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Hoarding Disorder (aka Pathologic Hoarding)

Summary: Hoarding disorder (aka compulsive hoarding or pathological hoarding) is 1) acquiring possessions and 2) being unable to discard them, even if the items are no longer useful, and/or fail to spark joy. Hoarded items fill the person's home, and can cause severe problems with day-to-day activities and relationships, and even pose a danger to life through being a fire and safety hazard. The good news is that there are many strategies, treatments and supports to help those who hoard.
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Bob lives in a house, but has collected so many books and newspapers that they have filled his rooms and hallways. Just last week, his wife left him due to the clutter. 

Cathy has secretly kept over thirty cats in her small home. Just week, neighbours have complained and she is worried that she’ll be forced to get rid of them.


It is normal that human beings need to acquire and use various possessions in order to survive.

Unfortunately, some people end up 1) collecting too many things, and 2) have troubles getting rid of possessions that they no longer need. When severe enough, it may be hoarding disorder…

What is Hoarding Disorder?

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), hoarding disorder is characterized by persistent difficulty discarding or parting with possessions, regardless of their actual value, to the point that it causes harmful effects for the person, or to those around the person (e.g. family members or landlords).

Harmful effects of excess clutter include:

  • Rendering rooms and hallways unusable: When hoarding is severe enough, a home becomes so full of possessions that there are blocked hallways, exits and rooms. This leads to fire hazards, problems with insects, and becomes a public health issue, especially if the person lives in an apartment. In extreme cases, people have died -- due to stacks of possessions collapsing and crushing people, or leading to the person being trapped and starving to death at home.
  • Crowding out one’s relationships attachments with people: Human beings are a social species, and in general, need to feel connected to people and activities that give a sense of purpose, hope and meaning. In people that hoard, their connections with possessions can replace and crowd out their connections to people and activities. If a hoarder lives with other people, it usually causes conflicts with others. The whole family may become isolated, and/or partners will leave.

Common items that are hoarded may include:

  • Clothing,
  • Newspapers and magazines,
  • Animals (e.g. having numerous pets such as cats, that are well in excess of local bylaws).

How Common Is It?

Hoarding occurs in 2-5% of the population (Samuels, 2008), generally in individuals in their 50’s. Although popular shows such as "Hoarders" have increased public awareness about hoarding, it is still difficult to estimate how many people have problems with hoarding as hoarders usually keep their hoarding secret.

Hoarding urges occur in children and youth as well, but since they tend to live in a household (that is owned and controlled by adult caregivers), their ability to acquire and save possessions is limited compared to adults. Thus, severe hoarding does not usually begin to be a problem until adulthood, and even then, may take decades before it comes to the attention of professionals.

Why Do People Hoard?

Hoarding involves two steps:

1. Acquiring things, which can happen for many reasons such as:

  • The culture of materialism reinforced constantly in advertising and popular culture tricks people into thinking they need or want something.
  • Acquiring things is pleasurable: As hunter-gatherers, we are wired to gather, and for many, it is pleasurable.

2. Inability to discard things, which can happen for many reasons such as:

  • They may feel that the item has functional value (e.g. “One day, I might use this fruit juicer.”)
  • They may feel that the item has helpful information (e.g. “I might one day read this book.”
  • They may feel that the item is rare and hard to replace (e.g. “They no longer make this CD.”)
  • The item may have sentimental value (e.g. “My grandmother gave this to me.” “My first love from high school wrote this letter.”)
  • They may have distress with throwing out things: In many cases, they may have had problems grieving and dealing with loss.
  • They may have an actual problem with their ability to organize which makes it hard to get rid of things. They may not notice they have several of the same identical item, when they only need one.

Self-Help for Hoarding

Is hoarding so severe that it poses a fire safety hazard? E.g. piles of newspapers blocking fire exits.

  • If so, then a high priority is
    • Declutter so that you have free routes in and out of the residence
    • Declutter so that you have entrance and exits from each room.
    • Declutter around heat and ignition sources, i.e. furnaces, stoves, portable heaters, baseboard heaters, water heaters or uncovered light bulbs,
    • Make sure smoke detectors are functioning.

