Hoarding is a form of obsessive-compulsive disorder. Individuals feel the need to hoard things as a means of staying safe. It’s normal to have some degree of hoarding. I find it very hard to chuck old clothes and always think I may need them in the future. I am not a hoarder in the true sense of the word however as I don’t keep clutter around that interferes with my daily living.
For individuals with HD, the difficulty with getting rid of things causes their living spaces to become so cluttered that they are nearly unusable. Without help, HD can interfere with daily tasks like cooking, cleaning, personal hygiene, and/or sleeping. Extreme clutter can lead to eviction, increased risk for fire, and impaired access to emergency services. In addition, HD can lead to poor sanitation and cause serious conflict with families and communities.
It is estimated that around 2% – 6% of the population suffers from hoarding disorder.HD appears to affect men and women at similar rates.HD is believed to be a universal phenomenon with consistent clinical features in all races, ethnicities, and cultures around the world.
Hoarding symptoms appear to be almost three times more common in older adults (ages 55-94 years) compared to younger adults (ages 34–44 years), although hoarding symptoms can occur in young children as well.
Hoarding symptoms begin to appear early in life and continue throughout the entire lifespan, increasing in severity with each passing decade if untreated:
- Ages 11–15 — symptoms may first emerge
- By the mid-20’s — symptoms begin interfering with every day functioning
- By the mid-30’s — individual demonstrates clinically significant impairment and is likely to meet full criteria for a diagnosis of HD
Around 75% of individuals who have HD have a co-occurring mental health condition.
- The most common co-occurring disorders are major depressive disorder, social anxiety disorder/social phobia, and generalized anxiety disorder.
- Around 20% of people with HD also have OCD.
There is more than one type of hoarding disorder. There are different levels of hoarding that identify the severity of a person’s disorder. The National Study Group on Compulsive Disorganization created a clutter hoarding scale with five levels of hoarding. Understanding each level of hoarding disorder can help people understand how to help those affected by the condition.
Hoarding Level 1
The first level of hoarding is the least severe. The residence of a level 1 hoarder may include:
- Light amounts of clutter and no noticeable odors.
- All doors and stairways are accessible
- No more than three areas with animal waste throughout the house.
Hoarding level 1 involves few signs that an individual has a hoarding disorder. The lack of clutter might hide the condition, but the individual may still have difficulty throwing away items and shop excessively for objects they do not need.
Hoarding Level 2
Hoarding level 2 requires a blocked exit from a person’s residence, one appliance not working for at least six months or the presence of a malfunctioning heating, cooling or ventilation system for at least six months. This level of hoarding involves additional clutter around the residence, specifically in two or more rooms, and narrow pathways through the home. There must also be at least a light amount of mildew in one bathroom or the kitchen. Other characteristics include:
- Light pet odor
- Pet waste on the floor
- At least three incidents of feces in a litter box
- Minimal fish, bird or reptile care
- Evidence of household rodents
- Overflowing garbage cans
- Dirty food preparation surfaces
People within hoarding level 2 may avoid inviting people into their homes or show embarrassment due to the state of their residence. This level of hoarding may cause anxiety or a depressed state and lead to withdrawal from social interaction.
Hoarding Level 3
Residences within hoarding level 3 have visible clutter outside of the home, including items that are usually indoors (such as televisions and furniture). At least two appliances have been broken for six months, and one area of the house has light structural damage. The number of pets exceeds regulations, and animal tanks and cages are neglected. There is visible and audible rodent evidence, fleas, spider webs and narrow paths through the halls and stairways. Other characteristics include:
- At least one unusable bathroom or bedroom
- Small amounts of hazardous substances or spills on the floors or surfaces
- Excessive dust
- Dirty clothes, towels and sheets
- Blocked electrical outlets resulting in tangled cords
- Overflowing garbage cans
- Odors throughout the house
A person within this level often has poor personal hygiene and weight issues due to an unhealthy diet. An individual in this level of hoarding may become dismissive or angry when approached by friends or family members about the state of their lifestyle.
Hoarding Level 4
Residences within hoarding level 4 have noticeable mold and mildew throughout the building, structural damage that is at least six months old, odors and sewage buildup. The number of pets exceeds regulations by at least four, and there are more than three visible areas with aging animal waste. The bedroom is unusable and rotting food is on surfaces. Other characteristics include:
- Aged canned goods
- No clean dishes or utensils
- Beds with lice, or other bugs, and no sheets or covers
- Excessive webs and spiders
- Bats and other rodents audibly noticeable in the attic and walls
- More than one blocked exit
- Flammable substances stored in the living room
People within hoarding level 4 have poor hygiene and may not bathe for weeks. These individuals often have worsening mental health and focus their emotional energy on grandiose plans or nostalgic memories.
Hoarding Level 5
Hoarding level 5, the most severe type of hoarding disorder, involves severe structural damage to the residence. Broken walls, no electricity or running water, fire hazards, and visible rodents and other non-pet animals are a few of the characteristics of homes within hoarding level 5. Other signs include:
- Clutter filling bathrooms and kitchen
- At least four too many pets, per local regulations
- Noticeable human feces
- Rotting food on surfaces and inside a non-working refrigerator
People within hoarding level 5 often do not live at their residence due to the clutter but rather stay at a friend’s or family member’s house. They may also discharge their waste into bottles or buckets that remain inside the home. Individuals within this level of hoarding usually have noticeable symptoms of depression.
Aftermath of Hoarding
Hoarding can have severe consequences for not only the individual with the disorder but also their loved ones. Financial strain due to excessive shopping is one of the most common consequences of hoarding. Other effects include strained relationships and possible loss of housing due to eviction, depending on the severity of the disorder.
Children of people with a hoarding disorder may experience depression or another mental condition due to their living situation. Adolescents and teenagers may avoid social situations that involve inviting peers to their house because of their embarrassment about the state of the residence. Some children become resentful of their parents due to the unhealthy lifestyle they experience due to the hoarding.
Hoarding can also lead to substance abuse as a coping mechanism for the disorder. If your loved one’s hoarding has led to substance abuse, call The Recovery Village®. Representatives are available to help people find the treatment they need. The Recovery Village®’s rehabilitation centers specialize in addiction treatment and can address connected mental health disorders, including a hoarding condition.
Treatment for hoarding disorder
CBT is a type of therapy that helps individuals to examine the way they think and behave, and to change the thought processes or behaviors that may be problematic.
The specific CBT elements involved in HD treatment include restricting acquiring, practicing sorting and discarding, and cognitive restructuring to challenge thoughts and beliefs about attachment to items.
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