Around 2.5% of the population meets the diagnostic criteria for a hoarding disorder, according to the American Psychological Association (APA). This complex condition is often misunderstood, and people’s idea of hoarding is usually influenced by how it’s shown on TV or in movies.
However, there’s much more to this condition than what you see on screen. Hoarding isn’t a lifestyle choice nor a sign of laziness. It’s a recognized mental health condition that can manifest in different ways and requires the right treatment and support for recovery.
Learning about hoarding disorder and its five levels can help you and your loved ones understand this condition, recognize its symptoms, and find help when necessary.
Table of Contents
What Is Hoarding Disorder?
Hoarding disorder is a mental health condition in which a person finds it difficult to let go of material possessions, even when they have little to no value. They may also experience a strong desire to keep acquiring new items, and an inability to organize or prevent clutter.
A person’s hoarding behavior can range from mild to severe. It becomes a problem when it causes distress and negatively affects their health and quality of life.
Hoarding can exist on its own or alongside other conditions, like anxiety, depression, attention deficit hyperactivity disorder (ADHD), and obsessive-compulsive disorder (OCD).
Commonly hoarded items include newspapers, magazines, books, clothing, containers, household goods, major appliances, and supplies. Some people also hoard animals.
Hoarding and Collecting: What’s the Difference?
Hoarding items and collecting items are two distinct behaviors that can sometimes look alike. However, you can usually tell them apart according to how the items are organized, their intended use, and their impact on an individual’s daily life and well-being.
For instance, many people collect books, coins, or stamps as a hobby and for viewing pleasure. They keep their collection easily accessible and well organized on shelves, albums, or display cases. Collecting these items brings joy and doesn’t negatively impact their lives.
Meanwhile, a hoard is often messy, takes up a lot of space, and involves items of limited usefulness. Hoarding poses many risks, including unsafe and unsanitary living conditions.
Signs and Symptoms of a Hoarding Disorder
The first symptoms of a hoarding problem usually appear during a person’s teenage to early adult years and tend to worsen with each passing decade, according to the American Psychological Association (APA).
Signs and symptoms of a hoarding disorder may include:
- The buildup of clutter to the point of not being able to use your rooms
- Conflict and distrust with others who touch, borrow, or organize your things
- Social isolation and having poor relationships with family and friends
- Struggling to perform everyday tasks, like cleaning and cooking
- Problems with planning, organizing, or decision-making
- Experiencing extreme stress when trying to let go of items
- Continuing to get items that you don’t need or don’t have space for
How Is Hoarding Disorder Diagnosed?
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides the following criteria for diagnosing hoarding disorder:
- Persistent difficulty discarding or letting go of possessions, regardless of their value
- A perceived need to save possessions and feelings of distress in discarding them
- Symptoms result in the accumulation of items that clutter living spaces and compromise their intended use
- Clinically significant distress or impairment in important areas of functioning, including maintaining a safe environment for self and loved ones
- The hoarding behavior is not due to another medical condition, (e.g., brain injury)
- The hoarding behavior is not better explained by the symptoms of another mental disorder, (e.g., major depressive disorder, schizophrenia, autism spectrum disorder)
Mental health professionals may also speak with a person’s friends and family members to help them make a diagnosis. They may also use questionnaires in making their assessment.
Understanding the 5 Levels of Hoarding
To better understand the degree of clutter and the severity of hoarding behavior that a person is experiencing, the Institute for Challenging Disorganization developed a Clutter-Hoarding Scale.
This can serve as a tool for family members, friends, and health professionals in assessing the household environment of the struggling individual and identifying potential health and safety risks. It includes five progressive levels, such as:
Level 1: Low Clutter-Hoarding
The first level of hoarding involves non-excessive clutter, which is likely unnoticeable to friends and family. All rooms are being used for their intended purposes, and all doors, windows, and stairways are accessible in case of emergency. The home is safe and sanitized, with no odors.
At this stage, all household appliances are still fully functional, with plumbing, electricity, and HVAC systems in good condition. There’s an appropriate number of pets and no infestations.
Level 2: Guarded Clutter-Hoarding
When an individual reaches level 2, their hoarding behaviors become more apparent. Clutter is increasingly visible and obstructs functioning in living areas. Some household appliances, plumbing, or electrical systems aren’t fully functional. At least one major exit is blocked.
There’s also evidence that household pests, dander, and waste from pet animals are present. You may notice odors from dirty dishes, food preparation surfaces, toilets, or laundry.
Level 3: Elevated Clutter-Hoarding
At level 3, the person’s hoarded items overflow outside the home. At least one room has become unusable due to clutter, and light structural damage has occurred. Garbage cans are full, odors are obvious, and the house has accumulated dust, dirt, and debris.
There’s visible mildew in the bathroom or kitchen, along with dirty laundry, dishes, and toilets throughout the house. A light insect infestation is present, with evidence of unclean pets.
Level 4: High Clutter-Hoarding
This level represents a highly unsafe and unsanitary home environment. Excessive clutter prevents access to exits, entrances, hallways, and stairways. Serious issues, like water damage, sewer backups, mold and mildew, and broken doors and windows are present.
Dishes and utensils become unusable, and rotting food poses health risks to inhabitants. There’s evidence of poor animal sanitation, including spiders and webs around the house.
Level 5: Severe Clutter-Hoarding
At the last and most severe level, the house becomes unlivable, with irreparable damage to its interior and exterior structure, and disconnected or unreliable electrical, water, and sewage systems. All key living spaces, including most appliances, are unusable.
You may observe extreme clutter, both in and out of the home, along with overgrowth of greenery. Human urine and feces may be present, with heavy insect infestation, and pets that are at risk or dangerous to people.
What Causes a Hoarding Disorder?
There is no single factor that predisposes or causes a person to develop a hoarding disorder. However, research has been able to identify several risk factors and potential causes that can make a person more likely to have the condition, such as:
- Genetics and having family members who have a hoarding disorder
- Stressful life events and traumatic experiences
- Compulsive buying behavior
- Mental health conditions, like depression and anxiety
- Alcohol use disorder or other forms of substance use disorders
- Brain injury and problems with attention, organization, and decision-making
- Having a childhood deprived of material objects
- Growing up in a cluttered home or unhealthy family environment
Potential Risks and Consequences of Hoarding
If left untreated, a hoarding disorder can put the individual’s health and safety at risk. The condition can also cause harm to their home, pets, and family members, and negatively affect their relationships, finances, and performance at work or school.
Some of the potential risks and consequences of hoarding are:
- Hard to clean areas that are prone to mold growth or insect infestations
- Inability to prepare food or maintain personal hygiene
- Unhygienic spaces can become a breeding ground for bacteria and illnesses
- Clutter can cause trips and falls, or may collapse on people
- Fire hazards and blocked exits during emergencies
- Noticeable odors in the home
- Difficulty performing repairs and maintenance, resulting in structural damage
- Not being able to invite visitors, which can cause isolation and loneliness
- Family conflicts and legal issues, like eviction
How Is Hoarding Disorder Treated?
There are multiple treatment options for people with hoarding disorder, but the most well-known and commonly used form of treatment is Cognitive Behavioral Therapy (CBT).
With the help of a licensed therapist or mental health professional, an individual will learn to identify harmful thought patterns that trigger accumulating items. They’ll learn to challenge these beliefs and resist the urge to hoard items, while gradually reducing the clutter in their home.
Other types of treatment for hoarding disorder include motivational interviewing and skills training in organizing items, discarding possessions, and reducing excessive acquisition. Treatment may also involve getting regular help and emotional support from family and friends.
Get Help for Hoarding Disorder Today
Hoarding disorder is a challenging and potentially harmful condition that can greatly affect the quality of your life and relationships if left on its own. The good news is that hoarding is highly treatable, and professional help is always available.
If you or a loved one are currently struggling with hoarding disorder, Long Island Interventions can provide the treatment you need, and guide you on the path to full and lasting recovery. Give us a call today or visit our About page to learn how we can help you and your family.
Published on: 2024-09-23
Updated on: 2024-09-23
