There are significant differences between collecting and hoarding. Collectors seek out specific items that they methodically organize and display. Hoarding occurs when an individual’s collections consist of relatively worthless objects or possessions, which they seem unable to discard. Their living or workspace becomes so cluttered that it results in unsafe conditions. Messy or disorganized behavior is not necessarily a symptom of hoarding, but mental health professionals estimate that between two and six percent of the population has a chronic hoarding disorder.

Clutter vs. Hoarding

Most households have some amount of clutter, often because of busy schedules. People usually clean up untidy areas eventually and toss out things they don’t need. The main difference between clutter and hoarding is that clutter doesn’t build up due to an individual’s inability to part with the items. A person with a hoarding disorder feels a strong attachment to even generic belongings, bestowing sentimental value on them or finding security in their presence.

Signs of Hoarding

A person exhibiting hoarding behavior is in a constant state of disarray and disorganization, filling their home, workspace, car, and yard with newspapers, junk mail, clothing, broken gadgets, and more. Suggestions from well-meaning friends or family members to clean up and throw away some of their possessions cause extreme stress and anxiety. Compulsive buying and constant bargain-hunting are early signs of hoarding behavior. The individual may hoard free items such as condiment packets from restaurants. They often feel embarrassed about their living conditions or have an intense fear of someone touching or removing their possessions. These symptoms often lead to social withdrawal.

Risk Factors

Hoarding is three times more likely to affect older adults between the ages of 55 to 94 than those in their 30s or 40s, according to the American Psychiatric Association. Researchers have not found a specific cause for hoarding disorder. Some studies suggest men are more likely to be hoarders than women, although both sexes can develop the disorder. There may be a familial link, as many people with hoarding disorders have a family member who also exhibits symptoms. A stressful life event, such as the death of a loved one, may provoke or worsen symptoms. Some evidence points to brain injuries as another potential cause.

Clinical Symptoms of Hoarding Disorder

Although psychiatrists once viewed hoarding as an obsessive-compulsive disorder (OCD) behavior, the DSM-5 recognized hoarding disorder as a unique diagnosis in 2013. Research shows that people with hoarding disorders experience different brain functions than those with OCD. Hoarding symptoms usually start around the age of 13. Without treatment, the disorder becomes chronic and progresses. As the individual accumulates more clutter, dysfunction levels increase. A person with a hoarding disorder is generally in substantial distress, facing diminished work performance or strains in their relationships. About 75% of individuals with a hoarding disorder also have an additional mental health condition, such as depression, alcohol abuse, attention deficit hyperactivity disorder, obsessive-compulsive disorder, or social anxiety.

Hoarding As a Symptom

Hoarding is a stand-alone disorder but may be a symptom of other disorders, as well, including

• Obsessive-compulsive personality disorder: a rigid need for order and adherence to rules and regulations
• OCD: uncontrollable, recurring thoughts or behaviors that the individual feels they must repeat over and over
• ADHD: an inability to focus, impulsive acts, and excess movement that does not fit into the current setting
• Depression
• Dementia: a loss of cognitive function and behavioral abilities common in older adults.
• Pica eating disorder: eating non-food materials
• Prader-Willi syndrome: a rare genetic disorder causing a constant sense of hunger
• Psychosis: disruptions in thoughts leading to difficulty in perceiving what is real or not

Animal Hoarding

Some people with a hoarding disorder collect large numbers of animals, regardless of their ability to provide adequate care. A Tufts School of Veterinary Medicine study found that although the behavior is present in all ages and sexes, 76% of the animal hoarding cases involved females. Around 60% of these women were over the age of 60. Later studies highlight that animal hoarding is not only a serious mental health issue but an animal cruelty and public health problem as well. The hoarder doesn’t intend to be cruel to animals and often believes they are providing adequate care. They often start out with good intentions but are unable to keep up with the growing demands of caring for a large number of animals. Without treatment, the studies show a 100% chance of relapse in animal hoarding behavior.

Health and Safety Concerns

Hoarding behavior leads to health and safety issues that endanger both the person who hoards and the surrounding community. Piles of paper goods and flammable items create fire hazards. Rodent and insect infestations cause unsanitary conditions and potential health risks. Because the clutter prevents regular cleaning and maintenance, the home may develop electrical, plumbing, or structural issues. Clutter may prevent timely action by first responders in the event of a medical emergency or fire at the site.

Diagnosis

To determine whether an individual is exhibiting symptoms of a hoarding disorder or if the hoarding is a symptom of another issue, a mental health professional or physician assesses the behavior. A hoarding disorder diagnosis requires confirmation of three specific conditions: ongoing difficulty to get rid of possessions, major distress if faced with the scenario of discarding possessions, and an unusable living space due to the accumulation of possessions. Further clues include indecisiveness, procrastination, perfectionism, and distractibility. To determine the individual’s day-to-day level of functioning, the health professional may also ask permission to speak with family or friends.

Treatment

The goal for the treatment of a hoarding disorder is to decrease the person’s need to acquire, save, and keep material items that hold no true value for them. The cognitive-behavioral therapy approach teaches people how to discard items gradually. Additionally, mental health therapists teach decision-making and organizational skills and relaxation techniques. Physicians may prescribe medications to deal with symptoms such as anxiety or depression.

Social Implications of Hoarding Disorders

Because hoarding appears to have developed only in the last few decades, some social science professionals see the symptoms as an attempt to adapt to the world’s changing materialism. Animals prepare for cold winters or famine by hoarding food. Those with hoarding disorders often say they are collecting items — just in case. Having a family member or friend with a hoarding disorder can be difficult and frustrating. If they do not respond to attempts to assist them in creating a safer living space, it may become necessary to contact local authorities.