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Hoarding
by Mayo Clinic Staff
May 31, 2007
Definition
Hoarding is the excessive collection of items that seem to have limited or no value, such as newspapers or trash, along with the inability to discard them. Hoarding creates such cramped living conditions that entire rooms may be filled to capacity, and homes may be left with only narrow pathways winding through stacks of clutter. Some people also collect animals, keeping hundreds of dogs, cats or other animals in their homes, as filth and waste pile up and the animals become sick.
Hoarding, also called compulsive hoarding and compulsive hoarding syndrome, is thought to be connected to obsessive-compulsive disorder. But many aspects of hoarding remain a mystery, and researchers continue to learn about this recently recognized problem.
While some people poke fun at hoarding, it's no laughing matter. People who engage in hoarding put themselves and even neighbors in danger because of fire hazards, unsanitary conditions and even the real possibility of getting buried under an avalanche of junk. Treating compulsive hoarding sometimes proves difficult because people who hoard often don't see it as a problem. But intensive treatment can help people who hoard understand their compulsions and perhaps even live a safer and more enjoyable life.
Symptoms
People who hoard feel compelled to acquire or save items that others may consider worthless. They may stock up on items at garage sales or rummage through other people's trash. They often spend lots of time moving items in their home from one pile to another, without actually discarding anything. They may be so preoccupied by all their clutter and belongings that they don't socialize with family or friends.
Hoarding affects emotions, thoughts and behavior. Signs and symptoms of hoarding may include:
The homes of people who engage in compulsive hoarding usually offer telltale clues that something's wrong. Countertops, sinks, stoves, desks, stairways and virtually all other surfaces are stacked with stuff. And when there's no more room inside, the clutter may spread to the garage, vehicles and yard.
People who engage in hoarding typically collect items because they believe these items will be needed or have value in the future. They worry about not having these items on hand. They also don't want to feel as if they're wasting anything, so they save everything. For some, the piles of belongings are a source of comfort.
Hoarding animals
People who hoard animals may collect dozens or even hundreds of pets, such as cats, dogs, ferrets, rabbits, rats or other animals. They usually hoard animals that can be confined inside and concealed more easily. Because of their sheer numbers, these animals usually aren't cared for properly. Many become so ill that they die or have to be euthanized, if discovered.
Veterinarians may be the first to notice signs of animal hoarding when owners seek help for a steady stream of sick or injured pets.
Causes
It's not clear what causes hoarding. Some researchers believe that hoarding occurs on a continuum ? some people may simply be considered harmless pack rats, while others have a much more severe form of collecting that endangers their life. Hoarding is currently considered a subtype of obsessive-compulsive disorder (OCD), and it's sometimes called OCD hoarding. It may one day be classified as a separate disorder, though. Exactly what triggers hoarding compulsions and desires is still under investigation. Like OCD, it may be related, at least in part, to genetics and upbringing.
Risk factors
Hoarding can affect anyone, regardless of age, sex or economic status. It's not clear how common hoarding is, though. That's partly because researchers have only recently begun to study it and partly because some people never seek treatment. About 2.2 million Americans have obsessive-compulsive disorder, according to the National Institute of Mental Health, and some estimates suggest that about a quarter of people with OCD have compulsive hoarding.
Here are some risk factors and features about hoarding that researchers have come to understand:
When to seek medical advice
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. But because hoarding tends to get worse over time and it's hard to overcome on your own, it's important to seek medical advice.
Like others, you may be in denial that you need help for hoarding. These questions, some of which have been adapted from the UCLA Hoarding Severity Scale, can help you to decide whether you may benefit from professional help:
Consult a mental health or medical provider on your own for guidance. 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 at stake.
Tests and diagnosis
Hoarding isn't yet considered an official, distinct disorder. However, it can be diagnosed as a subtype or symptom of obsessive-compulsive disorder or obsessive-compulsive personality disorder.
To help diagnose obsessive-compulsive disorder, mental health providers perform a thorough psychological evaluation. They ask many questions about your obsessions, compulsions and emotional well-being and may also talk to relatives and friends. If your mental health professional believes you have compulsive hoarding, he or she will perform a similar evaluation, with additional questions that focus on your collecting habits. You may also fill out psychological questionnaires.
In addition, mental health providers will check for three characteristics of hoarding:
And because other mental health disorders often go hand in hand with hoarding, your mental health provider may also ask you questions to see if you may have symptoms of depression, social phobia, anxiety or other problems.
