Is Hoarding a Mental Illness? Understanding Hoarding Disorder

For decades, hoarding was dismissed as laziness, eccentricity, or simply a consequence of poor housekeeping. People who lived with compulsive accumulation were shamed rather than supported. That changed in 2013 when the American Psychiatric Association officially recognized Hoarding Disorder as a distinct mental health condition. The answer to the question is clear: yes, hoarding is a mental illness, and understanding it as such is essential to effective treatment.

This guide explains how hoarding disorder is classified, what causes it, how it relates to other mental health conditions, who it affects, and what treatment options are available — with a focus on resources accessible to Ohio residents.

DSM-5 Classification of Hoarding Disorder

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) — the standard reference used by mental health professionals in the United States — classifies Hoarding Disorder as a standalone diagnosis under the category of Obsessive-Compulsive and Related Disorders.

Diagnostic Criteria

To receive a formal diagnosis of Hoarding Disorder, an individual must meet all of the following criteria as defined by the DSM-5:

• Criterion A: Persistent difficulty discarding or parting with possessions, regardless of their actual value
• Criterion B: The difficulty is due to a perceived need to save the items and distress associated with discarding them
• Criterion C: The accumulation of possessions congests and clutters active living areas and substantially compromises their intended use. If living areas are uncluttered, it is only because of interventions by third parties (family members, cleaning services, authorities)
• Criterion D: The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning, including maintaining a safe environment for self and others
• Criterion E: The hoarding is not attributable to another medical condition (such as brain injury or cerebrovascular disease)
• Criterion F: The hoarding is not better explained by the symptoms of another mental disorder (such as obsessions in OCD, decreased energy in major depressive disorder, delusions in schizophrenia, or cognitive deficits in major neurocognitive disorder)

Diagnostic Specifiers

The DSM-5 includes two important specifiers that help clinicians describe the presentation more precisely:

Specifier	Description	Prevalence
With excessive acquisition	The individual actively acquires new items through purchasing, obtaining free items, or stealing, beyond what is needed or has space for	Approximately 80-90% of individuals with hoarding disorder
With good or fair insight	The individual recognizes that hoarding-related beliefs and behaviors are problematic	Varies; better insight is associated with better treatment outcomes
With poor insight	The individual is mostly convinced that hoarding-related beliefs and behaviors are not problematic despite evidence to the contrary	Associated with more severe hoarding and greater functional impairment
With absent insight/delusional beliefs	The individual is completely convinced that hoarding-related beliefs and behaviors are not problematic	Least common; most challenging to treat

Learn more about the terminology used in hoarding disorder diagnosis and treatment in our hoarding disorder glossary entry.

Why Hoarding Was Separated from OCD

Before 2013, hoarding was classified as a symptom of Obsessive-Compulsive Disorder (OCD) rather than its own condition. Research over the preceding two decades demonstrated that this classification was inaccurate and led to ineffective treatment approaches. Key findings that drove the reclassification include:

• Different brain activity: Neuroimaging studies show that hoarding activates different brain regions than OCD. Specifically, hoarding is associated with abnormal activity in the anterior cingulate cortex and insula — areas involved in decision-making and emotional processing — while OCD primarily involves the orbitofrontal cortex and caudate nucleus
• Different treatment response: The standard pharmacological treatment for OCD (selective serotonin reuptake inhibitors, or SSRIs) shows significantly lower effectiveness for hoarding symptoms than for typical OCD symptoms
• Different symptom profile: People with hoarding disorder do not typically experience the intrusive, unwanted thoughts (obsessions) and repetitive behaviors (compulsions) that characterize OCD. Instead, they experience difficulty with decision-making, emotional attachment to objects, and avoidance of the distress associated with discarding
• Independent occurrence: The majority of people with hoarding disorder do not meet diagnostic criteria for OCD, and most people with OCD do not exhibit significant hoarding behaviors

This reclassification was a watershed moment for the hoarding field. It opened the door to specialized research funding, targeted treatment development, and greater public understanding of hoarding as a genuine medical condition rather than a character flaw.

What Causes Hoarding Disorder?

