Hoarding disorder: signs, causes, risks and treatment

The Royal College of Psychiatrists explains that hoarding happens when you collect large amounts of stuff and cannot throw anything away. Unlike a hobby, the pile is usually very disorganised. Collectors tend to arrange what they own and others often see it as interesting or valuable, whereas hoarded items tend to be seen by others as useless or of little value.

Cluttered or messy homes are not automatically a problem; the College says they would not usually be considered one unless they disrupt people's lives. A person who hoards often feels very attached to the items and can become upset if someone tries to throw them away, yet may not be bothered by the state of the home even though it can badly affect their life.

The NHS notes that what is collected varies widely. It is often a mix of objects other people struggle to see value in, but it can include rescuing large numbers of animals or keeping huge amounts of old data such as emails and hard drives.

The NHS lists the main symptoms and then the knock-on effects.

• Keeping or collecting so many things that it affects your life or the lives of people you care about.

• Being unable to manage the things you have collected but still finding it very difficult to get rid of them.

• Becoming extremely attached to the things you have collected.

• Feeling the need to get more things even when you already have a lot, with very strong positive feelings whenever you do.

• Struggling with everyday tasks such as cooking, cleaning and paying bills.

• Disagreements with friends and family about your things.

• Not being able to use rooms in your home because they are too full.

Hoarding can be an illness in its own right, but the Royal College of Psychiatrists says it can also be part of another health problem, and treating that problem comes first. Its examples show why assessment matters.

The NHS says it is not known exactly what causes hoarding disorder, because there has been little research. Factors that may increase the chance include negative childhood experiences such as growing up in poverty, having things taken away, abuse or neglect; being someone who always worries about making mistakes or who spends a lot of time alone; grief after a bereavement or loss, or another major life change or stressful event; and having a close family member who also hoards.

The Royal College adds that many people with the disorder had a deprived childhood but not all, that personality traits such as perfectionism or being reclusive may play a part, and that the average age at which people come to the attention of services is 50, by which time the problem is usually well established.

Severe hoarding can be a risk to the person and to others, according to the Royal College of Psychiatrists. The risks it lists are infestation by mice, rats or cockroaches (often from hoarded food); fire; belongings blocking the way out; difficulty cooking or eating; severe structural damage to a house or flat; and piles of possessions collapsing and causing injury.

Those risks are why agencies sometimes become involved. The College says health, social services and the fire service may all be involved and will usually visit the home. If a person refuses an assessment, mental health legislation can be used where there is a psychiatric disorder, or public health legislation where there is a risk to that person or others, always balancing individual rights against public health and safety. If someone is in immediate danger, such as a fire, call 999.

The NHS says a GP who suspects hoarding disorder or another mental health condition will usually refer you to a mental health specialist, who will ask about mood, behaviour, health and family history. A diagnosis of hoarding disorder is made if no other mental health condition could be causing the problem. The NHS advises seeing a GP if you think you might have it, if someone you know thinks you might, or if you have been diagnosed and treatment is not helping.

Treatment can help manage symptoms but may take time. The main treatments the NHS says a GP may offer are talking therapies, usually CBT with a therapist, individually or in a group, and antidepressant medicines that can help treat anxiety. The Royal College describes CBT as the most effective psychological treatment and sets out the stages: building trust with the therapist, understanding what makes it hard to discard, agreeing not to acquire more during treatment, clearing items together while looking at the thoughts and feelings about possessions, with the aim of reducing, recycling and reusing. Treatment can take a long time because hoarding has usually gone on for years.

The College says selective serotonin reuptake inhibitors (SSRIs), which are used for anxiety and obsessional problems, also seem to help people who hoard, with improvement usually slow over weeks or months, and that research continues into other medicines. Any decision on medicines belongs with the prescribing clinician.

It is often a relative or neighbour who notices the problem. The Royal College notes that many people feel too ashamed or embarrassed to talk about it, that others can be critical, and that the hoarding is the problem, not the person. It says help works best when it is compassionate and sensitive. The NHS suggests that if you are worried about someone else you encourage them to speak to their GP, and points to the charity Mind for information and support for people affected and for those helping someone who hoards.