming that everything is important.”

Doctors don’t know what causes hoarding disorder. There’s no X-ray or blood test for a diagnosis. Instead, doctors assess how well people are functioning in their lives.

Hoarding disorder can start during a person’s teens or later. It may grow more severe over the decades.

Do you know someone who may need help? For ideas about how to bring up the topic, see the Wise Choices box. Try to be gentle, calm, and patient. It may take several conversations before the person agrees to work on the problem.

Try not to start an argument. “If a person is not really motivated to do something about the problem, they can dig in their heels. Arguing can even make the problem worse,” Tolin warns.

There’s no effective medication for hoarding disorder, although studies are in progress. Tolin says, “Right now, cognitive behavioral therapy is the only evidence-based treatment we have for hoarding.” This is a type of talk therapy that teaches people how to change their thinking patterns and react differently to situations.

Tolin’s team hopes to improve cognitive behavioral therapy so that it’s even better at helping people to discard items. They’re analyzing the brain activities of people before and after they’re successfully treated for hoarding disorder. If the research team can identify the biological mechanisms of successful treatments, they may be able to develop treatments that are even better.

Some people with hoarding disorder are helped by joining a support group with others who have the disorder. There are also organizing professionals who specialize in helping people get rid of clutter.

How to Help a Person Who Hoards

Explain why you’re concerned:

• “I’m worried that you could fall or become trapped.”
• “I’m concerned that you may lose custody of your children.”
• “I’m afraid your home will catch on fire.”

Then say how to get help:

• “I can help you find a therapist who specializes in hoarding.”
• “We can look for a self-help program on how to let things go.”
• “We can find support groups for people who hoard.”
• “We can ask the county for resources.”