Hoarding disorder is a mental health condition characterized by persistent difficulty discarding possessions and excessive accumulation of items, resulting in cluttered living spaces that significantly impair daily functioning. Clinical criteria for diagnosis of hoarding disorder from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision (DSM-5-TR) include the following (1): Persistent difficulty discarding or parting with possessions, regardless of their actual value.
Hoarding disorder (HD) is defined as a persistent difficulty discarding possessions, resulting in an accumulation of belongings causing severe clutter and the obstruction/congestion of living areas which creates significant distress and impairment in functioning (APA, 2013). This condition affects approximately 2% to 6% of the general population, with prevalence increasing significantly with age—Hoarding Disorder (HD) is estimated to affect 4–6% of older adults, with increasing diagnostic prevalence with age (8).
Table of Contents
- What Is Hoarding Disorder?
- Signs and Symptoms
- What Do People Hoard?
- Animal Hoarding
- Why Do People Hoard?
- Consequences of Hoarding
- Co-Occurring Conditions
- Hoarding Across the Lifespan
- Treatment Options
- How Therapy Can Help
- Frequently Asked Questions
What Is Hoarding Disorder?
According to the DSM-5-TR, hoarding disorder includes the following: Persistent difficulty discarding or parting with possessions, regardless of their actual value. The difficulty discarding is due to the perceived need to save the items and to the distress associated with discarding them. The accumulated possessions congest and clutter active living areas (i.e., not basements or storage areas) and substantially compromise the intended use of these areas. The hoarding causes significant distress or significantly impairs social, occupational, or other areas of functioning.
Hoarding disorder is a new diagnosis in DSM-5. Instead, there is evidence for the diagnostic validity and clinical utility of a separate diagnosis of hoarding disorder, which reflects persistent difficulty discarding or parting with possessions due to a perceived need to save the items and distress associated with discarding them. Hoarding disorder may have unique neurobiological correlates, is associated with significant impairment, and may respond to clinical intervention.
Signs and Symptoms
People with hoarding disorder typically experience several key symptoms:
- Persistent difficulty discarding possessions - Persistent difficulty discarding or parting with possessions, regardless of their actual value. This difficulty is due to a perceived need to save the items and to the distress associated with discarding them.
- Excessive acquisition - Around 80-90% of people who hoard also engage in "excessive acquisition."
- Cluttered living spaces - The difficulty discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially compromise their intended use.
- Significant distress or impairment - The condition causes problems in relationships, work, and daily functioning
- Limited insight - Some individuals with hoarding disorder may recognize and acknowledge that they have a problem with accumulating possessions; others may not see a problem.
What Do People Hoard?
Old clothes, magazines, CDs/videotapes, letters, pens, old notes, bills, and newspapers, etc., are among the most commonly hoarded items. People may collect items with perceived practical value, sentimental significance, or even objects others would consider worthless. Objects acquired by people with hoarding lack a consistent theme, whereas those of collectors are narrowly focused on a particular topic.
The key distinction between hoarding and collecting is organization and functionality. Hoarding is not the same as collecting. Collectors typically acquire possessions in an organized, intentional, and targeted fashion. Once acquired, the items are removed from normal usage, but are subject to being organized, admired, and displayed to others.
Animal Hoarding
Animal hoarding may form a special type of hoarding disorder and involves an individual acquiring large numbers (dozens or even hundreds) of animals. This serious condition involves:
- Large numbers of animals - Accumulation of numerous animals, which has overwhelmed that person's ability to provide even minimal standards of nutrition, sanitation, and veterinary care
- Inadequate care - Failure to acknowledge the deteriorating condition of the animals (including disease, starvation, and even death) and the household environment (severe overcrowding, very unsanitary conditions)
- Lack of insight - People who hoard animals typically show limited insight regarding the problem.
- Serious consequences - Most hoarders claim that the animals are being well cared for and are healthy, despite evidence to the contrary, suggesting that hoarders possess an unrealistic belief system (12).
Between 3,000–6,000 cases of animal hoarding are discovered annually in the US. On average, 39–47 animals are hoarded in individual cases, although sometimes hundreds of animals are found with a hoarder. Cats and dogs are the most common victims in cases of animal hoarding, but rats, reptiles, and other critters can be subject to a hoarding environment, too.
