How to diagnose hoarding disorder

If you believe your client might have Hoarding Disorder (HD) based on the DSM-V definition, several standard rating scales listed here can help you make a diagnosis and assess the severity and impact of HD on the client.

Saving Inventory-Revised (SIR)
The Saving Inventory-Revised is a 23-item questionnaire designed to measure three features of HD: excessive acquisition, difficulty discarding, and clutter. Scoring instructions are located at the end of the questionnaire, along with a table showing the average scores of people who do not suffer from HD, as well as cutoff scores that typically indicate a significant clinical hoarding problem and/or HD diagnosis.

Hoarding Rating Scale (HRS)
The Hoarding Rating Scale is a brief 5-item scale that can be given as a semi-structured clinician interview or as a questionnaire. This tool includes 5 questions about clutter, difficulty discarding, excessive acquisition, and the resulting distress and impairment caused by hoarding. Initial studies suggest that a score of 14 or higher on the HRS indicates a probable hoarding problem/HD diagnosis.

Clutter Image Rating (CIR)
The Clutter Image Rating is a tool that helps standardize definitions of clutter by showing a series of images depicting rooms in various stages of clutter. This allows the client, the clinician, or another observer to select the image on the scale that best corresponds with the state of the main rooms in the home. The CIR contains three sets of 9 pictures to clarifiy the level of clutter in the kitchen, the living room, and the bedroom. The living room photos can be used to rate other types of rooms in the home. In general, rooms that are rated as picture #4 or higher indicate a probable hoarding problem/HD diagnosis.

How to diagnose hoarding disorder

Compulsive hoarding is a progressive disease. Nobody wakes up one morning and feels that their home is missing decades of outdated newspapers, or an array of broken electrical appliances. As a result, diagnosis is rarely simple or straightforward.

Typically, compulsive hoarding will not become apparent for several years. It may even take longer than this. Hoarders are prone to feeling a great deal of personal shame and embarrassment about their issue.

This means that they’ll do whatever it takes to hide it. It could take decades before the compulsion causes structural damage to a home, and it becomes apparent to the untrained eye that something is awry.

This can be the first warning sign of compulsive hoarding. If a previously gregarious friend or family member stops engaging, there will be a reason. Naturally, hoarding is not the first thing that anybody thinks of. It always remains a possibility, though.

Perhaps the biggest red flag of hoarding is somebody constantly declining visits to their home. If your loved one seems embarrassed by the idea of you entering their house, there will be a reason.

Sadly, the embarrassment that hoarders feel prevents them from asking for help themselves. It usually takes somebody else gaining access to the property by hook or by crook, and making a referral on the hoarder’s behalf. Continued near the bottom of this page.

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How to diagnose hoarding disorder

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Denial is also a driving force in compulsive hoarders. Somebody that lives with the uncontrollable urge to hoard will never accept that their devotion to possessions is detrimental to their quality of life.

A compulsive hoarder will often minimise their issue. They will refer to their possessions as a collection, and claim that their home is far less cluttered than it really is.

They will also display anxiety at the idea of parting with possessions, describing them as essential. Compulsive hoarders will genuinely believe that plan to fix that broken toaster, read that decade-old magazine and learn to play that rusty saxophone.

Because of this, compulsive hoarders refuse to see that they have a problem. As they’re adamant that they are not unwell, they will not seek treatment. This brings us back to our initial barrier against diagnosis. Unless somebody else steps in and makes a referral, the hoarder will never receive the help they need.

It’s rare that compulsive hoarding is a solitary issue. In many cases, the behaviour is linked to other mental illness. This is referred to as co-morbidity among psychiatric circles.

Research is still ongoing into the conditions that accompany compulsive hoarding. However, common diagnoses include:

  • Severe bouts of depression.
  • General anxiety disorder (GAD)
  • Social phobias, leading to reluctance to engage with others.
  • Post-traumatic stress disorder (PTSD)
  • Attention Deficit Hyperactivity Disorder (ADHD)
  • Grooming disorders, such as trichotillomania, skin picking and nail biting.
  • Dementia.

Testing, and potential diagnosis, for each of these issues is highly recommended in a compulsive hoarder.

How to diagnose hoarding disorder

How to diagnose hoarding disorder

How to diagnose hoarding disorder

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How to diagnose hoarding disorder

Holding on to possessions we have no use of is one of the common human traits. Many people find it difficult to part from things that they may or may not have use for in the future. When this habit becomes more than being a little disorganized or shy of OCD, it may develop into a hoarding problem.

Hoarding disorder is a persistent mental health disorder when a person finds it difficult to part with their possessions because of a perceived need to save them. A person with hoarding disorder experiences upsetting thoughts at the mere thought of getting rid of their things.

