Hoarding disorders are when someone acquires an excessive number of things, storing them in a chaotic way and typically resulting in unmanageable clutter. We explain more about hoarding, why it happens, signs and symptoms, and how to find help.
What is hoarding disorder?
Unlike collecting (when you may keep items of historic or monetary value, or relating to a personal interest such as a hobby), hoarding is often disorganised. While a collection has meaning, items are typically organised, easy to access, or even displayed, a hoard is disorganised, takes up significant amounts of space, and is often inaccessible.
Hoarding can become a significant problem to the health and well-being (physically and mentally) of the individual, affecting not only their lives but those that they live with. Relationships with close members of friends and family can also become affected.
Hoarding disorders can be difficult to treat. Many people experiencing a hoarding disorder do not see their behaviour as a problem or struggle to see how it may be affecting their life, loved ones, or even risking their health. Others may realise that they have a problem, but feel unable or reluctant to seek help. This can be due to feelings of shame, guilt, and humiliation.
Signs of problem hoarding
If the amount of clutter or things someone owns interferes with their day-to-day life, it can be a clear sign of problem hoarding. This could mean that entire rooms have become inaccessible in their house or that using certain rooms like the bathroom or kitchen has become unsafe. It could also mean that things are stacked in a way that could potentially be dangerous to them, for pets, or for visitors.
Another sign that someone may have a significant problem is how their things are affecting their quality of life. For example, if excessive levels of clutter are causing them distress, negatively affecting their relationships, or causing issues with friends or family. Being highly defensive, angry or upset when others offer to help clear clutter or get rid of rubbish can also be a sign.
What do people hoard?
Hoarding disorder can involve just about any item or object. The items within a hoard may be well-kept, damaged, or what you may consider to be rubbish. Common hoards can include:
- paperwork (bills, receipts, or other documents)
- junk mail (leaflets, letters, magazines, flyers, expired coupons)
- newspapers or magazines
- containers (cardboard boxes, plastic bags, takeaway boxes)
- data (emails, electronic files, digital photos)
Why do some people hoard?
Where does the compulsion to hoard come from? The exact reasons why people begin to hoard aren’t fully understood. It’s thought that hoarding can be a symptom of other conditions. This can include:
- early signs of someone developing dementia (they may have difficulty figuring out what to keep and what to dispose of)
- severe depression
- psychotic disorders (e.g. schizophrenia)
- OCD (obsessive-compulsive disorder)
According to the NHS, in some cases, hoarding is considered to be a condition itself. Often associated with self-neglect, you may be more likely to hoard if you:
- are not in a relationship and live alone
- had a deprived childhood (lacking either material objects, or having poor relationships with family members)
- have family members with a history of hoarding
- grew up in a cluttered home (and may not have learned how to sort or prioritise things)
Someone who hoards may believe that keeping things will make them happy. Others may worry that if they get rid of things, they may need them again someday and be unable to acquire them. While others struggling with big, stressful life events like the death of a loved one, may feel unable to prioritise things and may want to keep everything.
Causes of compulsive hoarding
Many of us have wardrobes full of clothes we haven't worn for years, shelves stacked with books we rarely read and mantelpieces decorated with ornaments we hardly even notice anymore. When these things start to get out of control - for example, when we can no longer fit new clothes into our wardrobe, or when clutter starts to take over tables, most people will have a cleanout. This might mean spending a day 'spring cleaning' by taking old clothes to charity shops, scrapping forgotten clutter, shredding old documents and so on.
A compulsive hoarder, however, will rarely or never willingly throw anything away. They will simply acquire a new wardrobe or start stacking clothes on any available surface.
Compulsive hoarding can be very difficult to understand. It may look like laziness, it may look like eccentricity, or it may look like plain greed. But more often than not, the problems run much deeper than that.
Unique brain patterns
A study conducted in 2008 by the Department of Psychiatry at UC San Diego School of Medicine examined brain scans of compulsive hoarders and discovered abnormal activity in the part known as the 'bilateral anterior ventromedial prefrontal cortex' (BAVPC), or in layman's terms, the part of the brain associated with decision making. This part is unique to mammals and is thought to be the most advanced part of the human brain.
