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Hoarding disorder is a mental health condition characterized by persistent difficulty in discarding possessions, regardless of their value, leading to cluttered living spaces and significant distress or impairment in daily functioning (1). Unlike collectors, individuals with hoarding disorder accumulate items excessively, often resulting in hazardous living conditions (2). Recent studies highlight the complexity of hoarding disorder, linking it to cognitive impairments, genetic factors, and environmental influences (3) (4). Understanding this disorder is crucial for effective diagnosis and treatment, improving the quality of life for those affected.

What is Hoarding Disorder?

Hoarding disorder is a mental health condition characterized by persistent difficulty in discarding or parting with possessions, regardless of their actual value. This behavior results in the accumulation of a large number of items, leading to severely cluttered living spaces that cannot be used for their intended purposes, such as cooking or sleeping. Unlike collectors, who organize and display their items, individuals with hoarding disorder often accumulate things in a disorganized manner, creating unsafe and unsanitary conditions.

The disorder typically begins during adolescence and can worsen over time, becoming more problematic in older age. People with hoarding disorder often feel a strong need to save items and experience significant distress at the thought of discarding them. This can lead to a range of issues, including isolation, difficulty managing daily tasks, and strained relationships with family and friends. Hoarding disorder can also pose serious health and safety risks, such as fire hazards, falls, and infestations.

Hoarding disorder is distinct from other conditions like obsessive-compulsive disorder (OCD), though it shares some similarities. Treatment often involves cognitive-behavioral therapy (CBT) aimed at reducing the hoarding behaviors and improving organizational skills (Mayo Clinic) ( (Merck Manual). 

Symptoms of Hoarding Disorder

Hoarding disorder is marked by a range of symptoms that significantly impair daily functioning and quality of life. One of the primary symptoms is the persistent difficulty in discarding or parting with possessions, regardless of their actual value. This behavior stems from a perceived need to save these items and the distress associated with discarding them. As a result, individuals accumulate large quantities of items, leading to severe clutter that congests living spaces, making them unusable for their intended purposes such as cooking or sleeping.

Common symptoms include:

These symptoms not only create physical hazards such as fire risks and tripping hazards but also pose serious health risks due to unsanitary conditions. Effective management and treatment, such as cognitive-behavioral therapy (CBT), are crucial for mitigating these symptoms and improving the individual’s quality of life (NHS).

Causes and Risk Factors

The exact cause of hoarding disorder remains unclear, but researchers have identified several potential factors that may contribute to its development.

Understanding these causes and risk factors is crucial for developing effective treatment strategies and helping individuals manage their hoarding behaviors.

Diagnosis of Hoarding Disorder

Diagnosing hoarding disorder involves a comprehensive assessment conducted by a mental health professional. The diagnosis is primarily based on the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (7). The key diagnostic features include persistent difficulty discarding or parting with possessions, regardless of their actual value, and the resultant accumulation of items that congest and clutter living areas, substantially compromising their intended use.

Assessment Tools

Mental health professionals use several tools and structured interviews to diagnose hoarding disorder. One commonly used tool is the Structured Interview for Hoarding Disorder (SIHD), which includes questions that align with the DSM-5 criteria for hoarding disorder. The SIHD has demonstrated excellent reliability and validity in diagnosing hoarding disorder  (Cambridge University Press & Assessment)​.

Diagnostic Criteria

According to the DSM-5, for a diagnosis of hoarding disorder, the following criteria must be met:

  1. Persistent difficulty discarding or parting with possessions, regardless of their actual value.
  2. This difficulty is due to a perceived need to save the items and distress associated with discarding them.
  3. The accumulation of possessions congests and clutters active living areas to the extent that their intended use is substantially compromised.
  4. The hoarding causes significant distress or impairment in social, occupational, or other important areas of functioning (​​ (Cambridge University Press & Assessment)​.

Evaluation Process

The diagnostic process often includes detailed interviews, self-report questionnaires, and possibly home visits to assess the severity of clutter and the impact on daily functioning. Tools like the Hoarding Rating Scale-Self Report (HRS-SR) are used to quantify the severity of hoarding symptoms and their impact on the individual’s life (Tolin et al., 2010)​ (8)​.

Differential Diagnosis

It’s important to distinguish hoarding disorder from other conditions such as obsessive-compulsive disorder (OCD), where hoarding behaviors might also be present but are typically driven by different underlying mechanisms. A thorough evaluation helps in ruling out other potential causes and confirming the diagnosis of hoarding disorder.

Impact of Hoarding Disorder

Hoarding disorder significantly impacts individuals, their families, and the broader community. This condition is associated with a range of adverse effects that extend beyond the mere accumulation of items.

Understanding the broad impact of hoarding disorder is crucial for developing comprehensive treatment plans that address both the physical and psychological aspects of the condition.