Hoarding disorder does not have a single cause. Research points to a combination of genetic, neurological, psychological, and environmental factors.

Genetic Factors

Hoarding disorder has a significant genetic component. Studies of twins and families have established the following:

• Approximately 50% of people with hoarding disorder have a first-degree relative who also hoards
• Twin studies estimate the heritability of hoarding at approximately 36% to 50%
• Specific chromosomal regions (including 14q and 3q) have been linked to compulsive hoarding in genome-wide linkage studies

Neurological Factors

Brain imaging research has identified several neurological differences in people with hoarding disorder:

• Decision-making deficits: Reduced activity in the prefrontal cortex, which governs executive function and decision-making
• Emotional processing: Heightened activity in the insula, which processes emotions related to disgust, pain, and attachment, when confronted with discarding decisions
• Attention and categorization: Difficulties with sustained attention, categorization, and organization that are distinct from other mental health conditions
• Information processing speed: Slower processing speed for decisions involving personal possessions compared to control groups

Psychological Factors

• Emotional attachment to objects: Objects serve as extensions of identity, safety, or memory. Discarding an item feels like losing part of oneself
• Avoidance behavior: The distress associated with making discard decisions leads to avoidance, which reinforces the accumulation cycle
• Perfectionism: Fear of making the "wrong" decision about an item leads to decision paralysis
• Perceived utility: Overestimation of the future usefulness of items ("I might need this someday") drives retention
• Responsibility beliefs: Feeling responsible for the "welfare" of objects or guilt about waste

Environmental and Life Experience Factors

• Traumatic experiences: Loss of a loved one, divorce, abuse, or other traumatic events are common triggers for the onset or worsening of hoarding behavior
• Material deprivation: Growing up in poverty or experiencing periods of material scarcity can lead to excessive saving behaviors
• Learned behavior: Growing up in a hoarding household normalizes accumulation and may not provide models for organization and discarding
• Social isolation: Loneliness and lack of social connections can lead to objects serving as substitutes for human relationships

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Relationship to Other Mental Health Conditions

Hoarding disorder frequently co-occurs with other mental health conditions. Understanding these relationships is important for effective treatment.

Hoarding and Depression

Major depressive disorder is the most common co-occurring condition, affecting approximately 50% to 75% of individuals with hoarding disorder. The relationship is bidirectional — depression can reduce motivation to organize and discard, while the consequences of hoarding (social isolation, shame, loss of functional living space) can trigger or worsen depression.

Hoarding and Anxiety Disorders

Generalized anxiety disorder and social anxiety disorder co-occur in approximately 25% to 45% of hoarding cases. Anxiety about making wrong decisions, losing important items, and being judged by others all contribute to avoidance behaviors that maintain hoarding.

Hoarding and ADHD

Attention Deficit Hyperactivity Disorder is present in an estimated 20% to 30% of people with hoarding disorder. Executive function deficits associated with ADHD — including difficulty with organization, prioritization, and sustained attention — significantly overlap with the cognitive challenges seen in hoarding.

Hoarding and Trauma/PTSD

Post-traumatic stress disorder is found in approximately 20% to 25% of hoarding disorder cases. Traumatic experiences, particularly loss and deprivation, are common in the histories of people who develop hoarding disorder.

Hoarding and OCD

Despite the historical connection, only about 15% to 20% of people with hoarding disorder also meet criteria for OCD. When both conditions are present, the hoarding symptoms are often more severe and more difficult to treat.

Co-occurring Condition	Estimated Prevalence in Hoarding Disorder	Impact on Treatment
Major Depressive Disorder	50-75%	May require antidepressant medication alongside hoarding-specific therapy
Generalized Anxiety Disorder	25-45%	Anxiety management techniques integrated into treatment plan
ADHD	20-30%	Executive function support and possibly stimulant medication
PTSD	20-25%	Trauma processing may need to occur before or alongside hoarding treatment
OCD	15-20%	Combined approach addressing both conditions; typically more intensive
Social Anxiety Disorder	20-30%	Gradual exposure to social situations and home visits as part of recovery

Prevalence: How Common Is Hoarding Disorder?

Hoarding disorder is more common than many people realize. The following statistics frame the scope of the problem nationally and in Ohio.

