Can a hoarder be cured?

Hoarding disorder is a complex condition that is often misunderstood. Hoarders have persistent difficulty discarding possessions, regardless of their actual value. This results in cluttered living spaces and significant distress or impairment in functioning.

Table of Contents

What causes hoarding disorder?

Hoarding disorder is believed to have multiple contributing factors:

Genetics – Hoarding tendency can run in families, suggesting a genetic component.
Trauma – Stressful life events may trigger hoarding in predisposed individuals.
Brain abnormalities – Certain areas of the brain associated with decision-making, attention, and emotional processing appear to function differently in hoarders.

Perfectionism – Hoarders may feel they need to make the “perfect” decision about possessions, so they avoid deciding.
Attachment to possessions – Hoarders form strong emotional attachments to belongings.
Indecisiveness – Hoarders struggle with decision-making around organizing and discarding items.

What are the symptoms of hoarding disorder?

The key symptoms of hoarding disorder include:

Persistent difficulty discarding or parting with possessions, regardless of their actual value.
Excessive accumulation of items that clutter and fill up active living areas.

Inability to control the urge to acquire and save items that are not needed.
Disorganization and inability to manage everyday tasks due to clutter.
Significant distress or impairment in work, social or home life due to hoarding.

Other common symptoms include:

Feeling emotionally attached to belongings.
Perceived need to save items for fear of losing important information.

Indecisiveness around possessions.
Loneliness and social isolation.
Strong urges to acquire and difficulty resisting acquisition of free items.

Denial of the severity of the clutter problem.

How common is hoarding disorder?

Hoarding disorder affects an estimated 2-5% of the population. Some key facts about its prevalence:

Onset is typically in adolescence or young adulthood.

More common in older adults, affecting up to 30% of people age 55-94.
Seen in 2-3 times as many females as males.
Up to 25% of people with obsessive compulsive disorder also have compulsive hoarding.

Hoarding occurs along a spectrum from normal saving tendencies to severe clinical hoarding that impairs functioning. An estimated 2.5 million people in the U.S. have problematic hoarding behaviors that interfere with their everyday lives.

Is there a cure for hoarding disorder?

There is no known “cure” for hoarding disorder in the traditional sense. However, many people with hoarding can and do improve significantly with proper treatment and ongoing management.

Key principles for treating hoarding include:

Cognitive-behavioral therapy (CBT) – The frontline psychological treatment helps challenge beliefs, improve decision-making, and develop skills to declutter and prevent re-accumulation.
Medications – Antidepressants or anti-anxiety medications are sometimes used to relieve associated symptoms, especially when co-occurring OCD or depression is present.
Harm reduction approach – Setting small, achievable goals focused on safety and functioning rather than aesthetics or perfection.

Ongoing support – Hoarding tends to be chronic. Following CBT with support groups, coaching, or maintenance sessions helps sustain progress.

What does treatment for hoarding disorder involve?

CBT is the primary treatment for hoarding. Key components may include:

Psychoeducation – Teaching about hoarding and how CBT can help.

Motivational enhancement – Building motivation and self-efficacy.
Decision-making training – Improving decision-making skills around possessions.
Organizational skills training – Learning personal organization and problem-solving strategies.

Cognitive restructuring – Identifying and reframing thoughts and beliefs about possessions.
Exposure therapy – Gradually confronting feared discarding situations.
Relapse prevention – Maintaining gains long-term.

Treatment is a gradual process of working to clear clutter, while learning skills to manage urges to accumulate and save. There is no instant fix. A specialized therapist familiar with hoarding is recommended.

What are common treatment goals and outcomes?

Goals depend on the individual case, but often focus on:

Improving safety – Removing tripping hazards, allowing safe access through home.

Establishing functional living spaces – Clearing key areas like bedroom, kitchen, bathroom.
Reducing acquisition – Gaining control over urges to acquire unnecessary items.
Improving organization and decision-making skills – Learning to sort, prioritize, and make decisions about possessions.

Processing emotions – Working through grief, loss, trauma, or other emotions attached to belongings.

With CBT, many hoarders improve functioning and are able to:

Significantly reduce clutter in living spaces.

Better manage urges to acquire, accumulate and save unneeded items.
Become more decisive about organizing possessions and discarding excess.
Improve everyday functioning – cooking, sleeping, moving through home.

Resume social activities and relationships.

However, hoarding tends to be chronic. After initial improvement, ongoing support helps sustain long-term gains.

What maintenance strategies help sustain progress?

Maintenance strategies that can help hoarders avoid re-accumulation and loss of progress include:

Support groups – 12-step groups and peer support provide motivation and accountability.
Coaching – Individual or peer coaching offers continued encouragement and skills practice.
Follow-up CBT sessions – Periodic tune-up sessions to prevent relapse.

Clutter image ratings – Photographing spaces and rating clutter can highlight re-accumulation.
Skills practice – Continuing use of organizational skills and decision-making strategies.
Lifestyle changes – Pursuing meaningful life activities and goals beyond possessions.

Relapse prevention plan – Identifying triggers for acquisition and clutter accumulation.

