Overview
Hoarding disorder is an ongoing difficulty in getting rid of or parting with possessions, leading to severe clutter and cramped living conditions. People with hoarding disorder believe they need to save these items and experience distress at the thought of getting rid of them. Hoarding ranges from mild to severe, affecting daily functioning in some cases. Symptoms include accumulating too many items, difficulty throwing things out, and the buildup of clutter that restricts the use of rooms. Hoarding disorder is linked with other mental health conditions, such as depression, anxiety disorders, obsessive-compulsive disorder (OCD), and attention-deficit/hyperactivity disorder (ADHD).
Understanding the disease
Symptoms
The symptoms of hoarding disorder include getting and keeping too many items that you may not have a need for right now and don't have space for, ongoing difficulty throwing out or parting with your things, regardless of their actual value, feeling a need to save these items and being upset by the thought of getting rid of them, building up clutter to the point where you can't use rooms, trying to be perfect and avoiding or delaying decisions, and problems with planning and organizing. Hoarding can range from mild to severe and can significantly impact daily functioning. It often begins during the teenage to early adult years and worsens with age. The disorder is associated with personality traits, family history, and stressful life events.
Risk Factors
The risk factors for developing hoarding disorder include:
- Personality: People with hoarding disorder often have a behavior style that includes trouble making decisions and problems with attention, organization, and problem-solving.
- Family history: There is a strong association between having a family member with hoarding disorder and having the disorder oneself.
- Stressful life events: Some individuals develop hoarding disorder after experiencing stressful events they had difficulty coping with, such as the death of a loved one, divorce, or losing possessions in a fire.
Development
Hoarding disorder can develop due to a combination of factors, including personality traits, family history, and stressful life events. It typically begins around ages 15 to 19 and tends to worsen with age. Hoarding is more common in older adults than in younger adults. Hoarding disorder often involves specific personality traits, such as difficulty making decisions, problems with attention, organization, and problem-solving. A family history of hoarding disorder is also a significant risk factor. Having a family member with the disorder increases the likelihood of developing hoarding tendencies. Stressful life events can contribute to the development of hoarding disorder. Traumatic experiences, such as the death of a loved one, divorce, or losing possessions in a fire, may lead individuals to hoard as a coping mechanism. It's not clear what causes hoarding disorder, but genetics, brain function, and stressful life events are being studied as possible causes. Although there's no known way to prevent hoarding disorder, seeking treatment at the earliest sign of a problem can help prevent the disorder from worsening. Treatment typically involves a combination of psychotherapy and medication to address the underlying mental health issues associated with hoarding.
Assessment and Diagnosis
Triage
You should see a doctor or mental health provider with expertise in diagnosing and treating hoarding disorder as soon as possible if you or a loved one has symptoms of hoarding disorder. If the hoarding disorder threatens health or safety, you may need to contact local authorities, such as police, fire, public health, child or elder protective services, or animal welfare agencies.
Diagnosis
To diagnose hoarding disorder, it is best to see a mental health provider who has expertise in diagnosing and treating the condition. They will conduct a mental health exam that includes questions about emotional well-being, your beliefs and behaviors related to acquiring and saving items, and the impact of clutter on your quality of life. The mental health provider may also ask your permission to talk with relatives and friends, as well as examine pictures and videos of your living spaces and storage areas affected by clutter. They will also assess if you have symptoms of other mental health conditions.
Management and Treatment
Complications
The potential complications of hoarding disorder include increased risk of falls, injury or being trapped by shifting or falling items, family conflicts, loneliness and social isolation, conditions that aren't clean and can be a health risk, fire hazard, poor work performance, and legal issues such as eviction. Hoarding disorder is also linked with other mental health conditions such as depression, anxiety disorders, obsessive-compulsive disorder (OCD), and attention-deficit/hyperactivity disorder (ADHD).
Treatment
The main treatment for hoarding disorder is cognitive behavioral therapy (CBT), a skills-based approach to therapy. CBT helps individuals learn how to better manage beliefs and behaviors linked to keeping clutter. It is important to find a therapist or mental health provider with expertise in treating hoarding disorder. In addition to therapy, medications may be prescribed, especially if the individual has anxiety or depression along with hoarding disorder. Selective serotonin reuptake inhibitors (SSRIs) are the most commonly used medicines for this purpose. Lifestyle changes, such as reaching out to others, maintaining cleanliness, ensuring proper nutrition, and seeking help, can also be helpful in managing hoarding disorder. Remember that diagnosis and treatment should be done under the guidance of a qualified mental health professional.
Preparing for medical consultation
To prepare for an appointment for hoarding disorder, make a list of your symptoms and how long you've experienced them. Also, consider the types of items you tend to save, your feelings about getting and keeping items, and the impact of clutter on your life. Prepare to discuss these topics with your mental health provider. They will likely ask about your beliefs and behaviors related to clutter and may involve family members or friends in the assessment process. Additionally, be aware that it's important to focus on your goals and prioritize your well-being when dealing with hoarding disorder. Taking small steps with professional help can lead to improvements in your living situation.