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Hoarding Disorder: Symptoms, Stages, Causes, & Treatment

Written by Jonathan Strum

& Medically Reviewed by Amalia Sirica, LCSW

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Last Updated - 2/11/2022

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Updated 02/11/2022

Hoarding disorder is characterized by an inability to part with possessions, and it can negatively impact many aspects of a person’s life.

Hoarding disorder (HD) is a mental health condition that makes it difficult to part with one’s possessions. A person with this disorder may experience significant distress when asked to get rid of items, as they feel they need to save them. Around 2.6% of the population has a hoarding disorder.

What is Hoarding Disorder?

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) places hoarding disorder in the “obsessive-compulsive and related disorders” class. The manual provides specific symptoms and other criteria used to diagnose and identify hoarding disorder. It also specifies that the hoarding cannot be the result of another medical condition or be better explained by symptoms of another mental disorder.

Is Hoarding a Mental Illness?

Hoarding is considered a mental illness if it meets DSM-5 criteria and begins to cause significant distress in one or more areas of a person’s life. If hoarding gets unmanageable, it can pose health risks and lead to unsanitary conditions in a person’s home.

Hoarding Disorder Symptoms

Since hoarding disorder can cause significant distress, it can be helpful to know its signs and symptoms. This can potentially assist with prevention and early treatment. Symptoms of HD may include:

  • Being unable to stop accumulating possessions despite not having space
  • Significant difficulty discarding possessions
  • Possessions building up in the home, eventually making spaces unusable
  • Struggling with procrastination and decision-making
  • Buildup of food or trash, sometimes to the point of becoming unsanitary
  • Feeling safe due to being surrounded by one’s things

Types of Hoarding

Hoarded items can vary widely from person to person. Examples of things a person may hoard include:

  • Newspapers and magazines
  • Books
  • Clothes
  • Containers/plastic bags
  • Animals
  • Bills, receipts and letters

5 Stages of Hoarding

There are five stages of hoarding, and each stage represents an increasing level of severity and disruption. The stages include:

  • Level one: Minimal clutter, all entrances and exits in the house are accessible
  • Level two: Conditions start to become unsanitary, garbage is not being removed, some evidence of household pests
  • Level three: Odors begin to occur throughout the home
  • Level four: Absence of clean dishes or utensils, rotting food, exits start to be blocked
  • Level five: No usable rooms, noticeable human feces, heavy vermin infestation

What Causes Hoarding?

A person can develop hoarding disorder for a wide variety of reasons. For example, several mental health conditions are highly associated with hoarding disorder, such as depression, generalized anxiety disorder and social phobia. Any of these conditions could make it more likely for a hoarding disorder to develop or worsen.

Physical or mental disabilities can also make it difficult for someone to care for their homes. Some people with HD may have grown up in a cluttered home or have a family history of hoarding. HD is essentially a form of self-neglect, which can result from low self-esteem and difficult life experiences.

Risks and Consequences of Hoarding

Hoarding disorder can create a variety of risks and consequences. For example, a person may be reluctant to let someone into their home due to the nature of the hoarding. This can cause feelings of isolation and loneliness, which could potentially lead to deeper feelings of depression.

Hoarding also presents physical health risks because it can make cleaning difficult, increasing the likelihood of an unhygienic home. The clutter can also increase the likelihood of blocked exits or trip hazards.

Diseases Caused by Hoarding

Research shows that there is a link between hoarding disorder in older adults and an increased risk for fire, unhygienic conditions and disabilities. People with HD were also more likely to experience sleep apnea, diabetes, seizures, head injuries, cardiovascular issues and arthritic, hematological and lung conditions.

This can be important information to keep in mind when treating HD, as some people might require both mental and physical health care.

Hoarding Disorder Treatment

The most common treatments for hoarding disorder include:

  • Cognitive-behavioral therapy (CBT): CBT treatment for hoarding disorder includes confronting the person’s beliefs about hoarding and restructuring them. The person might also be challenged to stop collecting more items and discover what is causing the hoarding behavior.
  • Motivational interviewing (MI): Motivational interviewing helps people make positive and lasting change in their life through motivational techniques.
  • Skills training: The goal of this treatment method is to help the person solve problems and make decisions to remove clutter and keep their environment clean.
  • Medication: Medication for hoarding disorder aims to reduce anxiety or improve mood. The goal is to help the person manage symptoms that could be leading to hoarding behavior.

People who struggle with mental health conditions like hoarding disorder may turn to drugs or alcohol in an attempt to cope. If you or someone you love is struggling with substance abuse and a co-occurring mental health disorder, The Recovery Village at Baptist Health can help. Contact us today to learn more about dual diagnosis treatment programs that can work well for your needs.

View Sources

American Psychiatric Association. “What Is Hoarding Disorder?” Accessed January 28, 2022.

Substance Abuse and Mental Health Services Administration. “Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health.” June 2016. Accessed January 28, 2022.

NHS. “Hoarding Disorder.” June 12, 2018. Accessed January 28, 2022.

Cleveland Clinic. “Hoarding Disorder.” January 23, 2018. Accessed January 28, 2022.

Barnsley Metropolitan Borough Council. “Self neglect and hoarding.” Accessed December 16, 2021.

Ayers, R. Catherine; Iqbal, Yasmeen; Strickland, Katrina. “Medical conditions in geriatric hoarding disorder patients.” Aging & Mental Health, September 25, 2017. Accessed December 16, 2021.

Frost, Randy O.; Steketee, Gail; Tolin, David F. “Comorbidity in Hoarding Disorder.” Depression and Anxiety, October 3, 2012. Accessed December 16, 2021.

International OCD Foundation. “Treatment of Hoarding Disorder.” Accessed December 16, 2021.