National Statistics

• 2.5% of the adult U.S. population is estimated to meet diagnostic criteria for hoarding disorder — approximately 6.5 million people
• Hoarding affects men and women at roughly equal rates, though women are more likely to seek treatment
• The average age of onset is 11 to 15 years old, though clinically significant hoarding typically does not manifest until the 30s or later
• Hoarding severity tends to increase with age, with the highest rates of clinically significant hoarding found in adults over 55. Our guide to the five levels of hoarding explains how severity is measured
• Only an estimated 5% to 15% of people with hoarding disorder seek treatment on their own

Ohio-Specific Data

• Based on the 2.5% prevalence rate and Ohio's adult population, approximately 290,000 Ohioans live with hoarding disorder
• Ohio's aging population is particularly affected — adults over 65 represent the fastest-growing demographic for new hoarding interventions in the state
• Urban areas including Columbus, Cleveland, Cincinnati, and Akron report the highest volume of hoarding-related code enforcement complaints
• Rural Ohio counties face unique challenges due to limited access to specialized mental health providers and cleanup services — see our guide to free hoarding cleanup resources in Ohio for assistance options
• Ohio's Area Agencies on Aging report that hoarding is among the top five reasons for home safety referrals for seniors

Treatment Options for Hoarding Disorder

Because hoarding disorder is a recognized mental illness, it has established, evidence-based treatment protocols. Treatment is most effective when it addresses both the psychological roots of hoarding and the physical conditions it creates.

Cognitive Behavioral Therapy (CBT) for Hoarding

CBT specifically adapted for hoarding disorder is the gold standard treatment. Unlike general CBT, hoarding-specific CBT includes components tailored to the unique challenges of the condition:

• Motivational interviewing: Building the client's internal motivation to change rather than imposing external pressure
• Cognitive restructuring: Identifying and challenging the thought patterns that drive accumulation and difficulty discarding (such as overvaluing items, catastrophizing about waste, and all-or-nothing thinking)
• Exposure and response prevention: Gradual, supported practice with discarding items and resisting the urge to acquire new ones
• Skills training: Building practical organization, decision-making, and categorization skills
• In-home sessions: A critical component where the therapist works with the client in their actual living environment, providing real-time support during sorting and discarding

Research shows that hoarding-specific CBT produces clinically significant improvement in 60% to 80% of participants, though complete resolution of symptoms is less common. Treatment typically requires 20 to 30 sessions over 6 to 12 months.

Medication

There is currently no FDA-approved medication specifically for hoarding disorder. However, several medications may help, particularly when co-occurring conditions are present:

• SSRIs (e.g., paroxetine, sertraline, fluvoxamine): May reduce hoarding symptoms modestly, and are more effective when co-occurring depression or anxiety is present
• SNRIs (e.g., venlafaxine): Some evidence of benefit for hoarding symptoms, particularly in individuals with comorbid anxiety
• Stimulants: When ADHD co-occurs with hoarding, stimulant medication may improve executive function and indirectly reduce hoarding severity

Medication alone is generally not sufficient to treat hoarding disorder. The best outcomes are achieved when medication is combined with hoarding-specific CBT.

Group Therapy and Support Groups

Group-based treatments have shown promise for hoarding disorder:

• Buried in Treasures workshops: A structured 16 to 20 session group program based on the book by Drs. Tolin, Frost, and Steketee. Several Ohio communities offer these workshops through mental health agencies and community organizations
• Peer support groups: NAMI Ohio and local mental health boards facilitate support groups where individuals with hoarding disorder share experiences and strategies
• Online support communities: Virtual groups provide accessibility for individuals in rural areas or those not yet ready for in-person participation

Professional Hoarding Cleanup

While cleanup alone does not treat the underlying mental illness, professional cleanup is an essential component of recovery. A safe, organized living environment supports mental health treatment and prevents the health hazards associated with hoarding conditions. The key is integrating cleanup with ongoing therapy so that the psychological changes keep pace with the physical changes.

Visit our Ohio Hoarding Cleanup Directory to find providers who coordinate with mental health professionals for integrated treatment approaches.

