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Gabriel M. Zakkak

What is Hoarding?

before and after trash in kitchenThe Mayo Clinic defines “Hoarding Disorder” as a condition where people have a persistent difficulty getting rid of possessions, regardless of actual value, because of a perceived need to save them to such an extent that their living space becomes unusable. 

The expansive accumulation of materials range from mild (some rooms are somewhat compromised) to critical (all rooms are filled to capacity and may require a hazmat response). 

Without intervention, Hoarding Disorder can interfere with cooking, cleaning, and sleeping leading to issues with personal hygiene and health; access to medical care in emergencies; and safety from fire. More importantly, it could also contribute to loss of life and could endanger anyone living in close proximity to a hoarded structure.

Specifics on Hoarding Disorder

  • In May 2013, Hoarding Disorder became a new mental health diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
  • The American Psychiatric Association states studies have shown that “Hoarding Disorder is estimated at approximately 2-5% of the population.”
  • This affects people of all ages, races, genders, nationalities, levels of education and socioeconomic standings. 
  • Permanently removing possessions causes significant distress for people with Hoarding Disorder. Unless psychiatric help is obtained after a cleanout occurs, recidivism is common.  However, people with Hoarding Disorder are not known to seek help on their own.
  • Only 15% of people with Hoarding Disorder can acknowledge they have a problem.  There are three levels of understanding of their situation:
    • The individual knows there is a problem but makes no changes.
    • The individual might recognize some aspects of a problem but might not understand the dangers or might not be willing to change.
    • The individual is adamant that their surroundings and behaviors are not problematic despite the seriousness of their situation.

  • Hoarding tendencies usually surface between the ages 11-15 and get worse with age.  There are three times as many adults ages 55-94 affected by Hoarding Disorder.  As people age, they acquire things, and if they are not actively discarding along the way then accumulations begin.
  • By middle age, symptoms are often severe and may be harder to treat.
  • Often, significant clutter has developed by the time it reaches the attention of others. 
  • People with Hoarding Disorder generally endure a life-long struggle.

Genetics or Early Family Life.  Often in families, if one parent has Hoarding Disorder it can be passed on to children.  It is believed that 50% of people who hoard have a family member who also hoards. 

Characteristic Personality Traits.  Having the following traits has been found to pre-dispose a person to Hoarding Disorder:

  • indecisiveness or having decision making deficits leading to either impulsivity or avoidance/procrastination
  • being detail oriented to the point of perfectionism
  • difficulty categorizing or overcategorizing
  • vulnerability
  • difficulty planning or following through with a plan or distractibility

Deterioration of Brain Functioning or personal illness making it difficult to care for yourself. Sometimes there is a co-morbidity of conditions commonly seen along with Hoarding Disorder, such as:

  • depression (53%)
  • general anxiety disorder (24%)
  • obsessive-compulsive disorder (OCD) 18-40% (compulsive hoarding is generally thought of as one symptom of OCD as only 5% of people display it as a primary symptom)
  • attention-deficit/hyperactivity disorder (ADHD) (28%)
  • dementia or Alzheimer’s Disease
  • chronic debilitating disease or Illness

Sudden Stressful Events. Some examples are:

  • the death of a loved one
  • moving out of a childhood home
  • divorce
  • eviction
  • devastating loss due to fire 


  • People tend to save things they believe will be needed in the future, especially if they grew up in hard times and have learned behaviors.
  • There can be a hatred of wasting something perfectly good and believing what they are doing is noble, like not throwing things away helps save the Earth. 
  • Trauma victims may have self-worth security issues.  They believe the more they have, the more they are worth.  Items can become a love substitute, bring comfort, replace real relationships and give a sense of security.  Some people feel safer surrounded by things.
  • There may be a perception that all possessions are valuable, despite actual value, which stems from indecisive behavioral tendencies and not being able to decide what to keep and what to throw away.  Additionally, there could be fear of accidentally throwing away something valuable.
  • Physical limitations of a person may make organizing and sanitizing problematic.
  • People develop an emotional attachment to items serving as a reminder of happier times or representing beloved people or pets that are no longer in their lives.
  • Denial of a problem occurs even when the clutter interferes with the ability to have a normal life.
  • Some people start as collectors and become hypersensitive to any changes in color, texture, shape, size, or deformity.  They end up keeping everything that is different or unique and end up with an expansive collection they cannot maintain.

Hoarding Versus Clutter or Collecting?

While hoarding and clutter can look similar to the untrained eye, the two can affect a structure in vastly different ways.  Hoarding causes a loss of functionality of space and creates serious life safety and structural issues due to the immense packing of possessions in all the free space.  Clutter is simply a disorganization of items, which does not cause serious issues to health and welfare.  Please refer to the Hoarding Clutter Scale as a visual aid.  

Please refer to the Clinical Assessment to determine if you, or someone you know, may have a hoarding issue.

There is a big difference between hoarding and collecting. When hoarding behavior occurs, items are unorganized, piled in disarray, and not set up for display.  Individual items may not be able to be easily accessed and their storage can cause the resident a lot of stress.  When collecting occurs, however, items are kept in good condition and are often displayed for others to see in a categorized or other organized manner, even if collections are expansive.  Usually, a collection focuses on a certain theme (i.e. stamps, model cars, military memorabilia, sports, history, toys, etc.) and generally bring the resident a lot of pride and happiness.

free stuff signA list of common things that people hoard include: 

  • magazines
  • newspapers
  • clothing
  • grocery bags
  • garbage
  • food (perishable and non-perishable)
  • animals, on rare occasion


Hoarding in the Media


Bratiotis, Christiana, Cristina Sorrentino Schmalisch, and Gail Skeketee.  The Hoarding Handbook: A Guide for Human Service Professionals.  Oxford University Press, June 22, 2011.




Neziroglu, Fugen, et al.  Overcoming Compulsive Hoarding: Why You Save and How You Can Stop.  New Harbinger Publications, Jan. 1, 2004.




Steketee, Gail and Randy Frost.  Compulsive Hoarding and Acquiring: Workbook.  Oxford University Press, Dec. 7, 2006.




Steketee, Gail and Randy Frost.  Stuff:  Compulsive Hoarding and the Meaning of Things.  Mariner Books, Jan. 4, 2011.




Steketee, Gail and Randy Frost.  Treatment for Hoarding Hoarding Disorder: Workbook Treatments that Work.  Oxford University Press, Nov. 7, 2013.




Tolin, David, Randy Frost, and Gail Steketee.  Buried in Treasures: Help for Compulsive Acquiring, Saving and Hoarding.  Oxford University Press, Nov. 15, 2007.




Tompkins, Michael and Tamara Hartl.  Digging Out: Helping Your Loved One Manage Clutter, Hoarding, and Compulsive Acquiring.  New Harbinger Publications, Nov. 1, 2009.


  • Packrat. - A documentary about hoarding, distributed by Fanlight Productions.
  • Finding Vivian Maier - A documentary film detailing the life and career of Vivian Maier and her unbelievable collections of 100,000 photographs, distributed by Ravine Pictures LLC.
  • Grey Gardens - A documentary film of the cousins of Jackie Onassis: Big and Little Edie Beale. The duo lived in their disorganized and run-down mansion in East Hampton, New York, distributed by Janus Films.
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