Hoarding disorder has a big stigma attached to it. People with this disorder face a lot of shaming and judgment from others which makes them fearful and stressed in every aspect of their lives. This kind of discrimination negatively affects a person’s social, work, and personal lives.

A hoarder’s stuff usually takes up all available surfaces and can even spread tho the garage, storage rooms, and backyards. Hoarding often creates cluttered living conditions. People with this disorder may not always see it as a problem, making treatment difficult but not impossible.

The gradual build-up of clutter and trouble in discarding things are the first signs of hoarding disorder. This problem often surfaces during teenage and early adult years and can stay for a long time. The cluttering may start with small things but may eventually develop making attracting attention. Some symptoms of hoarding are as follows:

  • Excessive collecting items that are not needed
  • Having difficulty discarding items
  • The tendency to be indecisive, procrastinating, and disorganized
  • Significant distress in daily functioning
  • Difficulty in leaving personal space or home

Hoarding is different than collecting things. People who collect things such as stamps, coins, model figures, intentionally search out for specific items. Even if the collection is large, it doesn’t create clutter and cause stress or anxiety to the collector.

How to diagnose hoarding disorder

Causes Of Hoarding Disorder

There has been no particular determined cause of the disorder. It is termed as a disability disorder and it often comes in combinations. People left vulnerable or overwhelmed after a trauma or loss can develop hoarding disorder.

Hoarding usually develops in the teenage years and tends to get worse with age. Risk factors include:

1. Personality – people with hoarding disorder have temperament issues and are not stable which can lead to being indecisive.

2. Family – Genetics is also a risk factor for people with hoarding disorder.

3. Trauma – a stressful event, like the loss of a loved one or a job, can trigger hoarding. Although it may be seen as a coping mechanism.

Hoarding can complicate a person’s ability to function daily. It can also create trouble with family members and society in general. Hoarding can create social isolation, loneliness, unsanitary living conditions, and fire hazard.

How to diagnose hoarding disorder

Stages And Types Of Hoarding

There are 5 stages of hoarding:

1. Hoarding Level One –

the clutter is not excessive and the living space is considered sanitary.

2. Hoarding Level Two –

the clutter is spread in more than one room, and there is light odor and the living space is not kept properly.

3. Hoarding Level Three –

one or more bedrooms are unusable and there are excessive dust, soiled living area, and visible clutter outdoors.

4. Hoarding Level Four –

there is a sewer problem, hazardous electrical wiring, mosquito and bug infestation, and unsanitary living conditions.

5. Hoarding Level Five –

there is a rodent infestation, the kitchen and bathroom are unsanitary and unusable and little to no plumbing.

Untreated hoarding problems can seriously affect a person and create extremely stressful living conditions. This can lead to substance abuse and panic disorders. There are different types of hoarding:

  • Object hoarding
  • Animal hoarding
  • Food hoarding
  • Trash hoarding

How to diagnose hoarding disorder

How To Help A Hoarder:

People don’t usually seek help for hoarding. Hoarding is a big stigma which is often ignored and overlooked among many other disorders. To help diagnose hoarding, a psychological evaluation is necessary.

Treating hoarding can be challenging as many people don’t recognize the signs of hoarding until too late. The first treatment to look for in this case should be cognitive behavioral therapy or CBT.

1. Psychotherapy

Psychotherapy or talk therapy is often the primary treatment for hoarding. As a part of CBT, a therapist might help to:

  • Identify thoughts and beliefs related to acquiring and saving items
  • Resist the urge to acquire more things
  • Organize and declutter things
  • Improve decision making and coping skills
  • Reduce isolation and increase social interaction
  • Motivate to attend group therapy and continue treatment

2. Lifestyle change

Accepting assistance from loved ones and professionals can help make changes in lifestyle and help declutter. Hoarding can lead to isolation and loneliness which in turn can lead to more hoarding. Visiting friends and family at regular intervals can help in the change of behavior. Changing eating habits and regular physical activity can also help with the rejuvenation of the mind and body.

How to diagnose hoarding disorder

Hoarding disorder is one of many conditions that have been overlooked by many over the years. One of the reasons treating hoarding disorder is hard because of the joy it brings to people. Mental health disorders as depression and anxiety can be very stressful on a person’s mind which influences them to seek treatment. Hoarding disorder patients don’t necessarily feel distressed until faced with the thought of parting from their cherished possessions.

Every disability deserves equal validation and acceptance. People with hoarding are often left feeling shameful and regretful. There is still a lot to learn about this disorder and the ways a person can be helped. With every other mental health disability, it is imperative to acknowledge, understand, and accept the problem.

Live life on your terms and find happiness in what you have, not what you want.

