OVERVIEW

What is Hoarding Disorder?

Hoarding disorder, also known as hoarding syndrome, is a mental disorder characterized by persistent difficulty discarding possessions.

Regardless of the actual value of items, individuals accumulate them in their living spaces, leading to cluttered environments that may pose threats to hygiene or safety. Despite experiencing distress, they struggle to control this behavior.

Professional psychological intervention or medication may be necessary for improvement. If diagnosed with hoarding disorder, seek active treatment. For friends or family members affected, offer patience, encouragement, and care to support their recovery.

How Common is Hoarding Disorder?

International studies suggest 2%–6% of the population may be affected, with higher prevalence among older adults (55–94 years), approximately three times that of younger adults (34–44 years). Nationwide epidemiological data on hoarding disorder remains limited in China.

SYMPTOMS

What are the manifestations of hoarding disorder?

The clinical characteristics of hoarding disorder mainly include the following aspects:

• Persistent difficulty discarding a large number of useless or worthless items, most commonly newspapers, old clothes, bags, books, documents, promotional brochures, etc.;

• Living spaces are cluttered with items, rendering these areas unusable for their intended purposes; the clutter may extend beyond the patient's daily living areas to other locations, such as gardens, cars, neighbors' properties, or workplaces, leading to a decline in quality of life, health and sanitation risks, fire hazards, and conflicts within families or with neighbors.

• Significant distress is experienced, resulting in impaired social functioning.

• Approximately 3/4 of hoarding disorder patients also suffer from mood or anxiety disorders, with the most common comorbidities being depressive disorder and anxiety disorder.

CAUSES

What are the causes of hoarding disorder?

The exact causes and mechanisms of hoarding disorder are not yet clear. According to available data, it may be related to genetic factors, environmental factors (such as experiences of stressful events), personality traits (such as indecisiveness), and other factors.

DIAGNOSIS

How is Hoarding Disorder Diagnosed?

The diagnosis of hoarding disorder requires meeting the following criteria:

• Persistent difficulty discarding or parting with possessions, regardless of their actual value.

• The difficulty in discarding is due to a perceived need to save the items and distress associated with discarding them.

• The accumulation of possessions results in cluttered living spaces that compromise their intended use. Cleanliness and order may only be restored through the intervention of others (e.g., family members, cleaners, authorities).

• The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning, including safety for oneself or others.

• The hoarding behavior is not attributable to another medical condition or mental disorder.

Many individuals with hoarding disorder avoid seeking medical help due to stigma. However, struggling with emotional difficulties is not your fault, and you have the right to seek support.

Are All Hoarding Behaviors Considered Hoarding Disorder?

Not all hoarding behaviors qualify as hoarding disorder.

• Some medical conditions, such as traumatic brain injury, post-brain tumor resection, cerebrovascular disease, or central nervous system infections, may present with hoarding symptoms.

• Certain mental disorders may also manifest hoarding behaviors, including autism spectrum disorder, intellectual disability, schizophrenia (driven by delusions or negative symptoms), depression, or obsessive-compulsive disorder. These cases should not be simply diagnosed as hoarding disorder.

What Conditions Should Hoarding Disorder Be Differentiated From?

Hoarding disorder should be distinguished from the following conditions:

1. Other Medical Conditions: If symptoms are directly caused by another medical condition, a diagnosis of hoarding disorder is not applicable.
2. Neurodevelopmental Disorders: If collecting items is a direct result of a neurodevelopmental disorder (e.g., autism spectrum disorder or intellectual disability), it cannot be diagnosed as hoarding disorder.
3. Schizophrenia Spectrum and Other Psychotic Disorders: If collecting items is driven by delusions or negative symptoms of schizophrenia or other psychotic disorders, it does not qualify as hoarding disorder.
4. Major Depressive Episode: If hoarding occurs due to psychomotor retardation, fatigue, or loss of energy during a major depressive episode, it is not hoarding disorder.
5. Obsessive-Compulsive Disorder (OCD): If symptoms stem from typical obsessions or compulsions (e.g., fear of contamination, harm, or incompleteness in OCD), they are not classified as hoarding disorder.
6. Neurocognitive Disorders: If collecting items results from a degenerative condition (e.g., frontotemporal degeneration or Alzheimer’s disease), it is not diagnosed as hoarding disorder.

TREATMENT

How to Treat Hoarding Disorder?

Hoarding disorder has only been recognized as an independent condition for a relatively short time. Due to patients' lack of insight and motivation for treatment, it can often become a challenging condition to manage.

Without timely intervention, hoarding disorder tends to follow a chronic and progressively worsening course. Currently, both psychotherapy and medication lack large-scale clinical trial evidence for their effectiveness.

• Psychotherapy: Multi-component cognitive behavioral therapy (CBT) is currently the most evidence-based effective treatment. Key components include comprehensive psychoeducation, collaborative goal-setting with patients, enhancing motivation for treatment, assisting patients in making decisions more easily, using graded exposure to help them cope with anxiety related to sorting and discarding items, and correcting cognitive distortions associated with hoarding behavior.
  Some researchers have incorporated cognitive rehabilitation techniques into traditional behavioral therapy, focusing on improving prospective memory, categorization, decision-making, problem-solving, and cognitive flexibility. This approach may be particularly beneficial for elderly patients with hoarding disorder.

• Medication: Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) may be effective for hoarding disorder. Compared to psychotherapy, patients may find medication more acceptable, though the evidence supporting its efficacy remains limited.

Receiving a diagnosis of hoarding disorder can be difficult to accept, but it is important to follow medical advice and engage in treatment actively. With proper intervention, improvement is possible.

DIET & LIFESTYLE

What should be paid attention to in life with hoarding disorder?

Some patients with hoarding disorder may develop symptoms due to stressful or traumatic life events. Therefore, in daily life, it is important to avoid excessive stress, maintain emotional stability as much as possible, and minimize indecisiveness when making choices about items.

PREVENTION

How to Prevent Hoarding Disorder?

First, start by helping individuals with hoarding disorder clean their living spaces from the external environment, restoring the area to a safe and functional state.

Second, offer psychological understanding by listening to their negative life experiences and emotions, providing appropriate counseling and social support.