Once safety issues have been addressed, then consider the following advice from Marie Kondo’s KonMari method.

Step 1: Discard things that you no longer need, or that no longer spark joy

  • Set aside a special date and time for tidying, which includes discarding. This is a big task, and simply doing a few minutes a day is not going to be sufficient. The more dedicated time that you can devote to this task, the better. If you can devote a half-day, or a full-day, then wonderful. If you can take a few days off to devote to this, then even better. Naturally, the larger the space to tidy, the longer this will take.
  • Do sort through your possessions by one category at a time. Examples of categories are: clothes, books, papers, office materials.
    • As you go through each category…
      • Put everything in that category in a pile in a room.
      • Touch each item, and ask yourself: 1) Do I need this? 2) Does this spark joy?
      • If not, then discard it -- thank the item for its service, and put it for donation, recycling, or in the garbage.
  • Do discard in the following order:
    • Clothes first, then
      • Take all your clothes out of the closet, drawers, hangers, etc.
      • Put them all in one place in your home, where you can see everything
    • Books
      • Find all the books throughout your home, and put them in one place.
      • Go through each book, hold it (without reading through it), and ask yourself:
      • “Does this book spark joy?”
        • If not, then give it for donation or recycling.
      • “Have I read this book yet?”
        • Note that if you have not read the book, chances are that you will never read it. Give it for donation or recycling.
      • Alternatively, consider that if you really need it again, you can always buy it again, or borrow it from the library.
      • For the future, consider buying electronic books, which you can read on your cellphone, computer, tablet or eBook reader.
  • Are you having trouble discarding something?
    • Ask yourself, “What stops me from discarding this? Is it:
      • An attachment to the past,
      • Fears about the future?
      • A combination of both.
    • This pattern may also be a pattern in your life.
    • If you notice this pattern, then ask yourself -- would you rather…
      • “Live your life attached to the past and having fears about the future?” or
      • “Be able to let go of the past, and be able to be open to new experiences, opportunities and relationships?”

Step 2: Organize and arrange the possessions that are left.

  • After discarding, then one can proceed with organizing and arranging.
    • Do you live on your own?
      • If so, then store all items of the same type in the same place.
      • E.g. Put all your books in one place, as opposed to storing them in multiple locations.
    • Do you live with other people, e.g. a spouse, family, etc.?
      • If so, then designate which spaces are public (for the family), and which ones are private spaces for each person in the family.
      • Each person can store their private belongings in their own private space (e.g. one’s own favorite books collection).
      • Public items (e.g. household tools that exist for the benefit of the household, such as the vacuum cleaner) can be stored in communal space, e.g. utility closet.Supporting a Loved One with Hoarding

Do you have a loved one who hoards? Here are some tips that may be helpful:


  • Do help your loved one get help. E.g. "I'm worried about you." "How can I be helpful?" "If there is anything I can do to help, let me know. If you want me to come with you to any doctor or counseling appointments or anything like that, let me know."
  • Do praise and reinforce any positives. E.g. "You’ve cleared the space on the table -- I can see the table top again. It feels so much better this way. How did you manage to do that?" "I notice that it's more clear near your front door. That's great!"
  • If your loved one is sensitive or uncomfortable with praise, then just use gratitude instead. E.g. "Thank you for doing that. It means a lot to me."
  • Do acknowledge the emotions behind some of the possessions, and validate those feelings. E.g. “I can see that your high school possessions mean a lot to you. I’d love to know more about that… I’m guessing those were important times, and its hard to move on from the past -- its not easy letting go. Anything that I can do to help you move on?”
  • Do offer to watch “Tidying Up with Marie Kondo” on Netflix with them :-)


  • Don't use negative comments to try to shame or embarrass the other person into stopping hoarding, as this tends to make the person defensive and less likely to listen to you. For example, if you say, “How can you live in such a mess!”, then it tends to lead the other person to come up with reasons why s/he hoards, which then strengthens the hoarding.
  • Don't lecture or tell the person what to do, unless a) your friend/loved one is asking for your help, and/or b) you have a strong enough trusting relationship to do this.