Complications
Hoarding can cause a variety of complications, including:
Treatments and drugs
Treatment of hoarding is often a challenge that comes with mixed success. For one thing, many people who hoard don't believe they need treatment. This is especially true if their possessions or animals offer comfort. And people whose animals are taken away will often quickly collect more to help fulfill emotional needs.
Treatment of hoarding is also difficult because researchers aren't yet sure which treatment is best. Try to find a therapist or other mental health provider who has experience in treating hoarding. While therapy can be intense and time-consuming, perhaps taking many months or even years, it can pay off in the long run.
There are two main types of treatment for hoarding.
Psychotherapy
Cognitive behavior therapy is the most common form of psychotherapy used to treat hoarding. As part of cognitive behavior therapy, you may:
Medications
Research continues on the most effective ways to treat hoarding with medications. The medications most commonly used for hoarding are selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant. Although these medications often work well for obsessive-compulsive disorder, their effectiveness for hoarding symptoms has been mixed.
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 and impairing your life.
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 you believe you need treatment for hoarding or not, here are some steps you can take to try to care for yourself:
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.
by Mayo Clinic Staff
May 31, 2007
Definition
Hoarding is the excessive collection of items that seem to have limited or no value, such as newspapers or trash, along with the inability to discard them. Hoarding creates such cramped living conditions that entire rooms may be filled to capacity, and homes may be left with only narrow pathways winding through stacks of clutter. Some people also collect animals, keeping hundreds of dogs, cats or other animals in their homes, as filth and waste pile up and the animals become sick.
Hoarding, also called compulsive hoarding and compulsive hoarding syndrome, is thought to be connected to obsessive-compulsive disorder. But many aspects of hoarding remain a mystery, and researchers continue to learn about this recently recognized problem.
While some people poke fun at hoarding, it's no laughing matter. People who engage in hoarding put themselves and even neighbors in danger because of fire hazards, unsanitary conditions and even the real possibility of getting buried under an avalanche of junk. Treating compulsive hoarding sometimes proves difficult because people who hoard often don't see it as a problem. But intensive treatment can help people who hoard understand their compulsions and perhaps even live a safer and more enjoyable life.
Symptoms
People who hoard feel compelled to acquire or save items that others may consider worthless. They may stock up on items at garage sales or rummage through other people's trash. They often spend lots of time moving items in their home from one pile to another, without actually discarding anything. They may be so preoccupied by all their clutter and belongings that they don't socialize with family or friends.
Hoarding affects emotions, thoughts and behavior. Signs and symptoms of hoarding may include:
- Inability to discard items
- Acquiring unneeded or seemingly useless items
- Keeping stacks of newspapers, magazines or junk mail
- Saving trash or used food containers
- Cluttered living spaces
- Impairment of daily activities
- Procrastination
- Trouble making decisions
- Perfectionism
- Difficulty organizing items
- Forming attachments to possessions rather than people
- Restricting others from touching or borrowing possessions
The homes of people who engage in compulsive hoarding usually offer telltale clues that something's wrong. Countertops, sinks, stoves, desks, stairways and virtually all other surfaces are stacked with stuff. And when there's no more room inside, the clutter may spread to the garage, vehicles and yard.
People who engage in hoarding typically collect items because they believe these items will be needed or have value in the future. They worry about not having these items on hand. They also don't want to feel as if they're wasting anything, so they save everything. For some, the piles of belongings are a source of comfort.
Hoarding animals
People who hoard animals may collect dozens or even hundreds of pets, such as cats, dogs, ferrets, rabbits, rats or other animals. They usually hoard animals that can be confined inside and concealed more easily. Because of their sheer numbers, these animals usually aren't cared for properly. Many become so ill that they die or have to be euthanized, if discovered.
Veterinarians may be the first to notice signs of animal hoarding when owners seek help for a steady stream of sick or injured pets.
Causes
It's not clear what causes hoarding. Some researchers believe that hoarding occurs on a continuum ? some people may simply be considered harmless pack rats, while others have a much more severe form of collecting that endangers their life. Hoarding is currently considered a subtype of obsessive-compulsive disorder (OCD), and it's sometimes called OCD hoarding. It may one day be classified as a separate disorder, though. Exactly what triggers hoarding compulsions and desires is still under investigation. Like OCD, it may be related, at least in part, to genetics and upbringing.
Risk factors
Hoarding can affect anyone, regardless of age, sex or economic status. It's not clear how common hoarding is, though. That's partly because researchers have only recently begun to study it and partly because some people never seek treatment. About 2.2 million Americans have obsessive-compulsive disorder, according to the National Institute of Mental Health, and some estimates suggest that about a quarter of people with OCD have compulsive hoarding.
