When to Help a Hoarder

Reviewed by Arefa Cassoobhoy, MD, MPH on February 04, 2020


Maybe your aunt’s home is so overrun with magazines, canned goods, and random clothing, there’s no place to sit down. Or, the elderly neighbor’s every window is blocked by stacks of cardboard boxes filled with newspapers, making you fear not only for his safety but your own should a fire ever break out.

When does a messy house become a sign of mental illness? And, at what point should you stage an intervention?

According to Elaine Birchall, MSW, RSW, author of Conquer the Clutter: Strategies to Identify, Manage, and Overcome Hoarding, three criteria must be present to be defined as hoarding disorder (HD):

  • Excessive accumulation and failure to discard proportionately things
  • Impaired daily living because household spaces and appliances (stoves, staircases, bathtubs, etc.) cannot be used for normal activities due to clutter
  • Distress, difficulty, and even danger while trying to function in and around these spaces

Notably, the person who hoards shares a similar level of risk with anyone who lives in close proximity to him or her, Birchall says. A fire risk, after all, doesn’t disappear at the property line -- your house or apartment is in danger, too.


In addition, “Even if a person who hoards insists the way they live is just fine,” if a neighbor, fire department, other residents of a multiunit dwelling, or mortgage company would become alarmed if they understood the true condition of the property, the hoarder has a problem -- and needs help.

According to the International OCD Foundation, about 75% of people with hoarding disorder at the same time have a mental health condition, with 20% living with obsessive-compulsive disorder.

Birchall adds, “When people live through extreme deprivation, some go on to hoard adaptively as a reaction to their stressful experiences. This can be a healthy form of procuring an extra supply -- if they use whatever they accumulate by a normal expiry date. But maladaptive hoarding, or compulsive hoarding, is the same behavior with a state of denial. They procure more and more with the belief they’re somehow protected against a downturn, unemployment, or prices going up. It’s to create an emotional safety zone.”


Yet hoarding is the opposite of a safe behavior, Birchall warns. In addition to increased risk from injury and the concern of fire, she says hoarding attracts vermin, whose droppings can cause respiratory illness.

Know someone with hoarding disorder who needs help? Call for a professional assessment by a hoarding specialist, Birchall advises. Assessments explore the personal history, home environment, plus the emotional and physical safety of a hoarder to create a plan, often involving cognitive behavioral therapy. The International OCD Foundation website can help you locate therapists, clinics, treatment programs, and more in your area.


By the Numbers

At least 154 million worldwide
Health experts estimate that 2% to 6% of the world’s population has a hoarding disorder.

Percentage of people with both OCD and HD who have a first-degree relative (parent, child, or sibling) who also hoards.

3X more common
HD occurs three times more often in older adults (ages 55 to 94) compared to younger adults (ages 34 to 44 years).


Ages 11 to 15
These are the years when hoarding symptoms often first appear. If left untreated, HD can increase in severity with each passing decade.

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Birchall, E. and Cronkwright, S. Conquer the Clutter: Strategies to Identify, Manage, and Overcome Hoarding, JHU Press, 2019.

Elaine Birchall, MSW, RSW.

International OCD Foundation: "Who Gets Hoarding Disorder?"

World-o-Meters: "Current World Population."

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