A Few Quick Stats about Hoarding
- U.S. adults affected by hoarding disorder: About 2.5%
- Older adults (70+): Around 6%
- With another mental health condition: Roughly 75% (commonly depression, anxiety, ADHD, or OCD)
- In people experiencing homelessness: Hoarding symptoms may affect up to 18%
Understanding Hoarding Disorder
When people picture hoarding, they often imagine homes so cluttered that walking safely from room to room is impossible. Piles of belongings may create dangerous living conditions. While this extreme is real, the reality of hoarding disorder is much more nuanced.
Hoarding disorder, as defined in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), involves three key features:
- Persistent difficulty discarding or parting with possessions, regardless of their value.
- Intense distress and anxiety when attempting to discard.
- Living spaces so cluttered that their intended use is compromised.
Hoarding was once classified as a subtype of obsessive-compulsive disorder (OCD). It is now recognized as a standalone condition.
What Hoarding Is Not
- Not just messiness. People with general clutter typically feel no attachment to it and welcome help.
- Not collecting. Collectors organize and value their possessions. People with hoarding disorder accumulate items in ways that impair safety and daily living.
Hoarding symptoms often begin in adolescence and become more severe with age. Beyond personal distress, hoarding deeply affects families and relationships.
Warning Signs of Hoarding Disorder
- Compulsively acquiring and saving items, even when space is gone
- Extreme difficulty discarding, even garbage or worthless objects
- Rooms or furniture rendered unusable
- Shame, embarrassment, and withdrawal from family or friends
- Fire hazards, sanitation risks, and tripping dangers
The 5 Levels of Hoarding: Understanding Severity
Hoarding is progressive, and professionals sometimes use a five-level scale to describe severity. Importantly, this scale is not part of DSM-5. It comes from the Clutter–Hoarding Scale, developed by the Institute for Challenging Disorganization, and is used as a practical safety and risk assessment tool.
Level 1: Minimal Impact
Clutter is present but does not significantly affect function. All exits are clear, rooms are usable, and sanitation is intact.
Level 2: A Few Safety Concerns
Clutter is more noticeable. Some surfaces or rooms are difficult to use. Light odors may be present, and one pathway may be blocked.
Level 3: Major Safety Concerns
Clutter blocks at least one exit. Rooms lose functionality. Odors and unsanitary conditions appear. Exterior clutter may be visible. Family conflict intensifies.
Level 4: Hazardous Living Conditions
Severe clutter blocks most entrances/exits. Structural damage, pest infestations, and waste are common. Toilets or showers may be unusable. Fire and injury risk is very high.
Level 5: Critical Mass (“Collyer’s Condition”)
The home is uninhabitable. Structural collapse, biohazards, and overwhelming clutter are present. Individuals may live in confined areas or leave altogether. Firefighters often call these “Collyer’s mansions”, after two infamous New York hoarders.
Clinical Diagnosis of Hoarding Disorder
At the Mind Study Center, led by Steve Khachi, MD, a nationally respected psychiatrist, diagnosis is always grounded in evidence-based standards:
- DSM-5 diagnostic criteria
- Comprehensive psychiatric evaluation
- Psychological and neuropsychological testing to assess decision-making, attention, and memory, while identifying co-occurring conditions such as ADHD, depression, or OCD
This thorough process ensures that patients and families receive an accurate diagnosis and a treatment plan tailored to their unique needs.
Treatment and Hope for Recovery
Hoarding disorder is treatable. Effective approaches include:
- Cognitive Behavioral Therapy (CBT for Hoarding)
The most effective treatment. CBT teaches skills to challenge harmful thought patterns, reduce acquiring, and practice discarding in structured ways.
- Exposure and Response Prevention (ERP)
Helps patients gradually face the anxiety of discarding and resist the urge to acquire.
- Medication (off-label use)
Certain antidepressants (SSRIs, SNRIs such as venlafaxine XR) may help, especially when depression or anxiety are also present. No medication is FDA-approved specifically for hoarding disorder.
- Specialized Support
Professional organizers and case managers trained in hoarding can complement therapy by addressing the day-to-day environment.
Our Approach at the Mind Study Center
At the Mind Study Center, located in Pasadena & serving the greater Los Angeles area, we specialize in comprehensive care for hoarding disorder. We provide:
- In-depth psychiatric and neuropsychological assessments
- Evidence-based therapy, including CBT and ERP
- Treatment for co-occurring conditions like depression, anxiety, OCD, or ADHD
- Family support to reduce strain and promote recovery together
We believe that recovery is possible, and with the right treatment, individuals can reclaim safe, functional living spaces and healthier lives.
Take the Next Step
If you or a loved one is struggling with hoarding disorder, the Mind Study Center can help. Our psychiatrists and psychologists are dedicated to providing accurate diagnosis, compassionate care, and effective treatment for hoarding disorder and related mental health conditions.
Contact us today to schedule a confidential consultation and begin the path to recovery.
References
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
- Frost, R. O., & Hartl, T. L. (1996). A cognitive-behavioral model of compulsive hoarding. Behaviour Research and Therapy, 34(4), 341-350.
- Tolin, D. F., Frost, R. O., & Steketee, G. (2007). An open trial of cognitive-behavioral therapy for compulsive hoarding. Behaviour Research and Therapy, 45(7), 1461-1470.