Why Do People Hoard?
Research has identified several factors that contribute to hoarding disorder:
Emotional Attachment to Objects
People who hoard tend to have stronger emotional ties to objects. In some cases, people may assign feelings to objects. For instance, someone may avoid donating a doll collection because they don't want to "hurt the dolls' feelings."
Information Processing Difficulties
Indecisiveness is heavily linked to compulsive hoarding. Individuals may wish to organize their things but be unable to decide where everything will go. Hoarders tend to have an excessive emotional attachment to possessions (hypersentimentality), so they deem objects as extensions of themselves (Frost & Harlt, 1996) and develop strong feelings for such things the same way it might occur with people, to the extent of calling it "love" (Frost & Gross, 1993).
Genetic Factors
Its etiology is largely unknown, but twin studies suggest that it is moderately heritable. Twin-cohorts between 26-48%, and a SNP-heritability of 11% for an unrelated sub-cohort. Hoarding is more common among individuals with a family member who also has a problem with hoarding.
Trauma and Loss
The team's interviews revealed that hoarders tended to start collecting their animals after a big disaster in their lives—the death of a child or the loss of a job, for example—a characteristic also not shared with generalized hoarding disorder. A history of trauma and a triggering event may be the difference between three animals living in a dwelling and 33.
Consequences of Hoarding
Hoarding disorder can have severe consequences affecting multiple areas of life:
Health and Safety Risks
- Fire hazards - Potential consequences of serious hoarding include health and safety concerns, such as fire hazards, tripping hazards, and health code violations.
- Falls and injuries - Health risks include falls and other injuries due to clutter
- Sanitation issues - High levels of clutter in the home environment create serious risks to personal safety from falls, food contamination, infestation, fire, and impeded escape routes (Steketee and Frost, 2014).
- Medical emergencies - Difficulty accessing individuals in need of emergency care
Social and Personal Impact
- Social isolation - It can also lead to family strain and conflicts, isolation and loneliness, unwillingness to have anyone else enter the home, and an inability to perform daily tasks, such as cooking and bathing in the home.
- Family conflicts - HD is associated with social isolation, distress, interpersonal conflicts, high rate of co-occurring mental disorders, and significantly lower quality of life
- Housing instability - For older adults, those consequences include health and safety risks, social isolation, eviction, and homelessness.
- Work impairment - People with hoarding have work impairment that's so severe that it's similar to those with psychotic disorders.
Co-Occurring Conditions
An estimated 60–80% of individuals with HD meet criteria for additional psychiatric disorders, with hoarding symptoms most prominently linked to depressive and anxiety disorders, trauma and stressor-related disorders, and attention deficit hyperactivity disorder (ADHD). Common co-occurring conditions include:
Depression
Among individuals with HD, the estimated prevalence of MDD ranges between 26% and 62%. Major depressive disorder is one of the most frequent comorbidities, often exacerbating hoarding symptoms.
Anxiety Disorders
Many people with hoarding disorder also experience other mental disorders, including depression, anxiety disorders, attention-deficit/hyperactivity disorder, or alcohol use disorder.
ADHD
While the prevalence of ADHD ranges between 3% and 21%. Similarly to ADHD, HD often involves difficulties with organization and decision-making. Individuals with both conditions may struggle with executive functioning, which can contribute to challenges in maintaining a clutter-free environment.
Important Distinction from OCD
DSM-IV lists hoarding as one of the possible symptoms of obsessive-compulsive personality disorder and notes that extreme hoarding may occur in obsessive-compulsive disorder. However, available data do not indicate that hoarding is a variant of obsessive-compulsive disorder or another mental disorder.
Hoarding Across the Lifespan
Childhood and Adolescence
Mean age of onset of hoarding symptoms has been estimated to be 13.4 years, with 60% of patients reporting that the onset of symptoms occurred by age 12, increasing to 80% by age 18.
Adulthood
Hoarding disorder often begins at a mild level during adolescence and gradually worsens with age, causing clinically significant impairment by the mid-30s.
Older Adults
Prevalence of provisional HD diagnoses (2.12%) increased linearly by 20% with every 5 years of age (z = 13.8, p < 0.0001). In populations over age 55, the prevalence of clinically impairing hoarding is over 6%, significantly higher than the general population prevalence.
