Hoarding Disorder in Adults

ICD-10 code: F42.3

Hoarding disorder (HD) is part of a cluster of diagnoses called the obsessive-compulsive and related disorders.  Obsessive-compulsive and related disorders are a group of psychiatric conditions that include:

  • Obsessive-compulsive disorder
  • Body dysmorphic disorder
  • Hoarding disorder
  • Trichotillomania
  • Excoriation (skin picking) disorder

These disorders are characterized by the occurrence of repetitive behaviors, often called compulsions.  Individuals with obsessive-compulsive disorder might engage in compulsive behaviors such as excessive washing, checking, arranging, or counting.  Individuals with body dysmorphic disorder might engage in frequent checking of their appearance in the mirror, or excessive grooming-related behaviors.  Individuals with hoarding disorder may engage in excessive acquiring of objects, combined with a strong need to save items.  Individuals with trichotillomania engage in excessive hair pulling, and individuals with excoriation disorder engage in excessive skin picking.

In some cases, the obsessive-compulsive and related disorders are also characterized by intrusive, unwanted, or distressing thoughts, called obsessions, which come to mind again and again.  People with obsessive-compulsive disorder might have obsessive thoughts about dirt or germs, thoughts of harming others, fears of making mistakes, or distress about things being out of order.  People with body dysmorphic disorder have repetitive, negative thoughts about their own appearance.  However, people with certain other obsessive-compulsive and related disorders (such as trichotillomania or excoriation disorder) often do not experience obsessive thoughts.

What is hoarding disorder?

Hoarding disorder is a newly-recognized psychiatric disorder that is thought to affect approximately 2-6% of adults.  Hoarding disorder is characterized by three main symptoms:

  • Persistent difficulty discarding (throwing away) or parting with possessions
  • The person has trouble parting with possessions due to a perceived need to save the items and distress associated with discarding them
  • The difficulty discarding leads to significant clutter in active living areas that interferes with their intended use.  For example, a person may be unable to use his or her dining room table, couch, and/or bed because of clutter. 
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Understanding Hoarding Disorder

Hoarding severity can range from fairly mild to very severe.  In severe cases, hoarding disorder can lead to family strain, impaired social relationships, eviction, illness (due to airborne pathogens), or death (due to house fires or falls).  Many people with hoarding disorder have physical health problems and other psychiatric conditions, most commonly depression, anxiety disorders, and attention deficit-hyperactivity disorder.

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How is hoarding disorder treated?

At this time, there is no published consensus about the best ways to treat hoarding disorder.  Currently, clinical research suggests that the most promising treatment is cognitive-behavioral therapy (CBT).  CBT consists of education about hoarding, building motivation, teaching strategies for sorting and discarding possessions, and challenging unhelpful thoughts and beliefs about possessions.  CBT can be conducted individually or in a group setting.

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