Hoarding disorder is a mental health condition that affects approximately 2.5% of the population, with higher rates among older adults. People with hoarding disorder experience persistent difficulty discarding possessions, regardless of their actual value, leading to excessive clutter that significantly impairs daily functioning and quality of life. Despite the challenges this condition presents, effective help is available through evidence-based treatments, support systems, and compassionate intervention strategies.
Hoarding disorder can profoundly impact not only the person experiencing it but also their family members, friends, and community. The accumulation of possessions often creates safety hazards, strains relationships, and leads to social isolation. Understanding the available treatment options and how to approach someone with hoarding disorder is crucial for facilitating recovery and improving outcomes for everyone affected.
Table of Contents
- Understanding When to Seek Help
- Talking to a Loved One About Hoarding Disorder
- Evidence-Based Therapy for Hoarding Disorder
- Support Groups and Community Resources
- The Cleaning Process: A Structured Approach
- Frequently Asked Questions
- Find Help for Hoarding Disorder
Understanding When to Seek Help
Hoarding disorder is characterized by difficulty parting with possessions because of strong urges to save the items. Difficulty discarding often includes items others consider to be of little value and results in accumulation of a large number of possessions that clutter the home. The condition typically begins in adolescence, with initial onset around age 16, and is chronic and progressive. Special populations, such as children, older adults, and people who do not voluntarily seek treatment, need special consideration for intervention.
Simply clearing out possessions rarely addresses the underlying issues. Pre-post effects revealed a large reduction in HD symptomatology (g = −1.09), sustained at follow-up in 18 studies, but symptoms often persist above the clinical cut-off for HD, highlighting the enduring clinical challenges in achieving symptomatic remission. Without proper treatment addressing the emotional and cognitive aspects of hoarding, individuals typically accumulate new items to replace what was removed.
Warning signs that professional help is needed include:
- Living spaces that cannot be used for their intended purpose due to clutter
- Significant distress when attempting to discard items
- Safety hazards such as blocked exits or fire risks
- Social isolation due to embarrassment about living conditions
- Conflict with family members or authorities about the hoarding
- Health issues related to unsanitary conditions
Talking to a Loved One About Hoarding Disorder
The constant buildup of clutter in the houses of hoarders makes it impossible for family members to live a healthy life. It can have appalling effects on their mental health and can lead to severe depression and suicidal ideation. However, approaching someone about their hoarding behavior requires sensitivity and understanding.
The shame and humiliation attached to hoarding do not allow the hoarders to seek help, causing them distress and hence continuing the vicious cycle of hoarding. By presenting the case of a patient with a spouse with a hoarding disorder, we want to bring to light the severity of the impact hoarding disorder can have on the partner and the grave need to spread awareness about it so that the patient or the family members can seek timely help.
Effective communication strategies include:
- Avoid judgment and criticism: Express concern without condemning the hoarding behavior
- Focus on safety and well-being: Emphasize health concerns rather than the mess itself
- Discuss impact on relationships: Share how the hoarding affects family dynamics without blame
- Respect autonomy: Acknowledge their right to make decisions about their possessions
- Suggest professional help: Offer to help find a therapist specializing in hoarding disorder
- Be patient: Recovery is a gradual process requiring ongoing support
Furthermore, the recognition of hoarding as a mental health issue was a subtheme that fostered interconnection. Understanding that hoarding is a recognized mental health condition, not a choice or character flaw, helps reduce stigma and encourages treatment-seeking.
What to avoid:
- Secretly throwing away possessions without consent
- Forcing immediate change or setting ultimatums
- Using shame or embarrassment as motivation
- Minimizing the emotional attachment to objects
- Expecting quick results from initial conversations
Evidence-Based Therapy for Hoarding Disorder
We then describe interventions for HD, focusing largely on cognitive-behavioral therapy for hoarding disorder (CBT-HD), the only treatment with conclusive evidence of efficacy. We review the components of CBT-HD and their rationale, noting that clinical results have been modest.
Cognitive Behavioral Therapy for Hoarding Disorder (CBT-HD)
CBT for HD (CBT-HD) generally results in large effect sizes from pre- to posttreatment (Rodgers et al., 2021), with most completers showing reliable change (Tolin et al., 2015). However, treatment gains are modest. Most participants continue to meet criteria for hoarding diagnosis at posttreatment, with only around 24–43% of patients showing clinically significant change at posttreatment.