There have been several instances where brain damage (from strokes, infections, injuries etc.) has resulted in a patient developing compulsive hoarding habits. Interestingly, researchers found that these patients had impairments in the BAVPC, the same part of the brain thought to be responsible for compulsive hoarding in non-lesion patients, suggesting that this area plays a key role in compulsive hoarding.
Some experts believe that compulsive hoarding runs in the family. A 2008 study showed that up to 85% of compulsive hoarders could identify a relative who had the same problem, while a 2009 study revealed that over 50% of compulsive hoarders had a direct member of their family (parent, sibling, or child) with similar problems.
Some experts believe certain life experiences can be blamed for compulsive hoarding. For example, a person who experiences a tragic loss, such as the death of a close friend or family member, might start to place more importance on their material possessions because they are afraid of experiencing those feelings of loss again. Compulsive hoarders gain a sense of comfort from being surrounded by their possessions, which perhaps stems from the fear of being left with nothing at all.
Signs of hoarding disorder
Compulsive hoarding can look different from person to person. It can also be hard to spot the signs, as a hoarder may hide their behaviour out of shame, guilt, or fear of being judged. Many hoarders struggle to recognise they have a problem, and may not know that the behaviour is out of the ordinary.
Someone with a hoarding disorder may:
- buy lots of seemingly useless things
- develop an emotional attachment to these items
- find themselves unable to throw anything away
- live limited lives due to junk taking over living spaces
- put their health at risk due to unsanitary conditions
- become increasingly isolated and unwilling to leave the house
- deteriorate both physically and mentally
- have other mental health problems such as depression and dementia
- put neighbours, family and animals at risk of harm
- keep items with little to no monetary value (e.g. carrier bags, cardboard, newspapers, or used containers)
- keep broken items they plan to fix but rarely or never follow through
- have trouble organising, categorising, or minimising items they own
- struggle with everyday tasks (cleaning, cooking, keeping up with bills)
- seem overly attached to items, to the point of refusing to let others touch, borrow, or get rid of them (even if others consider the items to be trash, e.g. stained old newspapers or broken carrier bags)
- have poor relationships with family or friends
Who can develop a hoarding disorder?
Signs of hoarding disorder can develop during your teenage years. For many, it becomes more noticeable as they get older and hoarding becomes more problematic. Often by the time a friend or family member realises there may be a problem, the person has been exhibiting the behaviour for quite some time.
The risks of compulsive hoarding: Are hoarding disorders a problem?
Compulsive hoarding can have a detrimental effect on the physical and mental health of the hoarder, the hoarder's family and the hoarder's neighbours.
Hoarding can gradually or suddenly overtake someone’s life. This can make their home unsafe, and negatively impact their relationships, personal hygiene, and work. As time progresses, someone who hoards may not want any visitors - including tradespeople who may need to carry out essential repairs.
Hoarding can cause and/or lead to:
- structural damage to their house and any connecting houses
- eviction by landlords or legal action by neighbours
- infestations of rodents and insects
- disease and infections (due to rotting food, uncleaned areas, pet waste, or undiscovered pet deaths)
- unsafe conditions that may lead to fires, property damage or further issues with gas, water, or wiring problems
- difficulty exiting or entering the property in case of emergency
- increased risk of trips, falls, or collapse of items on people
How to get help for someone with compulsive hoarding disorder
Hoarding is often a secretive habit. If you think you or someone you care about may have a problem that is getting out of hand, asking for help is the first step.
Speak with loved ones. Talking to friends and family can help you to get past the initial feelings of shame, guilt, embarrassment, and fear.
Reach out to a charity. If you aren’t ready to speak with someone close to you, HoardingUK is a UK-wide charity dedicated to supporting people affected by hoarding behaviours.
Speak with your GP. Talking with your GP can help to see what support is available in your area, such as local mental health teams and NHS therapists who can help with hoarding disorder, OCD, or other related issues.
Try hypnotherapy. Hypnotherapy can help to address underlying issues that may have led to unhelpful behaviours. With the help of a hypnotherapist, you can identify the triggers that are causing you to feel attached to things, make changes and learn new, more helpful ways of managing your emotions and compulsions.
Hypnotherapy Directory explains more about hypnosis for compulsive hoarding, and how working with a hypnotherapist can help you.
Things to avoid
It’s recommended that you don’t get extra storage space (e.g. hiring a storage unit, or offering to store things for a loved one) or go straight to the council or environmental health to tackle rubbish. This is because these will only handle the surface issue, rather than the underlying problems, meaning any apparent progress can quickly become undone as the person continues to hoard.