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Ohio Mental Health Resources for Hoarding Disorder

Ohio offers a range of mental health resources for individuals and families affected by hoarding disorder.

State-Level Resources

• Ohio Department of Mental Health and Addiction Services (OhioMHAS): Oversees the state's mental health system and can provide referrals to local boards
• NAMI Ohio: Offers education, advocacy, and support groups for people with mental health conditions including hoarding disorder
• Ohio Psychological Association: Directory of licensed psychologists, many of whom specialize in OCD and related disorders including hoarding
• Ohio Counselor, Social Worker, and Marriage and Family Therapist Board: Licensing database to verify credentials of treatment providers

County Mental Health Boards

Every Ohio county has a local Alcohol, Drug Addiction, and Mental Health (ADAMH) board that funds and coordinates mental health services. These boards can connect residents with affordable or free treatment options including:

• Individual therapy with hoarding-experienced clinicians
• Psychiatric evaluation and medication management
• Crisis intervention services
• Case management for individuals with complex needs

Hoarding Task Forces in Ohio

Several Ohio communities have established multi-agency hoarding task forces that coordinate mental health, public health, code enforcement, and social services:

• Franklin County (Columbus): Franklin County Hoarding Task Force
• Cuyahoga County (Cleveland): Cuyahoga County Hoarding Connection
• Hamilton County (Cincinnati): Hamilton County Hoarding Task Force
• Summit County (Akron): Summit County Hoarding Coalition
• Montgomery County (Dayton): Montgomery County Hoarding Intervention Team

These task forces take a collaborative approach, recognizing that hoarding is a mental health condition that requires support rather than punishment. They often provide the bridge between enforcement actions and therapeutic intervention.

For a detailed list of therapists in Ohio who specialize in hoarding disorder treatment, visit our Ohio therapists resource page.

Reducing Stigma Around Hoarding

One of the greatest barriers to treatment is stigma. Despite its recognition as a mental illness, hoarding is still widely misunderstood by the general public. Television programs that sensationalize hoarding conditions for entertainment have contributed to misconceptions that hoarding is a choice or a sign of moral failing.

Common Misconceptions

• Misconception: "People who hoard are just lazy." Reality: Hoarding disorder involves genuine neurological and psychological differences in decision-making and emotional processing
• Misconception: "They just need to clean up." Reality: Cleanup without treating the underlying condition leads to relapse in the majority of cases
• Misconception: "Hoarding only affects older people." Reality: Symptoms typically begin in adolescence, though severity increases with age
• Misconception: "Tough love works." Reality: Forced cleanouts without consent cause psychological trauma and often worsen hoarding behaviors
• Misconception: "Hoarding is the same as being messy." Reality: Hoarding involves persistent emotional distress about discarding items and clinically significant functional impairment

How to Support Someone with Hoarding Disorder

• Approach the person with empathy and without judgment
• Educate yourself about hoarding disorder as a mental health condition
• Avoid discarding items without the person's knowledge or consent
• Encourage professional help without issuing ultimatums
• Set boundaries that protect your own well-being while remaining supportive
• Celebrate small progress rather than focusing on what remains to be done
• Connect with family support resources through NAMI Ohio or local mental health organizations

The Connection Between Understanding and Recovery

Recognizing hoarding as a mental illness is not about applying a label. It is about opening the door to effective, evidence-based treatment. When hoarding is treated as a behavioral problem to be punished or shamed away, outcomes are poor. When it is treated as a medical condition with known causes and established treatments, recovery becomes possible.

In Ohio, the infrastructure for treating hoarding disorder continues to grow. More therapists are receiving specialized training, more communities are establishing hoarding task forces, and more cleanup providers are learning to work compassionately alongside mental health professionals. This integrated approach — treating both the mind and the environment — offers the best path to lasting recovery.

If you or someone you know is struggling with hoarding disorder in Ohio, help is available. Call the Ohio Hoarding Cleanup Directory at (330) 737-7740 for referrals to both cleanup providers and mental health professionals. You can also browse our provider directory, explore our resources page for support organizations, use our hoarding assessment tool to better understand the situation, or contact us for personalized guidance.