Hoarding Disorder: Symptoms, Causes, Diagnosis, and Evidence-Based Treatment Options

Understanding Hoarding Disorder

Hoarding Disorder is a mental health condition that makes it very hard for a person to let go of their belongings, even things that may not be useful. Over time, these items accumulate into substantial clutter in the home. This clutter can make it difficult to use living spaces and may even create safety risks. It can also affect a person’s health, relationships, and daily life.

There are several reasons why people with Hoarding Disorder save items. Sometimes it is because they feel a strong emotional attachment to the item. Other times, it is because they think the items might be useful later. Sometimes people with a hoarding disorder get stuck on the unique aspects of items that make them feel special, or fear having future regrets if they let go of something that they later miss. Many people have these feelings, but individuals with Hoarding Disorder experience them much more strongly and with many more types of items. As clutter grows, it can feel overwhelming and very hard to manage on your own.

Many people with this condition also collect more items than they can store, which is called "excessive acquisition". They may pick up free things, buy items on sale, or accept things from others, even when they do not have space for them.

How is Hoarding Disorder Diagnosed?

Mental health professionals use a guide called the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR¹) to diagnose conditions like Hoarding Disorder.

The DSM-5-TR is an official handbook created by experts that lists mental health conditions and the criteria needed for each diagnosis. According to the DSM-5-TR, a diagnosis of Hoarding Disorder includes the following criteria:

Enduring pattern of difficulty discarding possessions, regardless of their value.
A strong need to save items and distress associated with parting with them.
Cluttered living spaces that compromise their intended use
Significant distress or impairment in functioning, including safety concerns, relationship conflict, or difficulty at work or socially.

People often feel ashamed or misunderstood, which can delay seeking help. In many cases, family members are the first to recognize the problem.

Who Is Affected by Hoarding Disorder?

Research shows that:

About 2–3% of adults are affected.
Around 80–90% of individuals with Hoarding Disorder also struggle with excessive acquiring.
Symptoms often begin in adolescence but may become problematic later in adulthood.
Hoarding affects people of all genders, cultures, and income levels.

Many people also experience co-occurring disorders such as anxiety, depression, or challenges with executive functioning.

What Factors May Contribute to Hoarding Disorder?

The causes are complex and may include:

Genetic factors or family history – Hoarding tendencies sometimes run in families.
Brain-based differences – Some individuals with hoarding problems show differences in areas of the brain involved in decision-making, attention, and emotional processing.
Stressful or traumatic experiences – Loss, trauma, or major life stressors can trigger or worsen hoarding behaviors.
Learned behaviors – Growing up in an environment where saving or accumulating items was common can influence hoarding patterns.
Co-occurring mental health disorders, such as: anxiety, depression, ADHD, or OCD, may play a role.

Hoarding Disorder is not related to laziness or lack of willpower. It is a legitimate and treatable mental health condition.

Evidence-Based Treatment for Hoarding Disorder

Because hoarding behaviors develop gradually, change tends to happen step-by-step. Many individuals feel overwhelmed or unsure how to begin, making professional support especially important. Effective treatment options include:

Cognitive Behavioral Therapy (CBT) for Hoarding

Cognitive Behavioral Therapy (CBT) is a kind of counseling that teaches people new ways to think and act so they can better manage hoarding to:

Explore why discarding feels difficult.
Reduce urges to acquire new items.
Improve decision-making and organizational skills.
Challenge beliefs about the meaning or value of possessions.
Teach practical strategies for sorting and discarding.
Include in-home practice with therapist support.

Group-based Treatment

Many people benefit from group-based treatments for hoarding problems, which allow affected individuals to support one another as they go through the process of treatment. These treatments may be led by a professional therapist or a non-professional facilitator with experience in hoarding treatment. These groups typically focus on building the skills taught in CBT, including organizational, decision-making, and sorting skills. One well-known group approach is called the Buried-In-Treasures (BIT) Workshop, which follows the CBT workbook of the same name.

Team-Based Care

Many people do better when they have a support team working together. This team may include:

Therapists or counselors
Psychiatrists or other medical providers
Case managers or community programs
Professional organizers who understand hoarding
Family members or trusted supporters

Professional organizers can give hands-on help with sorting and organizing. However, they are not mental health professionals. This is why organizers and therapists need to work together so that both the practical and the emotional parts of hoarding can be addressed.

When to Seek Help

You may find support helpful if:

Your home is difficult or unsafe to use due to clutter.
Decluttering feels overwhelming or unmanageable.
Acquiring new items feels out of control.
Loved ones have expressed concern.
You avoid having visitors.
Clutter affects your health, safety, or relationships.

With compassionate, evidence-based care, individuals can make meaningful progress toward a safer, more functional living environment.

Frequently Asked Questions About Hoarding Disorder

What is Hoarding Disorder?

Hoarding Disorder is a mental health condition involving persistent difficulty parting with possessions. This difficulty leads to significant clutter that limits the use of living spaces and affects safety, relationships, and emotional well-being.

How is Hoarding Disorder different from collecting?

Collecting is organized, purposeful, and generally enjoyable. Hoarding typically involves disorganized accumulation, strong emotional distress about discarding, and clutter that disrupts daily life.

What are the most common symptoms?

Symptoms include cluttered living spaces, difficulty discarding items, acquiring more belongings than needed, avoidance of visitors, and feeling overwhelmed when attempting to make decisions about possessions.

What causes Hoarding Disorder?

Hoarding Disorder can develop due to a combination of genetic factors, brain-based differences, stressful life experiences, learned behaviors, and co-occurring mental health conditions.

Who is most at risk for developing hoarding?

Hoarding Disorder affects people of all backgrounds. Symptoms often begin in the teenage years and can become more noticeable in adulthood. Individuals with anxiety, depression, or attention-related challenges may be at higher risk.

How do mental health experts diagnose Hoarding Disorder?

A licensed mental health professional evaluates the person’s relationship with possessions, the level of clutter, and how these behaviors affect daily functioning.

Is Hoarding Disorder treatable?

Yes. Many people benefit from therapies such as Cognitive Behavioral Therapy (CBT) for hoarding, group-based treatment approaches, skills training, and coordinated support from professionals and family members.

What is CBT for hoarding?

CBT for hoarding is a structured therapy that helps individuals understand emotional and cognitive barriers to discarding, reduce acquiring behaviors, challenge belief patterns, and build practical organizational skills.

Can professional organizers help with hoarding?

Professional organizers can be valuable supports, especially when trained in hoarding-informed practices. However, organizing alone does not address the underlying emotional and cognitive aspects. Collaboration with therapists is essential.

What if a person refuses help?

This is common. Approaching the individual with empathy and avoiding judgment can reduce defensiveness. Loved ones can encourage small steps and seek guidance from mental health professionals for effective communication strategies.

When should someone seek support?

Support is recommended when clutter interferes with daily activities, when the person is unable to stop acquiring new items, relationships are strained, or the person avoids having visitors due to embarrassment or distress.

Where can I find help?

A licensed mental health professional with experience in anxiety and related disorders is a good place to start. ADAA's Find a Therapist directory can help connect individuals with support. Community services and trained organizers may also play a role in a team-based approach

Community Resources:

¹ The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) is a mental health reference book published by the American Psychiatric Association. It helps doctors and mental health professionals diagnose mental health conditions. The 2022 edition is the most recent update of the manual. Because it is created and reviewed by experts, it is considered a trusted source in mental health care. For more information on recent updates read What is the DSM and How is It Changing?