Treatment Options
Cognitive-Behavioral Therapy (CBT)
A specialized CBT approach for hoarding has shown progress in reaching treatment goals and has been modified to be delivered in group, peer-facilitated, and virtual models. We review the components of CBT-HD and their rationale, noting that clinical results have been modest.
Key components of CBT for hoarding include:
- Cognitive restructuring to address beliefs about possessions
- Exposure therapy and systematic discarding practice
- Skills training for organization and decision-making
- Motivational interviewing techniques
Innovative Treatment Approaches
- Virtual Reality (VR) therapy - Virtual reality (VR) offers the ability to create a virtual "home" including 3D scans of the patient's actual possessions that can be moved or discarded. VR discarding is an alternative to in-home visits and an approach that provides a stepping stone to real-life discarding. VR has been successfully utilized to treat many disorders but tested minimally in hoarding disorder. In nine older adults with hoarding disorder, we tested an 8-week VR intervention administered to augment a 16-week Buried in Treasures group treatment.
- Group therapy - Participants demonstrated significant improvements in hoarding symptoms, as well as symptoms of depression and anxiety, and quality of life. Improvements in hoarding symptoms were comparable to two published clinical trials on individual CBT for hoarding disorder.
- Community-based interventions - The objective of this paper was to examine the implementation and effectiveness of a community-based intervention for hoarding disorder (HD) using Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST).
Medication
No high-quality studies have examined the use of pharmacotherapy for patients with hoarding disorder (4). Nonetheless, pharmacologic interventions may be of some benefit, especially for patients with potentially responsive comorbid conditions (e.g., mood or anxiety disorders) (5). Several small observational studies of patients with hoarding disorder who were treated with a selective serotonin-reuptake inhibitor (SSRI), a serotonin-norepinephrine reuptake inhibitor (SNRI), or atomoxetine showed a reduction in hoarding severity.
Treatment Challenges
Poor insight, ego-syntonic nature of symptoms, and treatment resistance are often reported in patients. Further improvement of the therapeutic interventions in order to improve effectiveness and target the high rate of treatment drop out is needed.
How Therapy Can Help
This study confirms psychological therapies are effective in reducing hoarding symptoms, while indicating no superiority for CBT. Despite the benefits, symptoms often persist above the clinical cut-off for HD, highlighting the enduring clinical challenges in achieving symptomatic remission.
Therapy can help individuals with hoarding disorder by:
- Building insight and awareness about the condition
- Developing healthier decision-making skills
- Learning to tolerate distress when discarding items
- Addressing underlying trauma or emotional issues
- Improving relationships and social functioning
- Creating and maintaining organized living spaces
A qualified mental health professional can provide comprehensive assessment and develop an individualized treatment plan. Cognitive-behavioral therapy that is tailored to treat the specific hoarding symptoms is usually first-line therapy. However, clinical trials for cognitive-behavioral therapy have shown mixed results (1, 2) and other psychological interventions (such as acceptance and commitment therapy [ACT]) may be equally effective (3).
Frequently Asked Questions
Q: Is hoarding disorder the same as being messy or disorganized? A: No, hoarding disorder is a specific mental health condition that goes beyond typical messiness. It involves persistent difficulty discarding items, excessive acquisition, and significant distress or impairment in functioning. The clutter severely compromises the use of living spaces.
Q: Can children have hoarding disorder? A: While hoarding symptoms can begin in childhood or adolescence (average onset around age 13), the full disorder typically doesn't become clinically significant until adulthood. Early intervention when symptoms first appear may help prevent progression.
Q: How is hoarding disorder different from collecting? A: Collectors typically acquire possessions in an organized, intentional, and targeted fashion. Once acquired, the items are removed from normal usage, but are subject to being organized, admired, and displayed to others. Objects acquired by people with hoarding lack a consistent theme, whereas those of collectors are narrowly focused on a particular topic.
Q: What causes hoarding disorder? A: Hoarding disorder has multiple contributing factors including genetics (it often runs in families), brain differences in decision-making areas, traumatic life events, and difficulties with emotional attachment to objects. The cause of hoarding disorder is unknown.
Q: Can medications help with hoarding disorder? A: While no medications are specifically approved for hoarding disorder, some individuals may benefit from SSRIs or other medications, particularly if they have co-occurring conditions like depression or anxiety. Medication is typically most effective when combined with therapy.