Treatment and Management

Effective treatment and management of hoarding disorder often require a multifaceted approach, combining therapeutic interventions and, in some cases, medication.

Coping Strategies for Individuals and Families

Coping with hoarding disorder can be challenging for both the individuals affected and their families. However, there are several effective strategies that can help manage the condition and improve quality of life.

For Individuals:

  1. Cognitive-Behavioral Therapy (CBT):
  1. Motivational Enhancement:
  1. Executive Functioning Skills:
  1. Acceptance and Mindfulness:

For Families:

  1. Understanding and Reducing Accommodation:
  1. Improving Communication:
  1. Harm Reduction:
  1. Support Groups:

By implementing these strategies, individuals and families can work together to manage hoarding disorder effectively, improving both safety and well-being.


Hoarding disorder is a complex and multifaceted condition that affects not only the individuals who suffer from it but also their families and communities. Understanding the symptoms, causes, and impact of this disorder is crucial for effective diagnosis and treatment. With appropriate strategies, such as cognitive-behavioral therapy, motivational enhancement, and family support, individuals with hoarding disorder can manage their symptoms and improve their quality of life.

For families, adopting a supportive yet structured approach, reducing accommodation behaviors, and improving communication can help create a healthier environment for everyone involved. Ongoing research and clinical interventions continue to enhance our understanding of hoarding disorder, offering hope for better management and outcomes in the future.

By working together and utilizing available resources, individuals and their families can navigate the challenges of hoarding disorder and achieve meaningful progress towards a more organized and fulfilling life.


  1. Frost, R. O., & Hartl, T. L. (1996). A cognitive-behavioral model of compulsive hoardingBehaviour research and therapy34(4), 341–350.
  2. Arnold L. M. (2010). The pathophysiology, diagnosis and treatment of fibromyalgiaThe Psychiatric clinics of North America33(2), 375–408.
  3. Mataix-Cols, D., Frost, R. O., Pertusa, A., Clark, L. A., Saxena, S., Leckman, J. F., Stein, D. J., Matsunaga, H., & Wilhelm, S. (2010). Hoarding disorder: a new diagnosis for DSM-V?. Depression and anxiety27(6), 556–572.
  4. Guan, X., Tang, R., & Nancollas, G. H. (2004). The potential calcification of octacalcium phosphate on intraocular lens surfacesJournal of biomedical materials research. Part A71(3), 488–496.
  5. Nutley, S. K., Read, M., Martinez, S., Eichenbaum, J., Nosheny, R. L., Weiner, M., Mackin, R. S., & Mathews, C. A. (2022). Hoarding symptoms are associated with higher rates of disability than other medical and psychiatric disorders across multiple domains of functioningBMC psychiatry22(1), 647.
  6. Stumpf, B. P., de Souza, L. C., Mourão, M. S. F., Rocha, F. L., Fontenelle, L. F., & Barbosa, I. G. (2023). Cognitive impairment in hoarding disorder: a systematic reviewCNS spectrums28(3), 300–312.
  7. Frost, R. O., Steketee, G., & Tolin, D. F. (2012). Diagnosis and assessment of hoarding disorderAnnual review of clinical psychology8, 219–242.
  8. Hussain, N.M., AlMansouri, D.H., AlGhareeb, M. et al. Translating and validating the hoarding rating scale-self report into ArabicBMC Psychol 11, 233 (2023).
  9. Sekhon, A. K., & Leontieva, L. (2023). The Impact of Hoarding Disorder on Family Members, Especially the Significant OtherCureus15(9), e45871.
  10. Nguyen, B. K., Zakrzewski, J. J., Sordo Vieira, L., & Mathews, C. A. (2022). Impact of Hoarding and Obsessive-Compulsive Disorder Symptomatology on Quality of Life and Their Interaction With Depression SymptomatologyFrontiers in psychology13, 926048.
  11. Nakao, T., & Kanba, S. (2019). Pathophysiology and treatment of hoarding disorderPsychiatry and clinical neurosciences73(7), 370–375.
  12. Mathews CA, Uhm S, Chan J, Gause M, Franklin J, Plumadore J, Stark SJ, Yu W, Vigil O, Salazar M, Delucchi KL, Vega E. Treating Hoarding Disorder in a real-world setting: Results from the Mental Health Association of San Francisco. Psychiatry Res. 2016 Mar 30;237:331-8. doi: 10.1016/j.psychres.2016.01.019. Epub 2016 Jan 21. PMID: 26805562; PMCID: PMC6020681.
  13. Nakao, T., & Kanba, S. (2019). Pathophysiology and treatment of hoarding disorderPsychiatry and clinical neurosciences73(7), 370–375.

Herny Kaggwa
Written and reviewed by: Herny Kaggwa
PMHNP-BC, APRN. Clinical Director
Assured Hope Community Health. LLC
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