Hoarding

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 often in unsanitary conditions.

Hoarding, also called compulsive hoarding and compulsive hoarding syndrome, may be a symptom of obsessive-compulsive disorder (OCD). But many people who hoard don't have other OCD-related symptoms.

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 safer, more enjoyable lives.

Symptoms

In the homes of people who are compulsive hoarders, the 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 or napkins from a restaurant
• Difficulty managing daily activities, including procrastination and trouble making decisions
• Difficulty organizing items
• Shame or embarrassment
• Excessive attachment to possessions, including discomfort letting others touch or borrow possessions
• Limited or no social interactions

People who hoard typically save 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 save.

It's important to note that hoarding is different from collecting. People who have collections, such as stamps or model cars, deliberately search out specific items for their collections. Collectors often categorize their items and carefully display them. Hoarders, on the other hand, will save random items they encounter in their daily life and store them haphazardly in their homes or surrounding areas.

Hoarding animals
People who hoard animals may collect dozens or even hundreds of pets. Animals may be confined inside, so they can be 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, symptoms are often severe and may be more 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 in question.

Causes

It's not clear what causes hoarding. The condition is far more likely to affect those with a family history of hoarding, so genetics and upbringing are likely among the triggering factors.

Risk factors

Hoarding can affect anyone, regardless of age, sex or economic status. It's not clear, though, how common hoarding is. 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 13 or 14, and it tends to get worse with age. Hoarding may even start earlier than the teen years. Younger children may start saving items, such as broken toys, pencil nubs, outdated school papers and broken appliances.
• Family history. There is a very strong association between having a family member who is a compulsive hoarder and becoming a hoarder yourself.
• 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.
• A history of alcohol abuse. About half of hoarders have a history of alcohol dependence.
• 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.

Complications

Hoarding can cause a variety of complications, including:

• Unsanitary conditions that pose a risk to health
• Increased risk of falls
• An inability to perform daily tasks, such as bathing or cooking
• Poor work performance
• Family conflicts
• 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 remember 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 any other questions that may occur to you during your appointment.

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 appears to be more common in people with psychological disorders, such as alcohol dependence, obsessive-compulsive disorder, depression, anxiety and attention-deficit hyperactivity disorder.

To help diagnose compulsive hoarding 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.

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 difficulty accomplishing 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 or possessions are taken away will often quickly collect more to help fulfill emotional needs.

Try to find a therapist or other mental health provider who has experience in treating hoarding. While therapy can be intense and time-consuming, 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 a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs), such as paroxetine (Paxil). However, not everyone responds to this treatment.

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 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.

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.