WHAT IS COMPULSIVE HOARDING?
Compulsive hoarding is a disorder characterized
by difficulty discarding items that appear to most people to have
little or no value. This leads to an accumulation of clutter such
that living and workspaces cannot be used for their intended
purposes. The clutter can result in serious threats to the health
and safety of the sufferer and those who live nearby. Often people
with compulsive hoarding also acquire too many items - either free
In order to meet criteria for a diagnosis of compulsive hoarding, a
person must experience significant distress and/or impairment in
functioning as a result of their hoarding behavior. Common types of
functional impairment include: fire or health hazards caused by
excessive clutter, infestations, inability to have guests over to
the home, inability to prepare or eat food in the home, inability to
find important possessions because of clutter, inability to finish
tasks on time, and interpersonal conflicts caused by the clutter.
Not all hoarding is compulsive. Hoarding and saving behaviors can be
seen in people with various neuropsychiatric disorders, such as
psychotic disorders, dementia, eating disorders, autism, and mental
retardation, as well as in people with no psychiatric disorder.
However, it is most frequently associated with obsessive compulsive
disorder (OCD). Between 25-40% of people with OCD have compulsive
hoarding symptoms. It is not clear at this point whether compulsive
hoarding is part of OCD or whether it is a separate disorder that is
common in people who have OCD.
FREQUENTLY ASKED QUESTIONS:
What typically drives compulsive hoarding?
Discarding valuable items that might be
needed or useful someday
Losing important information
Making a mistake
Losing something that reminds a person of a
Not being able to do things as completely or
as well as one would like
Typical behaviors seen in compulsive hoarding
Saving far more items than are needed or can
Acquisition of more items than can be used.
Avoidance of throwing things away.
Avoidance of making decisions.
Avoidance of putting possessions in
appropriate storage areas, such as closets, drawers, or files.
Pervasive slowness or lateness in completing
What are some other symptoms of compulsive
Compulsive hoarding is part of a discrete clinical syndrome that
also includes indecisiveness, perfectionism, procrastination,
difficulty organizing tasks, and avoidance behaviors.
How disabling is compulsive hoarding?
Compared to people with non-hoarding OCD, those with compulsive
hoarding typically show:
More functional impairment
More social and family disability
More severe anxiety and depression symptoms
Older age when presenting for treatment
Poor insight into the severity of the problem
The clutter that accumulates in the homes of
people who hoard is often a serious fire risk. These homes are also
frequently vulnerable to infestation from rodents, insects, and
molds, which can put the inhabitants of the home at risk for various
health problems, including asthma, allergies and infections.
Family members are often frustrated by the gradual worsening of
symptoms and the extent of the person's impairment. They often want
very much to help but feel powerless to do so. They may become angry
at the person’s inability to clean or discard clutter, not
understanding that this is not possible without treatment.
Are people with compulsive hoarding just lazy?
No. Compulsive hoarding is not due to laziness or weakness of
character, nor is it due simply to disorganization. Rather, the
compulsive hoarding syndrome may be due to distinct brain
abnormalities that will not improve without treatment. People with
this problem are often acutely aware that the degree of clutter in
their home is socially unacceptable and often believe that others
will think them lazy or even crazy. Not surprisingly, they are
frequently secretive about their problems and will often isolate
themselves from family and loved ones. This may also be why they are
reluctant to seek treatment.
How many people suffer from compulsive hoarding in the United
The true prevalence is unknown, but it is estimated that up to 1.2
million people suffer from compulsive hoarding in the USA.
What causes compulsive hoarding?
Compulsive hoarding may be hereditary. Up to 85% of people with
compulsive hoarding can identify another family member who has this
problem. Abnormal brain development and brain lesions may also play
a role. Compulsive hoarding can begin after brain damage, such as
strokes, surgery, injuries, or infections. Family experiences and
psychological factors may also play a role in the development of
hoarding and emotional stress may heighten symptoms.
Research indicates that people with the compulsive hoarding syndrome
have unique abnormalities of brain function that are be different
from those seen in people with non-hoarding OCD and those with no
psychiatric problems. However, we do not yet fully know what causes
these brain abnormalities.
All people with significant hoarding behaviors should receive
thorough assessment to evaluate possible causes of hoarding
behavior, determine the correct diagnosis, and develop an
appropriate treatment plan.
What is the age of onset of compulsive hoarding?
People with compulsive hoarding who participate in research and
treatment studies have an average age near 50. Onset typically
occurs during teenage years, but may occur later in life, after
brain damage, a traumatic life event or episode of depression.
Regardless of the age of onset, there is usually a significant time
lag of many years between the onset of symptoms and when a person
first seeks treatment.
What is the course of compulsive hoarding syndrome?
Compulsive hoarding tends to be a chronic disorder. Left untreated,
it usually worsens gradually over time.
What treatments are available for compulsive hoarding?
Cognitive behavior therapy (CBT) using the technique of exposure and
response prevention appears to improve compulsive hoarding symptoms.
This technique decreases excessive fears of making decisions, losing
important possessions, throwing things away, and organizing saved
items out of sight, by gradual exposure to tasks that provoke these
fears. People with compulsive hoarding problems are encouraged to
resist their urges to engage in their usual behaviors, such as
postponing decision making, saving things “just in case,” or putting
things in piles rather than storing them. This ultimately results in
a decrease in anxiety, avoidance, and compulsive behaviors, and
changes the way people with compulsive hoarding think about their
CBT for compulsive hoarding can be effectively done either in
someone’s home or in a therapist’s office setting.
Medication – Drugs with potent effects on the brain chemical
serotonin seem most effective. Serotonin reuptake inhibitors (SRI's)
are highly effective and FDA-approved for treatment of OCD, but it
is not clear whether they are as effective for compulsive hoarding
as for other OCD symptoms. Very few studies have tested SRI’s or
other medications specifically for treatment of compulsive hoarding.
Some studies have found that SRI’s are beneficial for compulsive
hoarding, while others found that hoarding symptoms were associated
with poor response to SRI’s.
If someone does not have an adequate response to SRI’s, adding other
types of medications can often help to improve response. New
medications and new combinations of medications are always being
tried, giving reason for greater hope in the future.
A combination of medication and CBT appears to be the most effective
treatment regimen for most people with the compulsive hoarding
Participate in Compulsive
Hoarding & OCD Study