Causes and Risk Factors

The exact cause is unknown, but a combination of factors is believed to contribute: 

  • Family history There is a strong genetic link, with hoarding tendencies often running in families.

  • Brain function Differences in brain activity related to decision-making, attention, and organization may play a role.

  • Stressful life events Trauma, such as the death of a loved one or a divorce, can trigger or worsen hoarding behaviors.

  • Co-occurring conditions Hoarding disorder often co-occurs with other mental health conditions like depression, anxiety disorders, attention-deficit/hyperactivity disorder (ADHD), and obsessive-compulsive disorder (OCD). 

Treatments

Hoarding disorder

Hoarding disorder is a mental health condition characterized by persistent difficulty in parting with possessions, regardless of their actual value, leading to significant clutter and an inability to use living spaces for their intended purposes. 

Symptoms

Symptoms typically emerge during the teenage years and worsen with age. Key signs include: 

  • Difficulty discarding An ongoing inability to throw away or part with items due to a perceived need to save them or distress associated with discarding.

  • Excessive accumulation The buildup of a large number of possessions that congest and clutter active living areas (e.g., bedrooms, kitchens, bathrooms), compromising their intended use.

  • Significant distress or impairment The hoarding causes major problems in social, work, or other important areas of functioning, including maintaining a safe environment.

  • Associated features Difficulty organizing, indecisiveness, procrastination, perfectionism, and excessive acquisition (buying things they don't need or have space for) are common.

  • Health and safety risks Severe clutter can lead to unhygienic conditions, fire hazards, tripping risks, and structural damage to the home. 

Treatments

Treatment for hoarding disorder can be challenging because individuals often have limited insight into the problem or are ashamed, but significant improvement is possible with professional help. 

  • Cognitive Behavioral Therapy (CBT) This is the primary and most evidence-based treatment. It involves:

    • Challenging beliefs Helping individuals change distorted thoughts and emotional attachments to items.

    • Skills training Developing organization, decision-making, and problem-solving skills.

    • Practicing discarding Gradually confronting the anxiety of getting rid of items, often with the help of a therapist or support group.

    • Home visits Therapists or case managers often conduct in-home sessions to work directly with the individual in their environment.

  • Medication There are no FDA-approved medications specifically for hoarding disorder. However, antidepressants (SSRIs) may be prescribed to manage co-occurring symptoms of depression or anxiety, which can help individuals engage in therapy more effectively.

  • Support Groups Groups like the "Buried in Treasures" workshop, which uses CBT principles, can provide a supportive environment for sharing experiences and learning coping strategies.

  • Harm Reduction For severe cases, a harm reduction approach focuses on decreasing immediate risks (e.g., fire hazards) rather than forced cleanouts, which can be traumatic and ineffective long-term. 

Early recognition and treatment are crucial to improving outcomes and safety.