Hoarding Disorder

Hoarding Disorder:  What It Is And How To Treat It

Someone that has a hoarding disorder excessively acquires an abundance of possessions that they do not need or use and never throws them away.  Quite often these things are worthless, unsanitary, broken or hazardous.  These suffering individuals, often referred to as “pack rats” typically find that their disorder may end up interfering with their daily activities including sleeping, showering, cooking and most definitely cleaning.

It is not clear why people with a hoarding disorder refuse to throw anything away or why they allow the normal functions of their lives to become impaired.  Some people are even unable to return items that have been borrowed and in extreme cases, kleptomania is resulted, which is the uncontrollable need to steal.

This disorder can often lead to roach and rat infestations due to the unclean living conditions and injuries can occur from tripping over or bumping into items.  Some cases have been reported of people dying in fires because their hoarding was so severe that they could not get out of their home and the firemen could not get it.  Some hoarders are even delusional and actually believe that the things that they are collecting are valuable when the items are truly nothing more than garbage.  Others will keep food in their refrigerator long past the expiration date because they cannot bring themselves to part with it.

Hoarding Levels

There are basically five levels that someone with a hoarding disorder can fall under, including:

  1. Level One – This person has a standard household with perhaps a few things laying around that could be disposed of or organized.
  1. Level Two – A professional organizer should be utilized in this home to help the individual sort through things and gain control.
  1. Level Three – Any professionals working with individuals in these homes should have training on how to handle chronic disorganization.  They should also work within a community of mental health providers.
  1. Level Four – These homes require a team of service providers including psychologists, organizers and cleaners.  Traditionally, financial hardships, depression or medical issues are involved.  Crime scene cleaners, pest control services, maintenance experts and financial counselors may be called upon.
  1. Level Five – A home with someone that has a hoarding disorder at this level requires an intervention from many services.  These individuals may be considered mentally ill and only skilled professionals should take on a project of this nature.  Psychologists and people from fire and safety, building and zoning, legal aid and landlord (if applicable), will need to develop a written strategy before proceeding.

Obsessive-Compulsive Disorder Connection

Some experts believe that hoarding disorder and obsessive-compulsive disorder are related.  However, compulsive hoarding does not involve the same exact neurological mechanisms as those strictly associated with obsessive-compulsive disorder, nor do the individuals respond to the same drug therapy.  It is believed though that there may be a type of overlapping condition called impulse control disorder.  These individuals cannot control their buying the way that hoarders cannot control the fact that they refuse to dispose of anything.  Additionally, it has also been proven that many individuals with attention-deficit hyperactivity disorder have hoarding tendencies.



A study performed at the University of Iowa in 2004 suggested that if the frontal lobes in someone's brain are damaged, this can result in emotional disturbances and poor judgment.  Also, any damage to the right part of the prefrontal cortex can cause a hoarding disorder.

Psychotherapy is needed to help these individuals with their behaviors and emotions and the drug, paroxetine has been proven effective.  In some cases, cognitive behavioral therapy may also be recommended.