Here are some risk factors and features about hoarding that researchers have come to understand:
- Age. Hoarding usually starts in early adolescence, around age 11 or 12, and it tends to get worse with age.
- Family history. People are more likely to hoard if they have close family members who have compulsive hoarding.
- 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, marriage, eviction or losing possessions in a fire.
- Social isolation. People who hoard are typically socially withdrawn and isolated. In many cases, the hoarding leads to social isolation. But some people may turn to the comfort of hoarding because they're lonely.
- Perfectionism. People with compulsive hoarding are often perfectionists. They worry about making the right decision about what to do with each possession ? should they keep it or discard it? Trying to decide causes distress, so they avoid making a decision and simply keep everything.
- Excessive attachment to possessions. People who hoard often form emotional bonds to their possessions. That makes it hard to get rid of unneeded items.
When to seek medical advice
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. But because hoarding tends to get worse over time and it's hard to overcome on your own, it's important to seek medical advice.
Like others, you may be in denial that you need help for hoarding. These questions, some of which have been adapted from the UCLA Hoarding Severity Scale, can help you to decide whether you may benefit from professional help:
- How much of your home is affected or overrun by clutter and possessions?
- How anxious would you become if you had to discard some of your things?
- To what extent does clutter affect your personal relationships or ability to socialize?
- To what extent does clutter affect your ability to work or your daily functioning?
- Do routine tasks take longer because of clutter or the need to do things perfectly?
- How much do you procrastinate doing chores, organizing or discarding things?
- Do you have so many pets that you can't care for them properly?
- Do others encourage you to seek professional help?
- When someone you care about is hoarding
Consult a mental health or medical provider on your own for guidance. 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 at stake.
Tests and diagnosis
Hoarding isn't yet considered an official, distinct disorder. However, it can be diagnosed as a subtype or symptom of obsessive-compulsive disorder or obsessive-compulsive personality disorder.
To help diagnose obsessive-compulsive disorder, mental health providers perform a thorough psychological evaluation. They ask many questions about your obsessions, compulsions and emotional well-being and may also talk to relatives and friends. If your mental health professional believes you have compulsive hoarding, he or she will perform a similar evaluation, with additional questions that focus on your collecting habits. You may also fill out psychological questionnaires.
In addition, mental health providers will check for three characteristics of hoarding:
- Acquisition of a large number of possessions that others may consider useless, along with an inability to discard them
- Having a home or living spaces that are so cluttered they can't be used as intended, such as not being able to sleep in your bed
- Having significant distress over your hoarding or an impaired ability to accomplish your daily activities
And because other mental health disorders often go hand in hand with hoarding, your mental health provider may also ask you questions to see if you may have symptoms of depression, social phobia, anxiety or other problems.
Complications
Hoarding can cause a variety of complications, including:
- Unsanitary conditions that pose a risk to health
- An inability to perform daily tasks, such as bathing or cooking
- Poor work performance
- Loneliness and social isolation
- A fire hazard
Treatments and drugs
Treatment of hoarding is often a challenge that comes with mixed success. For one thing, many people who hoard don't believe they need treatment. This is especially true if their possessions or animals offer comfort. And people whose animals are taken away will often quickly collect more to help fulfill emotional needs.
Treatment of hoarding is also difficult because researchers aren't yet sure which treatment is best. Try to find a therapist or other mental health provider who has experience in treating hoarding. While therapy can be intense and time-consuming, perhaps taking many months or even years, it can pay off in the long run.
There are two main types of treatment for hoarding.
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
- Declutter your home during in-home visits by a therapist or professional organizer
- Learn and practice relaxation skills
- Attend 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 treat hoarding with medications. The medications most commonly used for hoarding are selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant. Although these medications often work well for obsessive-compulsive disorder, their effectiveness for hoarding symptoms has been mixed.
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 and impairing your life.
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 you believe you need treatment for hoarding or not, here are some steps you can take to try to care for yourself:
- If you are in treatment, stick to your treatment plan. 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 elsewhere so that you can bathe.
- If you can't use your stove or reach your refrigerator, you may not be eating properly. Try to clear those areas so that you can prepare nutritious meals. Or, find other ways to get nutritious meals, such as through community programs or with the help of family and friends.
- Hoarding can lead to isolation and loneliness, which in turn can lead to more hoarding. If you don't want visitors to your house, try to get out to visit with others.
- Remind yourself that you don't have to live in squalor and chaos ? that you deserve better and that you can enjoy life more.
- 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.
- To keep motivated to declutter, focus on your goals ? living a healthier and more enjoyable life.
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.