For many, ongoing support and lifestyle change are key to managing hoarding long-term. It is possible to maintain positive gains with proper treatment and consistent hard work.

When is forced clean-out appropriate for hoarding?

Forced clean-outs, where others clear a hoarder’s home without their consent, are controversial. Potential benefits include:

Quick resolution of safety hazards like falling risk and fire danger.
Improved sanitation if hoard included perishable garbage and human/animal waste.
Prevents eviction if hoarding violated lease terms.

However, many downsides exist:

Traumatic violation of privacy leaving the hoarder distrustful.
High risk of re-accumulation without addressing underlying issues.

No skills learning or self-efficacy around organizing and discarding.
Waste removal is costly if no change in hoarding behavior.

Experts recommend forced clean-outs only in cases of imminent health/safety threats, with advance notice and hoarder consent whenever possible. Counseling should follow to address core issues and prevent relapse.

What are signs that a hoarder needs emergency assistance?

Seek emergency hoarding assistance if:

Vital utilities like heat or plumbing are disconnected due to hoarding.
Hoarding prevents access of emergency responders or safe exit in a fire.

The individual is at immediate risk of eviction or homelessness.
The hoard poses an imminent health hazard (blocked toilets, exposed wires, mold).
Children or elderly/disabled residents are at risk due to unsafe living conditions.

Consult local social services, adult protective services, building inspectors, fire department, or hoarding task forces to intervene. They can assess the situation and order clean-out if warranted, as well as connect the resident to appropriate hoarding treatment resources.

How can family members help a hoarding loved one?

Family members can provide essential support to a loved one struggling with hoarding. DO’s and DON’Ts include:

DO	DON’T
Express love, concern and willingness to help	Attempt to clear clutter without permission
Educate yourself about hoarding	Threaten or issue ultimatums
Encourage professional help	Shame or criticize
Celebrate small successes	Touch or remove possessions without asking
Set healthy boundaries	Give up in frustration

The key is providing empathetic support while allowing the hoarder to retain autonomy and move at their own pace. Patience and understanding facilitate the long recovery process.

When is inpatient treatment appropriate for hoarding?

In extreme hoarding cases, inpatient treatment may be warranted, such as when:

Self-care is severely impaired, posing health risks.
Around-the-clock supervision is needed for safety and stabilization.

Severe medical neglect, suicidal ideation, or psychosis is present.
The individual has failed outpatient treatment despite adequate motivation.
Compulsive acquisition is dangerous and uncontrollable.

Inpatient hoarding programs provide:

Medical stabilization and supervision in a secure environment.
Intensive CBT, counseling, and skills training around acquiring, saving and organizing.

Access to psychiatry services and medication management.
Prevention of bringing possessions into the facility.
Transition to outpatient treatment and community resources.

However, experts view hospitalization as a last resort, given the expense, temporary nature, and mixed evidence for long-term improvement in hoarding symptoms specifically.

Can children or teenagers be hoarders?

Hoarding disorder is rare in children and adolescents, but some problematic hoarding behavior can occur. Signs may include:

Excessive accumulation of items like toys, books, clothes beyond what can reasonably be used or enjoyed.

Strong emotional attachment to possessions.
Distress when asked to clean room or organize belongings.
Preoccupation with collecting specific items.

Defiance of parent requests to tidy bedroom.

If affecting home cleanliness or child’s functioning, consider:

Counseling to uncover potential underlying issues.

Parent training on setting empathetic limits around clutter.
Organizational skills training and cognitive strategies to decide what to keep.
Encouraging positive hobbies and interests beyond collecting/saving.

Early intervention can help a child adopt healthier habits and prevent significant hoarding behaviors from developing.

Can you be forcibly evicted due to hoarding?

In certain cases, severe hoarding can legally justify eviction from rental housing. Common hoarding-related causes include:

Lease violations – Hoarding causes cleanliness, sanitation, or structural property damage issues.

Hazardous living conditions – Hoarding creates safety risks like blocked exits, fire hazards, or pest infestations.
Disturbing neighbors – Extreme clutter visible outside unit disturbing others’ right to “quiet enjoyment.”
Refusing entry – Preventing landlord legally required access for repairs and inspections.

Most areas require the landlord provide written notice to vacate and a window to remedy any hoarding-related lease violations before formally evicting. Thus, hoarders at eviction risk should immediately seek help addressing safety issues and reducing clutter. Tenants facing eviction due to hoarding may also qualify for assistance from social services or disability/housing advocates to prevent homelessness.

Conclusion

Hoarding is a challenging condition, but remission and lasting improvement are possible. The most effective treatment approach uses cognitive-behavioral therapy to help hoarders overcome the core emotional and organizational issues, while also addressing safety and functional impairment. Ongoing support helps maintain positive gains. Family members can provide vital assistance through education, encouragement and celebrating small successes. Severe hoarding cases may require emergency clean-out or inpatient stabilization, but these should be last resorts. Hoarding requires patience and compassion from loved ones, treatment providers and the broader community, but the hardship can be overcome.