Merck Manual

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Hoarding Disorder

By

Katharine A. Phillips

, MD, Weill Cornell Medical College;


Dan J. Stein

, MD, PhD, University of Cape Town

Last full review/revision Sep 2018| Content last modified Sep 2018
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In hoarding disorder, people persistently have such difficulty discarding or parting with possessions that objects accumulate and clutter living areas enough to make them unusable.

  • Unlike collectors, people accumulate things in a disorganized way and have difficulty parting with things of little value.

  • Doctors diagnose the disorder when people accumulate too many possessions, have great difficulty parting with these possessions, and are significantly distressed or are less able to function because of the hoarding.

  • Certain antidepressants and cognitive-behavioral therapy may help.

Hoarding symptoms often begin during adolescence. The disorder may be mild at first but may gradually worsen as people age, causing substantial problems by the time people are in their mid-30s. About 2 to 6% people are thought to have this disorder.

Symptoms

People with hoarding disorder have a strong need to save items and are very distressed when they are forced to part with the items or even think about parting with the items. People do not have enough space to accommodate all the items they accumulate. Living areas become so crowded and cluttered that they cannot be used, except for storing hoarded items. For example, stacks of hoarded newspapers may fill the sink and cover the countertops, stove, and floor in the kitchen, preventing the kitchen from being used to prepare meals.

Hoarding often interferes with people's ability to function at home and sometimes at work or school. For example, they may not allow other people, including family members, friends, and repairmen, into the house because they are embarrassed by the clutter. The clutter may be a fire and safety hazard, or the home may become infested with pests. Some people realize that hoarding is a problem, but many do not.

In animal hoarding, people accumulate more animals as pets than they have room for and can feed and provide veterinary care for. They allow the animals to live in unsanitary conditions. Often, the animals are overcrowded and lose weight and/or become ill. However, many people with the disorder do not recognize that they are not taking adequate care of the animals. Animal hoarders are very attached to their pets and do not want to give them up.

Without treatment, symptoms typically continue throughout life, with little or no change.

Diagnosis

  • A doctor's evaluation, based on specific diagnostic criteria

Doctors distinguish hoarding from temporary accumulation of stuff and clutter (for example, when property is inherited) because hoarding persists. It differs from collecting things (such as books or figurines) because hoarding, unlike collecting, is disorganized and interferes with the person's ability to use the cluttered rooms.

Doctors diagnose hoarding disorder when

  • People persistently have difficulty discarding or parting with possessions, regardless of their actual value.

  • People save items mainly because they feel they must, regardless of the item's value.

  • The accumulated possessions congest and clutter active living areas (not basements or storage areas) and interfere with using these areas for their intended purpose.

  • People feel greatly distressed by the thought of discarding any of their possessions and/or become less able to function (at work, in their family, or with friends) because of the hoarding.

Treatment

  • Certain antidepressants

  • Cognitive-behavioral therapy

Treatment with selective serotonin reuptake inhibitors (a type of antidepressant) may help.

Cognitive-behavioral therapy that specifically focuses on hoarding disorder may also lessen symptoms. For example, doctors may try to help people discard items, refrain from acquiring new possessions (if excessive acquisition is a problem), and become better at making decisions.

Because many people are unwilling to stop hoarding, doctors may need to use motivational techniques to help people participate in treatment.

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