When and How to Find Help

Are there still struggles hoarding and clutter, despite one’s best efforts? If so, then consider:

  • Start by seeing a decluttering consultant or ‘tidying expert’.
  • If this does not work, then consider seeing a mental health professional with expertise in hoarding.

Mental Health Treatments for Hoarding Disorder

Mental health professionals offer treatments such as:

  1. Cognitive behavioural therapy (CBT), delivered by a psychologist, psychotherapist, social worker, etc.
  2. Medication, which is prescribed by a doctor.
  3. Combination of 1) and 2).

Cognitive Behavioural Therapy (CBT)

Thoughts and Behaviours

CBT looks at the person's thoughts and behaviours that lead to hoarding, and seeks to change these thoughts and behaviours to stop the hoarding.

Hoarding Thought


I can't throw out this old newspaper because I (or someone else) might need it…

These newspapers can be thrown out because they’re all online nowadays.

I can't throw out these old books because I (or someone else) might want to read them.

Whoever needs these books can just borrow them from the library.

I can't throw out my old school notes, because I (or someone else) might need them.

These notes are out of date and I haven’t reviewed them in over 10-years, so I might as well throw them out.

I don’t want to throw out these newspapers and waste all that paper.

I can put these in the recycling, and let it be re-used.

Behavioural Hierarchy

A behavioural hierarchy is about coming up with a step-by-step plan where one gradually de-clutters. It involves:

  • Make a list of what things to throw out
  • Start with the easiest things
  • Gradually progress to the more difficult things to throw out

Whether or not you seek professional help or not, there are a lot of things that you can do to help with hoarding.

Ultimately, dealing with hoarding involves:

1. Reconnecting (or connecting) to people and activities that give a sense of belonging, purpose, hope and meaning.

Consider some of the following ways to build your connections:

  • Spend time with people
  • Spend time with nature
  • Spend time with animals
  • Join a club
  • Take a course, even if it is an online course
  • Volunteer somewhere
  • Join a church, or spiritual activity

2. Disconnecting from possessions as a way to meet your needs.

Before you acquiring something, ask yourself the following questions:

  • Do I have an immediate use for this?
  • Do I need it? How many do I already have?
  • Can I get by without it?
  • Do I feel compelled to have it?
  • Can I afford it comfortably?
  • Do I have time to deal with it appropriately? Maintain it?
  • Does it spark joy? 

If the answer is no to any of these questions, then don’t acquire it!


Ottawa Public Health. Helpful Questions & Strategies for Hoarding Situations [Brochure].

Metcalf E: Harmless Pack Rat or Compulsive Hoarder? Retrieved Sep 28 2010 from

Pertusa et al.: Compulsive hoarding: OCD symptoms, distinct clinical syndrome, or both? Am J Psychiatry. 2008 Oct; 165(10):1229-33.

Sansone RA et al.: Hoarding: obsessive symptom or syndrome? Psychiatry. 2010 Feb;7(2):24-7.

Samuels JF et al.: Prevalence and correlates of hoarding behaviour in a community-based sample. Behav Res Ther. 2008 Jul; 46(7): 836-44. Retrieved Sep 28, 2010 from More Information

Hoarding Center of the International OCD Foundation

Documentary on Vimeo

What Is the KonMari Method? Here's How to Declutter the Marie Kondo Way

The Life Changing Magic of Tidying Up | Marie Kondo | Talks at Google

About this Document

Written by members of the team.


Information in this pamphlet is offered ‘as is' and is meant only to provide general information that supplements, but does not replace the information from your health provider. Always contact a qualified health professional for further information in your specific situation or circumstance.

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Date Posted: Jul 19, 2011
Date of Last Revision: Aug 3, 2020

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