A police officer attempts to clear a path through the Collyer mansion, where two reclusive brothers . [+] died as a result of their hoarding. (photo: Wikipedia)

Forget Hoarders, and all those compulsively watchable episodes about eccentric people who can’t seem to throw anything away. Hoarding – or hoarding disorder, as it’s officially known – is real, it’s serious (tragic, really), and it’s more common than you think.

“Hoarding disorder is as common as obsessive-compulsive disorder, schizophrenia, bipolar illness, and autism,” writes Peter Roy-Byrne, MD, Editor-in-Chief of Psychiatry, in the New England Journal of Medicine’s JournalWatch.

In an article titled How Common Is Hoarding? Roy-Byrne discusses research published in the November 2013 issue of the British Journal of Psychiatry by Ashley E. Nordsletten of King’s College London, who analyzed a group of patients who qualified as hoarders according to a basic screening.

Nordsletten and her team found that of those who self-identify themselves as hoarders only 19 percent met the new diagnostic criteria. Nordsletten also found that hoarders were poorer, older, more likely to live alone, and tended to suffer from additional mental and physical illnesses in addition to hoarding.

What does this mean? Well, for one thing, it may mean the diagnostic criteria are too strict, missing people who define their hoarding as impacting the quality of their lives, whether or not they qualify under the DSM. It may also mean that to successfully treat hoarding disorder, therapists will need to address these additional factors that have an impact on the disease.

How to diagnose hoarding disorder is a hot topic because it’s been newly classified as a separate psychiatric disorder, independent of other diagnoses, in the DSM-5, the latest iteration of the Diagnostic and Statistical Manual of Mental Disorders. (Hoarding had previously been considered a subdiagnosis under Obsessive-Compulsive Disorder but is now realized to exist independently of OCD.)

A comprehensive literature review published earlier this summer in the Journal of Psychiatric and Mental Health Nursing found that 2 to 5 percent of the population meets the criteria for hoarding and that hoarding has a devastating impact on the families of those who suffer with the disorder.

All of this feels significant because our collective view of hoarding today seems to have veered down the wrong track, viewing it more as a disturbing but ultimately benign eccentricity and less as a serious and even life-threatening mental health condition. We treat it as something to laugh at, to be creeped out by, perhaps, but primarily as a cultural curiosity.

In six seasons of Hoarders, A&E’s popular TV show, viewers have peeped into an astonishing variety of disturbed lives, with a tone that alternates between horror-struck and tongue-in-cheek. Yes, many of the stories have been tragic, such as a mother who filled her daughter’s room so full of junk the child was forced to sleep on a recliner. But in the narration there’s little sense of shame at offering these lives up to slack-jawed ogling. (For contrast, let’s consider how we’d feel about a TV show called Schizophrenics, in which we follow around and spy on those afflicted with this psychiatric condition. )

Historically, though, hoarding has been recognized as a psychiatric illness that destroys lives. The 1947 media coverage surrounding the reclusive Collyer brothers of Harlem, who died walled in by mountains of stuff inside the family’s historic mansion, was quite somber, with stories emphasizing the tragedy and gruesomeness of their lives and deaths.

So will this new understanding of hoarding disorder change the way we diagnose, treat, and talk about those who suffer from it? Let’s get a conversation going, which is what the BJPsych and JournalWatch were clearly trying to do. If you or someone you love suffers from hoarding disorder, I’d particularly like to hear from you.

Hoarding is a disorder that that has long been misunderstood, but it is important that as a society, we make the effort to show compassion and understanding to those who suffer from it. Definitions of hoarding have changed over the years, and attitudes toward the disorder have evolved as well. Still, we have a long way to go when it comes to treating this condition, and it is important that we do so in a gentle manner.

What is Hoarding?

For years, many people thought that hoarding was merely a symptom of obsessive-compulsive personality disorder. However, while some OCD patients may exhibit hoarding behavior, the two disorders are not necessarily linked.

Today, hoarding may or not be linked to personality or anxiety disorders. While there is no consensus on a clear definition of hoarding, the American Psychological Association considers a hoarding diagnosis under specific symptoms and circumstances. These include:

  • Heavy emotional attachments to seemingly trivial items.
  • The inability to discard of these items and/or emotional outbursts when such an action is suggested
  • Strained relationships with friends and family due to the disorder
  • Dangerous living conditions that make one more susceptible to falls, fire hazards, or illness
  • Living in a home with rooms that have been rendered incapable of use due to the build-up of items to which the patient is emotionally attached

The APA estimates that up to 5% of Americans suffer from hoarding, but this inevitably affects their friends, families, and even communities in which they live.

How to face a loved one who hoards

Facing the problem of hoarding is a difficult process for any family, but it is important to realize that this is a disorder and that getting angry can cause even more emotional distress. You should not scold someone for hoarding, but rather attempt to understand what value they see in certain items that you might consider to be garbage. In some cases, you might find that your friend or relative has a detailed, well-thought-out answer, and you may even learn something about him or her.