Key components of CBT-HD include:
- Cognitive restructuring: Challenging beliefs about possessions and their importance
- Exposure exercises: Gradual practice discarding items and resisting acquisition
- Skills training: Developing organization, decision-making, and problem-solving abilities
- Motivational interviewing: Enhancing readiness for change
- Home visits: Practicing skills in the actual living environment
Treatment Innovations
Augmenting group hoarding disorder treatment with virtual reality discarding: A pilot study in older adults. Virtual reality helps people with hoarding disorder practice decluttering. This innovative approach allows individuals to practice discarding in a safe, virtual environment before attempting real-world decluttering.
Imagery rescripting is an experiential technique, often used in cognitive behavioural therapy (CBT), where participants introduce positive or benign information to 'rescript' the outcomes of negative mental imagery, in this instance worst-case scenarios of discarding. "It's typically used to reduce distress associated with negative memories; however, it's had success with other disorders characterised by future-focused mental imagery, such as generalised anxiety and obsessive-compulsive disorder (OCD)," Mr. Sabel says.
Addressing Co-occurring Conditions
Late Life Depression (LLD), or Major Depressive Disorder (MDD) in older adults, is commonly associated with executive dysfunction (1) and is known to contribute substantially to global disability (2) with estimated prevalence rates of 15–29% among community-dwelling older adults (3, 4). Psychotherapy interventions are effective (5) and commonly used to treat LLD with response rates ranging from 41–57% (6, 7). Hoarding Disorder (HD) is estimated to affect 4–6% of older adults, with increasing diagnostic prevalence with age (8), and is also significantly associated with executive dysfunction (9) and disability (10).
Treatment often needs to address co-occurring mental health conditions, particularly:
- Depression: Often requires integrated treatment approaches
- Anxiety disorders: Common in individuals with hoarding disorder
- ADHD: Executive function difficulties may contribute to hoarding
- Trauma-related conditions: Many individuals report traumatic experiences
Support Groups and Community Resources
Similarly, group therapy provided a space for individuals with HD to connect with others who were facing similar challenges and to receive social support (Chandler et al. 2019; McGrath et al. 2024; Noyes et al. 2024; Orr et al. 2019).
Benefits of Support Groups
Support groups offer unique advantages for individuals with hoarding disorder:
- Reduced isolation: Connect with others who understand the struggle
- Shared experiences: Learn from peers' successes and challenges
- Accountability: Regular check-ins help maintain progress
- Non-judgmental environment: Safe space to discuss difficulties
- Cost-effective: Often free or low-cost options available
Types of Available Support
In-person groups:
- Buried in Treasures workshops: The BIT+ intervention offers promise as a treatment option for hoarding. Adding in-home uncluttering practice may incrementally improve discarding practices. Future controlled trials are warranted.
- Local mental health organizations often host support groups
- Community centers may offer peer-led groups
Online support options:
- Join an online or phone-based support group. There are many well-run online support groups that you can access from ANYWHERE in the world.
- Virtual support groups have expanded access for rural communities
- Online forums provide 24/7 peer support
- Video-based groups offer face-to-face connection remotely
Family support groups:
- In hoarding difficulties, supporters may be family members or partners, but there may also be vital help available from friends or other types of contacts.
- Specialized groups for adult children of parents who hoard
- Partner and spouse support groups
- Educational workshops for family members
The Cleaning Process: A Structured Approach
When someone is ready to address the clutter, a systematic approach ensures safety and reduces overwhelm. At Fight the Blight, we believe healing begins when people are seen and heard, not shamed or blamed. That's why every part of our program is designed to restore dignity and provide practical support—not just a temporary cleanup.