Q: How can I help a loved one who hoards? A: Approach with compassion and avoid judgment. Encourage professional help, as hoarding disorder typically requires specialized treatment. Don't throw away their possessions without permission, as this can damage trust and worsen symptoms. Consider family therapy or support groups.
Find a Therapist
If you or someone you know is struggling with hoarding disorder, professional help is available. The condition is treatable, and many people experience significant improvement with appropriate therapy. Search our directory to find a therapist experienced in treating hoarding disorder in your area.
Our therapist directory includes mental health professionals who specialize in:
- Cognitive-behavioral therapy for hoarding
- Anxiety and obsessive-compulsive related disorders
- Trauma-informed treatment approaches
- Group therapy for hoarding disorder
Take the first step toward recovery by connecting with a qualified therapist today.
References:
- American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). Arlington, VA: American Psychiatric Publishing. https://doi.org/10.1176/appi.books.9780890425787
- Cath, D. C., Nizar, K., Boomsma, D., & Mathews, C. A. (2017). Age-specific prevalence of hoarding and obsessive compulsive disorder: A population-based study. American Journal of Geriatric Psychiatry, 25(3), 245-255. https://doi.org/10.1016/j.jagp.2016.11.006
- Dozier, M. E., & Ayers, C. R. (2020). Implementation and evaluation of a community-based treatment for late-life hoarding. International Psychogeriatrics, 32(10), 1205-1215. https://doi.org/10.1017/S1041610219001352
- Grassi, G., Moradei, C., Cecchelli, C., & van Ameringen, M. (2023). Who really hoards? Hoarding symptoms in adults with attention-deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD) and healthy controls. Journal of Psychiatric Research, 166, 74-79. https://doi.org/10.1016/j.jpsychires.2023.09.006
- Kassel, M. T., Kryza-Lacombe, M., Insel, P. S., Rhodes, E., Nelson, J. C., Bickford, D.,... & Mackin, R. S. (2024). Hoarding symptoms in late life depression are associated with greater executive dysfunction and disability and poorer response to depression treatment. American Journal of Geriatric Psychiatry, 32(2), 137-147. https://doi.org/10.1016/j.jagp.2023.08.009
- Nutley, S. K., Smit, D. J. A., Strom, N. I., et al. (2025). Classification of hoarding and comorbid neuropsychiatric symptoms. Journal of Psychiatric Research, 174, 58-70. https://doi.org/10.1016/j.jpsychires.2025.06.010
- O'Brien, S., & Laws, K. R. (2025). Decluttering minds: Psychological interventions for hoarding disorder - A systematic review and meta-analysis. Journal of Psychiatric Research, 181, 738-751. https://doi.org/10.1016/j.jpsychires.2024.12.029
- Postlethwaite, A., Kellett, S., & Mataix-Cols, D. (2019). Prevalence of hoarding disorder: A systematic review and meta-analysis. Journal of Affective Disorders, 256, 309-316. https://doi.org/10.1016/j.jad.2019.06.004
- Raila, H., Avanesyan, T., Valentine, K. E., et al. (2023). Augmenting group hoarding disorder treatment with virtual reality discarding: A pilot study in older adults. Journal of Psychiatric Research, 166, 25-31. https://doi.org/10.1016/j.jpsychires.2023.08.002
- Stumpf, B. P., Calácio, B., Branco, B. C., Wilnes, B., Soier, G., Soares, L., et al. (2023). Animal hoarding: A systematic review. Psychiatry Research, 328, 115487. https://doi.org/10.1016/j.psychres.2023.115487
- van Roessel, P. J., Muñoz Rodríguez, P. A., & Rodriguez, C. I. (2023). Hoarding disorder: Questions and controversies. Journal of Obsessive-Compulsive and Related Disorders, 38, 100825. https://doi.org/10.1016/j.jocrd.2023.100825
- Wheaton, M. G., Worden, B. L., Sternberg, L., et al. (2024). Buried in treasures workshop enhanced with in-home decluttering practice (BIT+): A randomized controlled trial in adults with hoarding disorder. Journal of Psychiatric Research, 176, 58-67. https://doi.org/10.1016/j.jpsychires.2024.06.034