How to diagnose hoarding disorder

How to diagnose hoarding disorder

All hands on deck with hoarding

Ultimately, fixing the problem of hoarding should be looked at as a team effort. Friends and family members should do their best to encourage their loved ones to seek help, but also to remain aware of their condition. If therapy is involved, it is just one step in the process, and the individual will need positive reinforcement from the people around them. There is no quick fix for this, and trying one is likely to lead to even more extreme behavior. Patience, compassion, and understanding are all key parts of the healing process.

Hoarding disorder is characterized by an ongoing resistance to discarding one’s belongings, even those with no value, like junk mail, old newspapers, and materials that most people would consider to be garbage. Hoarders also hold on to personal possessions that they no longer use, either because they feel emotionally attached to these items or because they believe they will need them in the future.

People with this condition may give in to the urge to acquire excessive amounts of objects that fill up their living space. The accumulation of clutter and lack of order and cleanliness can cause health and safety risks within the home, but discarding items may cause the hoarder to feel significant distress. In this way, hoarding disorder can create social, professional, and functional problems that affect not only the individual but also the people around them.


  • Symptoms
  • Causes
  • Treatment


According to DSM-5, the following symptoms are diagnostic of hoarding disorder:

  • There is a persistent difficulty discarding or parting with possessions, regardless of their value or lack thereof.
  • The difficulty in discarding possessions is due to distress associated with getting rid of them.
  • The difficulty in discarding possessions leads to the clutter of living spaces and compromises the use of living spaces.
  • The hoarding creates clinically significant distress or impairment in functioning, including the ability to maintain a safe space.

In some cases, the difficulty in discarding items is accompanied by excessive acquisition of items that are not needed or for which there is no available space.

A hoarder may be completely convinced that the hoarding-related activity—difficulty discarding items, excessive acquisition of items—is not problematic despite evidence to the contrary.

What is the difference between hoarding and collecting?

Unlike a collector, someone who accumulates related objects generally recognized as collectibles with some established value, a person with hoarding disorder gathers up random items and is overly attached to personal possessions that may not have any value whatsoever.

What are signs that I am in the presence of a hoarder?

Hoarders have many items, often in piles or stacks, and most of these items are of little or no objective value. In severe cases, almost every surface in an individual’s home, including floors, furniture, counters, and other fixtures, will be covered in piles of clutter, leaving the hoarder only a narrow path clear for walking through the living space, which for the most part is no longer usable.

Can hoarding become dangerous?

Hoarders often experience difficulty with personal hygiene and are at greater risk of falling and their residences become fire risks. The more cluttered and blocked their home becomes, the more stress the individual feels, because of the chaos within the living space and complaints from family members, neighbors, and even local law enforcement.

What is animal hoarding?

Hoarders do collect animals to an unhealthy level. And while there may be stereotypes of crazy cat ladies, there is not enough evidence showing that there are more female over male animal hoarders.

Problems of animal hoarding arise when pet owners:

• Do not provide proper nutrition, hygiene, and veterinary care.

• Do not provide a healthy environment.


The cause of hoarding disorder has yet to be identified, although there are known risk factors. People who experience a traumatic event, have difficulty making decisions, or have a family member who hoards are at higher risk of developing the disorder. The majority of people with hoarding disorder also suffer some type of depressive or anxiety disorder.

The tendency to hoard often begins in adolescence and worsens as a person gets older.

Hoarding disorder is viewed as a type of obsessive-compulsive disorder, and many OCD disorders are closely linked to anxiety. None of the symptoms of hoarding disorder is due to any other mental health condition or medical problem. One study found that among the reasons people reported for their hoarding, avoiding waste was the most common.

Is hoarding related to laziness?

No. Laziness and messiness are not related to hoarding, which is a mental health disorder. People who hoard experience great anxiety and distress over their habits and tendencies.

Are hoarding and ADHD related?

ADHD is commonly associated with hoarding, and there is research suggesting that individuals who have ADHD may show an increased risk for hoarding. According to the NIH, some 20 percent of hoarders may meet symptom criteria for ADHD.


Hoarding may persist for a lifetime, but effective treatment can help reduce the need to hold on to unnecessary items; it can also improve decision-making, stress-reducing, and organizational skills.

The primary treatments used to relieve symptoms of hoarding disorder include cognitive-behavioral therapy (CBT) and antidepressant medication, such as selective serotonin reuptake inhibitors (SSRIs). One or the other, or both, may be employed. Early clinical trials suggest that compassion-focused therapy may be more effective than CBT alone.

Can a hoarder be motivated to clean up?

An individual cannot be forced to throw away clutter. Nor will he likely welcome help in discarding his hoarded items. He may well feel his boundaries are being crossed, and that he has the right to live any way he pleases.