Hoarding Disorder: Symptoms, Causes, Treatment, and Diagnosis

Hoarding disorder is a psychological condition characterized by the persistent difficulty discarding or parting with possessions because of a perceived need to save them resulting in excessive accumulation of items regardless of actual value. Even the thought of parting or getting rid of the items can lead to distress.

People with hoarding disorder may have cramped living conditions due to excessive accumulation of items that may fill the home to its capacity. Some people also collect animals, keeping dozens or hundreds of pets and don’t care for them enough to maintain good sanitation.

Hoarding disorder may range from mild to severe with varying extent of impact in his or her life.

People with hoarding disorder often do not realize their problem and do not feel the need of treatment. To make such people realize and understand their compulsion, intensive treatment is necessary.

Clutter and difficulty discarding things is usually the first sign and symptom of hoarding disorder which often occurs during teenage and tends to become severe by middle age.

The emotions, thoughts and behavior of a person are highly affected by hoarding disorder.

Following may be some signs and symptoms of hoarding disorder:

Persistent inability to part with any possession, regardless of its value.
Excessive attachment to possessions, including discomfort letting others touch or borrow them or distress at the idea of letting an item go.
Cluttered living spaces, making areas of the home unusable for the intended purpose, such as not being able to cook in the kitchen or use the bathroom to bathe.
Keeping stacks of newspapers, magazines or junk mail.
Letting food or trash build up to unusually excessive, unsanitary levels.
Acquiring unneeded or seemingly useless items, such as trash or napkins from a restaurant.
Difficulty managing daily activities because of procrastination and difficulty making decisions.
Moving items from one pile to another, without discarding anything.
Difficulty organizing items, sometimes losing important items in the clutter.
Shame or embarrassment.
Limited or no social interactions.

People with hoarding disorder typically save items because:

They believe such items will be useful in future.
They might be emotionally connected with such items such as reminders of happy times or beloved person or pets.
They feel secure being surrounded by the saved items.

Hoarding disorder differs from collecting such that those involved in collecting (stamps, model cars etc.) search out for specific required items, categorize them to be displayed beautifully. Unlike hoarding disorder, collections are not cluttered and no distress and impairment is experienced on letting go of collected items.

Hoarding animals
Some people hoard dozens or even hundreds of animals or pets, confined inside or outside, making it impossible to care for them properly and maintain adequate sanitation questioning the health and safety of both person and animals.

When to see a Doctor
It is recommended to see the doctor when the symptoms of hoarding disorder are manifested.

Agencies that help with hoarding disorder can be consulted. Local authorities such as police, fire, public health, child protective services or animal welfare agencies, can also be contacted especially when health or safety is in question.

Till date the causes of hoarding disorder have not been explained.

Genetics, brain chemistry and stressful life events have been thought as possible causes.

You may be recommended to consult a mental health care provider such as a psychiatrist or psychologist, experienced in diagnosing and treating hoarding disorder.

People with hoarding disorder symptoms do not realize the behavioral problem they are experiencing. Efforts from family or friends or a mental health care provider is required to prepare them for conversation and help them realize their problems.

Following can help in the diagnosis of hoarding disorder:

Collecting history such as
- Key personal information, including traumatic events in your past, such as divorce or the death of a loved one.
- Medical information, including other physical or mental health conditions with which you've been diagnosed.
- Any medications, vitamins, or other herbal products or supplements you take, and their dosages.
A thorough psychological evaluation to rule out presence of other psychological disorders such as obsessive-compulsive disorder (OCD), depression or anxiety disorder. Hoarding disorder has been found to be common in people with above mentioned disorders.
Criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association should be met to confirm the diagnosis of hoarding disorder.

Diagnostic criteria for hoarding disorder include:

Difficulty throwing out or parting with your things, regardless of actual value.
Feeling a need to save these items, and the thought of discarding them upsets you.
Cluttered living areas because of accumulation of possessions making the space unusable for intended purpose.
Hoarding can cause significant distress or problems functioning at work, socially or in other important areas, such as home.

Another medical condition, such as a brain injury, or another mental disorder symptom, such as decreased energy from major depression may not be lead to hoarding disorder.

The people with hoarding disorder may not feel the need of treatment especially when their possessions or animals offer them comfort which makes the treatment more challenging. When the items or animals are taken away, they may start to collect them more in order to compensate the emotional needs.

Hoarding disorders can be treated by psychotherapy and medications.

Psychotherapy

Psychotherapy, also called talk therapy, is considered as the primary treatment. Among different forms of psychotherapy, the cognitive behavior therapy is the most common one used to treat hoarding disorder.

As part of cognitive behavior therapy, you may:

Explore the reasons behind your compulsion
Learn to organize, categorize and prioritize possessions to help you decide either keeping or discarding them.
Improve your decision-making and coping skills
Declutter your home during in-home visits by a therapist or professional organizer
Learn and practice relaxation skills
Attend family or group therapy
Have periodic visits or ongoing treatment to maintain healthy habits

Medications

Medications can be an effective way of treatment for hoarding disorder. Medications used are selective serotonin reuptake inhibitors (SSRIs), a type of anti-depressants.

Since the causes of hoarding disorder have not been fully understood, there are no known methods for its prevention.

However, initiating the treatment early may help prevent hoarding from becoming severe.

Lifestyle modifications are necessary in order to cope with hoarding disorder.

Following can be some of the ways to help reduce hoarding and care for yourself better.

Adhere to the treatment plans so that the effectiveness can be analyzed.
Maintain personal hygiene. Remove possessions piled in your tub or shower, so that it serves the intended purpose.
Maintain proper nutrition.
Try involving yourself with others to prevent loneliness and isolation.
Consider joining support groups to help learn about behavior and resources.
Keep yourself focused on your goals.
For those who hoard animals, trying seeking help from others to do best for your pets and provide them with proper nutrition, sanitation and veterinary care.
Accept assistance to understand your behavior and make necessary modification.
Seek help from local resources, professional organizers and loved ones for decision making, staying organized and keep home uncluttered to stay safe and healthy.

There are several risks and complications associated with hoarding disorder.

People of all ages, sexes or economic condition can be affected by hoarding disorder. It is difficult to determine the incidence of hoarding disorder probably because some people never seek treatment.

Following are some factors that increase the risk of people to get hoarding disorder.

Age: Hoarding usually starts around the age of 11 to 15, and it worsens with age. Younger children may show activities like saving items, such as broken toys, pencil nubs, outdated school papers and broken appliances. Hoarding has been found to be more common in older adults than in younger adults.
Personality: People with hoarding disorder usually have a temperament that includes indecisiveness.
Family history: Strong association has been established between having a family member with hoarding disorder and having the disorder yourself.
Stressful life events: Difficulty in coping with certain stressful life events such as the death of a loved one, divorce, eviction or losing possessions in a fire can lead to hoarding disorder.
Social isolation: People with hoarding disorder have been found to be socially withdrawn and isolated. In many cases, social isolation is the result of hoarding. But, in some cases, hoarding offers comfort because they're lonely.

Hoarding disorder can result in a variety of complications, some of which are mentioned below: