Hoarding in Adults

by Kelly Weaver, MA, RYT, Resource & Referral Counselor, Project INTERFACE

What is Compulsive Hoarding?

Compulsive hoarding can be distinguished from “normal” collecting by a number of extreme characteristics. According to Frost & Hartl, compulsive hoarding is a complex psychological disorder involving the acquisition of large quantities of seemingly useless items, accompanied by an inability to discard these items. Compulsive hoarders believe their possessions are particularly valuable and experience tremendous anxiety at the possibility of parting with them. Some compulsive hoarders are overly emotionally attached to possessions; they constantly purchase or obtain new items regardless of whether these are needed.

This excessive accumulation of objects causes considerable clutter and interferes with daily activities, such as cooking, cleaning, and moving through one’s living space. Papers of all varieties, from tax records to post-it notes, are the most frequently hoarded items.  In extreme situations, the living space becomes filled with stacks of papers, clothes, and other items, leaving only narrow pathways among piles. Compulsive hoarders are often perfectionists who take much longer than other people to finish tasks; this negatively impacts both their professional and personal lives.

In addition to impairing daily functioning, compulsive hoarding can create substantial distress associated with interpersonal relationships and physical health.  For example, the inability to dispose of items, such as old newspapers, broken dishes, and empty bottles, can cause significant relationship strain, bring about frequent arguments, and in some situations, lead to a spouse moving out and/or seeking a divorce. It is common for compulsive hoarders to experience social isolation; they are embarrassed by the clutter in their living spaces and as a result have limited interpersonal interactions.

Holding onto objects for an exceptionally long period of time can also be associated with medical difficulties. Factors such as poor ventilation, combined with water problems, can lead to mold accumulation.  An individual may not be able to see this mold because of the large quantity of items.  Living in poorly-ventilated and/or mold-contaminated conditions can  lead to a variety of illnesses.  One survey of elderly hoarders found that their hoarding constituted a physical health threat in 81% of identified cases. These threats involved fire hazards, risk of falling, unsanitary conditions, and inability to prepare food.

According to the Obsessive Compulsive Foundation, an estimated 700,000 to 1.4 million people in the United States are believed to have compulsive hoarding syndrome.

What causes Compulsive Hoarding?

According to Drs. Frost, Steketee, and colleagues, compulsive hoarding involves four main problem areas. Information processing deficits in the brain can cause compulsive hoarding.  Because of difficulty with decision making, organizational skills, and memory functions, a person is unable to differentiate between trash and treasure.

Another cause of hoarding involves emotional attachments to objects.  Compulsive hoarders view their possessions as parts of themselves, so throwing an item away is the same as throwing away a piece of self.

Poor decision-making skills plus a need for perfection lead to behavioral avoidance in the compulsive hoarder.  Deciding what to do with recently-acquired objects coupled with decisions about discarding items causes intense anxiety; thus, the compulsive hoarder postpones making such decisions or taking any action at all.

How is Compulsive Hoarding treated?

Compulsive hoarding is a type of OCD and counseling is the recommended treatment.  There are two well-established approaches to OCD: serotonin reuptake blocking medications and cognitive behavioral therapy (CBT).  Drs. Frost, Steketee, and colleagues have been at the forefront in developing the cognitive behavioral model. CBT for compulsive hoarding is directed towards decreasing clutter, improving decision-making skills, and improving organizational/ sorting techniques.  This specialized treatment approach for compulsive hoarders is proving much more effective than the more standard approach to OCD.  One study found an average improvement of 35% in symptoms over a 6-week period.

Individuals who are highly motivated to change their compulsive hoarding behaviors experience the maximum benefit from treatment.  Participation in an ongoing support group, along with support from family and friends, are also extremely important factors in success.

The information in the article above was drawn from the following sources:

  • Steketee, G.; Frost, R. (2003). Compulsive hoarding: Current status of the research. Clinical Psychology Review, 23 (7), 905-27.
  • Frost, R.O.; Hartl, T.L. (1996). A cognitive-behavioral model of compulsive hoarding. Behavior Research and Therapy, 34 (4), 341-50.
  • Hartl, T.L.; Frost, R.O. (1999). Cognitive-behavioral treatment of compulsive hoarding: a multiple baseline experimental case study. Behavior Research and Therapy, 37 (5), 451-61.
  • The Obsessive-Compulsive Foundation Compulsive Hoarding Website
  • Compulsive Hoarding Syndrome - An Introduction. Karron Maidment RN, M.A., Program Coordinator/Behavior Therapist, UCLA OCD Intensive Treatment Program
  • Hoarding - A Successful Compulsion. James Claiborn, Ph.D., Northeast Occupational Exchange, Portland, Maine, OC Foundation Compulsive Hoarding Website
  • Hoarding: Where Does It Belong? James Claiborn, Ph.D., Northeast Occupational Exchange, Portland, Maine, OC Foundation Compulsive Hoarding Website
  • Hoarding Advisor (www.hoarding-advisor.com)

Additional Sources of Information

General Resources on Aging and Wellness

Disclaimer: Material on the Project INTERFACE web site is intended as general information. It is not a recommendation for treatment, nor should it be considered medical or mental health advice. Project INTERFACE urges families to discuss all information and questions related to medical or mental health care with a health care professional.