Mental Health: Hoarding Disorder and Getting Your House in Order

Reviewed by: Dr. Steven Knauf, D.C.

By Martha Michael

Cardboard boxes are stacked in the corner and extend into the room like presents under a Christmas tree. Newspapers with 2019 datelines are piled high next to magazines that discuss fashion and news from 2014. Air fryers, deep fryers, and a pizza stone from a late-night shopping binge in 2012 are among the dust-covered items that consume the entire footprint of the kitchen counter. There’s no room in the garage for a car, no room in the house to stretch your legs -- only a walking path from the bedroom to the bathroom to the microwave to the couch. There’s no such thing as a flat surface.

At one time or another, most people have felt like their house was a pigsty and wished they had the energy to clean like Bradley Cooper in that scene in the movie Limitless.

It’s one thing to leave the dishes in the sink for a day or two and fail to use the vacuum as often as you should, but there are levels of hoarding that go beyond being messy. The diagnostic and statistical manual of mental disorders identifies some behaviors as signs of hoarding disorder.

Some people have a really tough time letting go of their stuff.

What Are the Symptoms of Hoarding Disorder?

Hoarding disorder, or HD, is defined by the American Psychiatric Association as “a persistent difficulty discarding possessions, resulting in an accumulation of belongings causing severe clutter and the obstruction/congestion of living areas which creates significant distress and impairment in functioning.”

An article by Science Direct says an estimated 2.5 percent of the general population in the United States suffers from hoarding disorder. The mean age that symptoms become evident is 13 years old, though research suggests hoarding is worse among older adults. Eighty percent of people with hoarding disorder report showing symptoms by the age of 18.

There are varying degrees of clutter and filth that result from an individual with this type of mental health issue. It’s characterized by a person who’s having trouble parting with possessions and fails to control their extreme attachment to them until it reaches a point where it’s causing health problems.

Are There Different Levels of Severity in Hoarding Disorder?

You can probably describe differences among people you know in the level of tidiness and sanitation they find acceptable. There are always some people who have more “stuff” and others who like their environment streamlined.

When collecting becomes problematic is when the process of acquiring stuff gets worse over time and becomes a lifestyle. It begins with a lax attitude toward cleanliness and can steamroll into a major health problem. Biohazard cleanup company Spaulding Decon describes various stages of hoarding.

Level 1

What begins as a lack of attention to organization grows into living spaces with light clutter and overcrowded storage, such as shelf space and bookcases. This level of hoarding is typically caused by a love of collecting and/or an inability to discard items when necessary.

Level 2

When a person’s collections become so voluminous they’re blocking exits and walkways, a new set of problems develop. The hoarder often feels embarrassment when guests come to their house because their issues have become noticeable.

Level 3

At this stage, you not only see neglect and structural damage in their living conditions, the hoarder’s hygiene begins to falter. They may have body odor and the home may have a foul smell from a buildup of trash or animal waste. It’s common to see visible signs of rodent infestation and fleas, sometimes the result of an individual owning more pets than they can manage.

Level 4

When hoarding continues, the residence becomes unsanitary, sometimes due to sewage problems and leaving food to rot. Entire rooms become unlivable and multiple exits are blocked at this point. The hoarder may further neglect their personal hygiene and fail to bathe for weeks.

Level 5

Finally, the consequences of compulsive hoarding can become dangerous due to fire hazards and the deterioration of the structure. Often, there are crumbling walls, and the house is uninhabitable due to the presence of human and animal feces. Clutter covers every available space -- counters, hallways, and floors. Many parts of the building are completely inaccessible.

Mental Health Factors That Contribute to Hoarding

There are numerous reasons why someone begins to accumulate too many things. According to the Cleveland Clinic, sometimes a traumatic experience is a catalyst for their intense desire to hang onto their possessions.

The attitudes and experiences contributing to hoarding disorder include:

• Inability to decide where to place objects
• Feeling stress at the thought of discarding possessions
• Lack of trust when others touch their belongings
• Fear that they will need the items in the future
• An item’s association to a loved one
• Think their belongings are too valuable to let go

Many people with hoarding disorder have personality traits that make it hard to extinguish unhealthy behaviors such as:

• Disorganization
• Procrastination
• Perfectionism
• Indecisiveness
• Distractibility

The fifth edition of the diagnostic and statistical manual used by mental health professionals reversed its previous designation for hoarding disorder as a subtype of obsessive-compulsive disorder or OCD. They found that HD can occur among individuals with no other mental health problem, so it’s now an isolated condition in the OCD spectrum.

Some of the comorbidities associated with hoarding disorder are:

• Depression
• Attention-deficit/hyperactivity disorder
• Obsessive-compulsive disorder

There are other features that may co-occur with a person’s hoarding issues. Risk factors include:

• Brain injury
• Trauma
• Impulsive shopping
• Substance use disorder
• Having a relative with HD

Some people don’t have a formal comorbidity or diagnosis but still suffer from symptoms of hoarding. They may have mental processing deficits.

People with hoarding disorder may have issues with:

• Organization
• Sustained attention
• Problem-solving
• Planning
• Visuospatial learning
• Memory

How Do You Treat Hoarding Disorder?

Most of us know the mental health boost you get from cleaning house and organizing your residence. You gain a sense of control and tend to feel calm when clutter is managed and surfaces are clean.

Someone with a hoarding disorder doesn’t get the chance to experience that level of relaxation. Their mental health challenges make treatment difficult, while attempts to help them can incite anger or frustration. If there’s someone in your life who has a growing problem with hoarding, it’s natural to want to help. Pointing them toward mental health resources is perhaps the most direct way to support them.

One of the most effective treatments for hoarders, according to the Mayo Clinic, is cognitive behavioral therapy, or CBT. A skills-based form of psychotherapy, CBT helps individuals manage their beliefs, which, in turn, affect their hoarding behaviors.

A large number of patients learn strategies through CBT, including:

• Identifying thoughts related to saving possessions
• A rise in desire to change
• Improved decision making
• Hiring a professional to help with decluttering
• Resisting the urge to add to their collections
• Coping with letting go of items
• Reducing solitude and increasing social connections

If you’re like most people, you neither identify closely with the series “Hoarders” or “Tidying Up with Marie Kondo.” Being a little messy or “not the best housekeeper” isn’t the issue for people with hoarding disorder. They have to address mental health challenges to get to that state of “ahhh” that others can acquire with the flick of a dust cloth.

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