Hoarding disorder – What is it?
By Dr Pauline Baleta, Psychologist, PhD Psychology, MAPS
It is estimated that hoarding disorder affects 2 to 6 percent of Australians (Kyrios, 2016) and that unfortunately this disorder falls through the gaps, with very few people receiving treatment for hoarding. Furthermore, Kyrios (2016) goes on to state that hoarding is a serious mental health condition with 25% of deaths in homes resulting from hoarding behaviour which is a fire hazard.
What causes hoarding disorder?
Hoarding disorder can result from a number of factors including both genetic and environmental. Very little is known about the actual causal factors of hoarding. Some of the underlying issues are linked to a fear of loss, with the individual struggling with the behaviour having experienced some significant loss in their lives that they are struggling to process. In addition, Kyrios (2016) goes on to state that another factor to consider is that “people who feel insecure about themselves as a result of their early upbringing, will overly acquire things, to defend themselves against the threats they feel are out there in the world,” “It’s almost as if they build a defensive wall around themselves through the use of objects. However, we can teach people to have a more positive relationship with possessions and to minimise the clutter in their homes.”
What is hoarding disorder?
Individuals with hoarding disorder have a persistent and pervasive difficulty getting rid of/parting with possessions due to a perceived need to save them. Any attempt to part with the items results in severe distress and thus resulting in saving them. The resulting clutter can result in difficulty utilising the living space and subsequent fire hazards (American Psychiatric Association, 2013).
Hoarding disorder used to be know as a form of obsessive compulsive disorder but has now been recognised as a disorder on its own. Individuals with hoarding disorder may also develop symptoms of depression and anxiety which will also need to be treated.
Hoarding disorder is characterised by the following symptoms (DSM 5):
- Persistent difficulty parting with items regardless of their value,
- The difficulty is due to a perceived need to save the items and distress in parting with them,
- The difficulty discarding possessions results in an accumulation of objects which results in cluttered living spaces and compromises their intended use,
- The hoarding can cause significant distress and can impair an individual’s occupational and social functioning and can pose a risk to their environment.
Londo (2022) describes five different levels of hoarding, described below:
- Clutter, but not concerning. An individual’s house might be a bit disorganised but is clean and sanitary. This level doesn’t require intervention.
- Deteriorating hygiene – possible hoarder. This level usually involves one important exit being blocked with clutter, some build-up of pet faeces and hair, overflowing garbage points, dirty dishes, mould and piling up laundry as well as some difficulty with plumbing and electrical circuits,
- Extreme disorganization, likely a disorder. At this level, treatment is indicated. This level involves a messy and cluttered environment which may consist of insect infestations, piles of objects obstructing living areas, multiple broken appliances, untidied spills and broken appliances, one room is not used for its intended purpose but rather storage,
- Excessive clutter and behaviour, contact professionals. This level is severe and involves structural damage in the house, excessive pet faeces and hair, clutter preventing access to stairs, doors etc, expired and rotting food and odours and build-up in sewerage.
- Severe unsanitary conditions, diagnosis hoarding disorder. This stage is characterised by extreme clutter making indoor living areas unusable, no ventilation, structural damage that is irreparable, pervasive mould and mildew, disconnected water and plumbing services, animals’ health is at risk and may even be considered a danger to inhabitants.
How do we treat hoarding disorder
There are very few specific treatment options available designed specifically for hoarding disorder, however the following treatment has shown some improvement in the disorder (Moulding et al, 2017):
- Cognitive behavioural therapy (CBT),
- Skills training for organization and decision-making,
- Exposure therapy to sorting out and decluttering – this is usually a home-based treatment,
- Behavioural techniques to support sorting and non-acquiring of possessions.
If you or someone that you know struggles with the above-mentioned difficulties, it is important to get help. The sooner you get help, the easier the disorder will be to treat. Dr Pauline Baleta can assist you in treating hoarding disorder.
Author: Dr Pauline Baleta, MA Psychology (UJ) Cum Laude, PhD Psychology (UP)
Dr Pauline Baleta is from South Africa where she was a fully registered senior clinical psychologist for the past 15 years, until she immigrated to Australia in April 2023.
To make an appointment with Dr Pauline Baleta try Online Booking. Alternatively, you can call Vision Psychology Wishart on (07) 3088 5422 .
American Psychiatric Association (2013)
Kyrios, M. (2016). Australian hoarders falling through the gaps, ANU communications and Engagement, The Australian National University, available from the World Wide Web:
Londo, G. (2022). The five stages of hoarding: What are they? Available from the World Wide Web: https://valortechnicalcleaning.com/blog/5-stages-of-hoarding/
Moulding R, Nedeljkovic M, Kyrios M, Osborne D, Mogan C. Short-Term Cognitive-Behavioural Group Treatment for Hoarding Disorder: A Naturalistic Treatment Outcome Study. Clin Psychol Psychother. 2017 Jan;24(1):235-244. doi: 10.1002/cpp.2001. Epub 2016 Jan 11. PMID: 26750388. Substance Abuse and Mental Health Services Administration. Impact of the DSM-IV to DSM-5
Changes on the National Survey on Drug Use and Health [Internet]. Rockville (MD):
Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 3.29, DSM-5 Hoarding Disorder. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t29