Do's and don'ts: Addressing a loved one’s hoarding disorder

If a friend, family, or other loved one is living with hoarding disorder, their behavior may significantly affect your ability to be as close to them as you would like. You may have difficulty spending time together because the items they hoard take up space, or you might experience tension because you believe they’re putting themselves in danger. You likely want to help your loved one, but that can be hard due to the behavioral and emotional challenges of the disorder. This article aims to help you understand hoarding disorder—including its symptoms and causes—and support a loved one experiencing this complex mental health condition.

An overview of hoarding disorder

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V), hoarding disorder is characterized by ongoing “difficulty discarding or parting with possessions, regardless of their actual value”. An individual with hoarding disorder may feel a strong need to hold on to belongings and experience negative reactions at the possibility of them being taken away. 

In addition to being a standalone disorder, hoarding can also be related to another mental health condition, such as obsessive-compulsive disorder or depression. Thought to impact approximately 2-6% of adults, hoarding disorder can seriously affect an individual’s life, potentially leading to complex emotional challenges, dangerous living conditions, and relationship conflict. 

The following are common symptoms of hoarding disorder:

• Acquiring and saving items regardless of their value
• Feeling extreme distress at the idea of getting rid of possessions
• Accumulating possessions to the point that it makes rooms unusable (e.g., piling newspapers on seating and dining areas)
• Struggling to stay organized or frequently losing important items or documents due to clutter
• Experiencing conflict with those who try to remove items from the space

When someone with a hoarding disorder accumulates large volumes of possessions, these items may pile up to the point that they create difficulty using a space for its intended purpose. Clutter in the home may lead to fire hazards, rodent or insect infestations, and other dangerous circumstances. If symptoms increase in frequency and intensity, the person may experience isolation from others and health challenges related to compromised living conditions.

How do i know if my loved one has hoarding disorder?

If you’re unsure about whether your loved one is exhibiting hoarding behavior, consider whether they display an attachment to items and distress at the possibility of losing them. Do they seem to treasure possessions that might otherwise lack value to them? Do they often have a hard time getting rid of things?

It can also be useful to use this Clutter Image Rating guide from the International OCD Foundation’s Hoarding Center. If rooms closely match images 4-9 in the three scenarios, your loved one may be experiencing hoarding disorder. This guide is not, however, meant as a diagnostic tool; hoarding disorder must be diagnosed by a healthcare provider. But it may help you determine whether your loved one could benefit from professional help. 

What are the causes of hoarding disorder?

You may wonder why someone experiencing hoarding disorder keeps so many possessions when it seems apparent that the behavior is unhealthy. There is no unified theory explaining the exact causes of hoarding. Many experts believe hoarding tendencies often begin as young as puberty, but most people who seek professional treatment for the disorder do not do so until they are 50 or older.

Some believe hoarding disorder tendencies are related to inherited brain patterns and are related to anxiety or obsessive-compulsive disorder. For some, hoarding begins following a significant traumatic experience.

If you are experiencing trauma, support is available. Please see our Get Help Now page for more resources.

People with hoarding disorder may acquire and keep items for a variety of reasons:

• They believe an item will be useful or valuable in the future
• They feel an item has sentimental value, is unique, or is irreplaceable
• They are concerned about running out of an item 
• They feel an item is too good of a bargain to pass up or throw away
• They think items will help them remember an important person or event they might otherwise forget

The do’s and don’ts of helping someone with hoarding disorder

It can be difficult to know how to approach helping a loved one who hoards. They may not realize their behavior is potentially unhealthy or dangerous, or they may know but feel uncomfortable addressing the situation with others. The following are do’s and don’ts of supporting a loved one with hoarding disorder. 

The do’s

While your loved one may experience the desire to hoard throughout their life, there are steps you can take to help someone experiencing hoarding disorder reclaim their space and improve their mental well-being. 

