hoarding

Hoarding is a behavior characterized by persistent difficulty discarding or parting with possessions, regardless of their actual value, due to distress associated with letting go. People with hoarding disorder accumulate items to the point that living spaces become cluttered and functioning is impaired. Hoarding differs from ordinary collecting or disorganization in its persistence, the distress caused by discarding, and the resulting impairment. Many individuals also engage in excessive acquisition, acquiring items they do not need or cannot use.

The exact causes are not fully understood, but a combination of genetic, cognitive, emotional, and environmental factors is involved. Neuropsychological studies point to decision-making and organization deficits, as well as maladaptive beliefs about possession. Hoarding disorder was recognized as a distinct diagnosis in DSM-5-TR. Diagnostic criteria include persistent difficulty discarding possessions, regardless of value, distress associated with discarding, and clutter that significantly impairs use of living spaces and safety; the symptoms are not attributable to another medical condition or better explained by another mental disorder, and there may be excessive acquisition.

Estimates suggest about 2-6% of the population may be affected, with onset typically in adolescence or early adulthood and a predominantly chronic course. Risk factors include family history, attachment issues, and childhood adversity. Hoarding often co-occurs with other conditions such as OCD, ADHD, depression, anxiety disorders, and autism spectrum traits.

Impact includes increased fire and sanitation risks, falls, eviction, social isolation, and strain on family and housing services. Treatments with the best evidence are adapted cognitive-behavioral therapies that address decision-making, organization, and exposure to discarding, often with motivational components. Pharmacotherapy has limited and inconsistent support. Severe cases may require coordinated cleaning and safety planning, usually as part of a broader, long-term management strategy.