Preparation Phase
Safety assessment:
- Check for immediate hazards (blocked exits, fire risks)
- Identify areas requiring professional cleaning
- Ensure utilities are functioning properly
- Document the space for treatment purposes
Gathering supplies:
- Heavy-duty trash bags and storage containers
- Protective equipment (gloves, masks, eye protection)
- Cleaning supplies and disinfectants
- First aid kit readily available
- Labels and markers for sorting
Sorting Process
Three-category system:
1. Keep: Items with clear current use or significant value
2. Donate/sell: Good condition items others could use
3. Discard: Broken, expired, or hazardous items
Decision-making strategies:
- Start with less emotionally charged areas
- Set time limits for decisions
- Use the "one-year rule" for unused items
- Take photographs of sentimental items before discarding
- Work in small, manageable sections
Professional Cleaning Services
Community-based efforts aimed at reducing public health and safety consequences of severe hoarding are needed. In severe cases, professional hoarding cleanup services may be necessary, particularly when:
- Biohazards are present (mold, pests, waste)
- Structural damage requires repair
- The volume exceeds what helpers can manage
- Specialized disposal is needed
- Time constraints exist (eviction threats)
Many companies specializing in hoarding cleanup understand the sensitive nature of the condition and provide:
- Confidential services with unmarked vehicles
- Trauma-informed approaches
- Coordination with mental health providers
- Assistance with valuable item recovery
- Follow-up support services
Frequently Asked Questions
What causes hoarding disorder?
Hoarding disorder has multiple contributing factors including genetics, brain differences, traumatic life events, and learned behaviors. Its etiology is largely unknown, but twin studies suggest that it is moderately heritable. Though we did not report any genome-wide significant SNPs, we report heritability estimates for the twin-cohorts between 26-48%, and a SNP-heritability of 11% for an unrelated sub-cohort. Many individuals report that hoarding behaviors provide comfort, control, or connection to memories.
How common is hoarding disorder?
The pooled estimated prevalence for HD was 2.5% (CI 1.7-3.6%) and subgroup analyses revealed that prevalence rates were similar for both males and females. The overall prevalence of hoarding disorder is approximately 2.6%, with higher rates for people over 60 years old and people with other psychiatric diagnoses, especially anxiety and depression. The prevalence and features of hoarding appear to be similar across countries and cultures.
Can hoarding disorder be cured?
While there is no "cure," hoarding disorder can be effectively managed with proper treatment. Large effect sizes were found from pre-treatment to post-treatment (g = 1.11; 95% CI: 0.92-1.29) and from pre-treatment to follow-up (g = 1.25; 95% CI: 0.94-1.56) on HD symptoms. Many individuals learn to control symptoms and maintain safer, more functional living spaces with ongoing support.
Is hoarding the same as collecting?
No, hoarding differs significantly from collecting. 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. Objects acquired by people with hoarding lack a consistent theme, whereas those of collectors are narrowly focused on a particular topic. In contrast to the organization and display of possessions seen in collecting, disorganized clutter is a hallmark of hoarding disorder.
Do medications help with hoarding disorder?
Pharmacotherapy for hoarding disorder has also been used, but empirical support is lacking due to nonblind study designs and small sample sizes. While no medications specifically treat hoarding disorder, medications may help manage co-occurring conditions like depression or anxiety that can worsen hoarding symptoms.
How long does treatment typically take?
Treatment duration varies significantly based on severity and individual factors. Treatment for HD generally requires a greater number of treatment sessions than other psychiatric disorders (Wootton et al., 2019), with 20 sessions or more often delivered during active treatment. Most people require ongoing support to maintain progress.
Find Help for Hoarding Disorder
If you or someone you know struggles with hoarding disorder, professional help is available. The journey to recovery requires patience, compassion, and evidence-based treatment approaches. We're glad you've reached out for help and support with hoarding disorder. Because hoarding disorder is closely related to OCD, you may wish to consult NAMI's Obsessive-Compulsive Disorder page, where you will find information on the condition, current treatments, and ways to support recovery. The following resources may be particularly helpful: The International OCD Foundation provides information for families, mental health professionals, and community responders and maintains a resource directory to locate therapists, treatment programs, clinics, and support groups.
To find a therapist specializing in hoarding disorder in your area, search the GoodTherapy directory or contact:
- International OCD Foundation's resource directory: hoarding.iocdf.org
- National Alliance on Mental Illness (NAMI): 1-800-950-NAMI (6264)
- SAMHSA's National Helpline: 1-800-662-HELP (4357)
Remember, seeking help is a sign of strength, not weakness. With proper support and treatment, individuals with hoarding disorder can achieve meaningful improvement in their quality of life and relationships.
References:
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- Centers for Disease Control and Prevention (CDC). (2025). Mental health conditions: Depression and anxiety. https://www.cdc.gov/mental-health
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