How can you support someone who may be reluctant to ask for help?
It can be common for people who hoard to refrain from asking for help and don’t allow people into their homes. This might be because they feel embarrassed or ashamed and may fear what other people might think of them. Perhaps they deny that they are a hoarder and may find it hard to accept they have a compulsion. If they are unwilling to accept help, there are some steps that you can take as a support person.
- Don’t try to clear up for them - whilst this might seem like it is helpful, it doesn’t get to the root cause of the problem.
- Be respectful - don’t refer to their items as ‘rubbish’. For the person hoarding, there is likely to be a reason why they are keeping these items. Try to understand this from their point of view.
- Offer general support and ask the person what they might find helpful.
- Suggest alternative places to meet so they don’t feel forced to let you into their home.
- Listen - start a conversation with them and listen to what they have to say. This might help you understand their thinking and they may be more likely to open up to you.
- Offer to attend appointments with them - they may be reluctant to seek help if they are worried about what others think. Offering to attend appointments with them, like seeing a GP or counsellor, may encourage them to get support as they know they are in a safe space.
- Reassure them that no one is going to throw their belongings away - they are there to help and discuss what can be done, with their involvement.
After being able to relate to my clients I learnt that it wasn’t the items they possess they need to talk about – it was what it represents for them. It takes time to recover from hoarding, and people who are recovering need empathy, care and support from people around them.
Counselling for compulsive hoarding
Without guidance and support, you may find it difficult if not impossible to clear out your treasured possessions. Even hiring an external company to clean your house for you isn't going to solve the problems - within days you are likely to start building up a brand-new collection of possessions. In reality, the problems come from inside your mind, not from inside your house.
Counselling can help you explore the problems that maybe you were not even aware of, change your patterns of thinking and help you learn how to make your own logical decisions.
When faced with stressful events, some people choose to battle with a new problem of their own creation, like producing chaotic clutter as a way of avoiding their real problem. Skilled counselling can be useful in this circumstance.
There are a number of different treatments that may be recommended for dealing with hoarding. Your GP may suggest antidepressants, as these have been shown to help some people with hoarding disorder. However, most commonly, cognitive behaviour therapy (CBT) is recommended.
CBT for hoarding
If hoarding is beginning to get out of control then CBT might be helpful in managing the problem, and it can also help the sufferer develop decision-making skills. It is important for a hoarder to learn the difference between a necessary possession and a useless one. Once they can adjust their patterns of thinking and stop associating the concept of 'possession' with control, or comfort, then they may finally be able to let go of their clutter.
Working with a CBT therapist can help you to understand why you are struggling to throw things away, as well as the reasons behind why clutter had built up. A counsellor may combine practical tasks with planning to encourage you to clear the clutter in your own home.
For many people, hoarding symbolises a more unconscious or hidden problem which is being ‘acted out’. This might be connected to worthlessness or loss and this can be explored by psychodynamic or psychoanalytic counselling or psychotherapy which aim to make the unconscious more accessible and understood. At its most extreme, hoarding can be a defence against psychotic breakdown where the clutter comes to represent the mental state of chaos. The breakdown of boundaries can be addressed in psychotherapy and the nature of filling space might be understood.
Sometimes hoarders attribute value to worthless articles which might reflect a person’s opinion of their own worth and value. If the hoarding does appear to be part of an obsessive-compulsive disorder then specialist help should be sought.
CBT can help you to change how you think and act, as well as to consider how your actions affect others. Regular sessions over a long period of time are often recommended for hoarding. Your therapist may recommend a mixture of types of sessions including some home-based sessions (though this can vary from therapist to therapist).
It’s important to remember that, no matter what kind of help you try, changing your behaviours and stopping hoarding requires commitment, motivation, and patience.
Your counsellor isn't there to declutter or get rid of your hoard for you. Instead, a therapist can help you to improve your organisational skills, challenge fears or compulsions that are causing you to hoard, and encourage you to declutter. They may help you learn new decision-making strategies, as well as identify and challenge underlying beliefs that have contributed to your hoarding problem.
Through working with a qualified, experienced therapist, you can gain a better understanding of your problem, helping you to build the framework to avoid slipping back into old, unhelpful habits that may have held you back.
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