Hoarding disorder is characterized by a persistent difficulty in discarding possessions and excessive acquisition, resulting in a cluttered living environment that can seriously interfere with daily functioning or interpersonal relationships. People with hoarding disorder often collect items that others consider to be of little or no value, such as old books, newspapers and magazines, used plastic bags or boxes, expired food, or even electronic files and emails.
The prevalence of hoarding disorder is about 2% to 6%, and it is more common in older people than in younger people. Since 2013, the American Psychiatric Association has defined hoarding as a mental disorder with specific diagnostic criteria. People with hoarding disorder often have co-existing psychiatric diagnoses such as depression, social phobia, generalised anxiety disorder and attention deficit disorder.
The causes of hoarding are multifaceted and may include cognitive factors (distorted beliefs), emotional factors (avoidance of negative emotions, guilt), behavioral factors (escape behavior), traumatic stress experiences, and impaired interpersonal relationships. Patients often show strong attachment to objects, and loneliness, in addition to being a cause, often exacerbates hoarding symptoms. The main current treatment is cognitive behavioral therapy. Other treatments include compassion-focused therapy, Gestalt therapy, and medication to treat co-existing anxiety and depression.
Family members and friends of individuals with hoarding disorder should support them with empathy and patience, avoid criticism, help create a sense of security, and encourage them to seek professional help. Respecting their choices is essential while guiding them to improve their hoarding behavior at their own pace. Primary care clinicians should be knowledgeable about hoarding disorder and refine their diagnostic and treatment skills to provide the necessary support to individuals with hoarding disorder and their family members.
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