When providing support for hoarding disorder, do: 

• Encourage them to seek professional help. Therapy is considered the first-line treatment for hoarding disorder. You can encourage your loved one by helping them find a therapist and other resources in their community.
• Take the time to learn about hoarding disorder. Doing research on hoarding can help you understand the reasons your loved one may be keeping excess items and give you an idea of how best to support them. Look for credible sources like the Mayo Clinic, the American Psychological Association, and the Anxiety And Depression Association of America.
• Help out if they ask for assistance with their belongings. During or after receiving professional treatment, someone experiencing hoarding disorder may seek your assistance in managing the accumulation of clutter in their home, car, and other spaces. Help when you can or consider arranging for professional movers and cleaners to do the work if the task becomes too daunting.
• Listen to them and remain empathetic. Hoarding disorder is a mental illness that is not the fault of the individual experiencing it. Try to provide compassion and emotional support to your loved one and avoid viewing them only in terms of this mental health condition. Hoarding is not something a person chooses to do. Your support and openness can encourage your loved one to seek professional treatment more than judgment or criticism.
• Recognize progress. Hoarding doesn't happen overnight, and it likely won't be solved overnight. Encourage and praise your loved one if you see them attempting to clean or organize a small space or making the decision to talk to a professional. You can provide helpful motivation that may help them get on track and make meaningful progress.

The don’ts

If your loved one is experiencing hoarding disorder, they may feel extreme distress at the idea of getting rid of their possessions. This can make it challenging to address their behaviors in a tactful and effective manner.

When providing support for hoarding disorder, don’t:

• Remove things from their home without consent. It may be tempting to try to clean up your loved one’s space, but that could lead to severe emotional distress at the idea of losing valuable or important items. Throwing things away or getting rid of them without permission may exacerbate the feelings and behaviors the individual exhibits. 
• Expect the cleaning process or the healing process to happen overnight. It can take a long time for someone experiencing hoarding disorder to get to the point of having a house that is unsafe, and it may also take a long time to change both the environment and the behaviors that caused it.
• Enable their behavior. While you may not want to see your loved one experience distress, adding to their clutter by buying or giving them things or taking them on shopping trips can be problematic. Instead try to provide support in other ways (e.g., spending time doing activities not related to consumption).
• Clean up after them. Organizing the space of someone experiencing hoarding disorder could keep them from addressing the deeper concerns that are leading to their behavior. If they choose to clean up, you can help them do so. 
• Expect perfection.  As with many behavioral challenges, someone experiencing hoarding disorder is likely to experience setbacks even after receiving professional treatment. Try to remain understanding and continue showing them love and support during their journey.

Navigating hoarding disorder with online therapy

Online therapy has been proven effective when treating compulsive hoarding. For example, in one study, researchers found that online cognitive behavioral therapy (CBT) led to reductions in clutter and hoarding symptoms for all participants. CBT is a widely utilized modality for hoarding that focuses on helping individuals reframe unhelpful thought processes, such as those that may be related to ideas about the value of possessions or concerns about getting rid of items.  

Online therapy can help you better understand hoarding disorder and process the emotions that may come with helping a loved one with the condition. With an online therapy platform like BetterHelp, you can connect with a therapist remotely, which can be helpful if you’re not comfortable discussing topics like hoarding in person. BetterHelp works with thousands of mental health professionals who are experienced in providing empathetic and non-judgmental support to those with various mental health concerns. Read below for some reviews of BetterHelp therapists, from people who have sought help in the past.

Therapist reviews

“I am not worried about being judged, and I appreciate the times when she empathizes or relates to parts of my life. Dr. Morritt is thoughtful in her responses in a way that allows me to let go, grow, and see other points of view."

"I began working with Courtney during a time when I was very anxious, overwhelmed, stressed, and needing someone to help me work through the chaos in my mind. Courtney was so empathetic, understanding, and non-judgmental, and encouraged me to let go of things that were no longer serving me. Courtney always checked in to see how I was doing if I hadn't been messaging her and that meant a lot to me. I felt respected, heard, and validated. I would recommend her to anyone."