The silent struggle with hoarding

Hoarding is recognised as a distinct psychological condition, often linked to neuropsychiatric disorders and is part of the obsessive-compulsive and related disorders spectrum, writes Fiona Vaz.

Kishore (name changed) lives in a cramped house with his family in Bengaluru. As Diwali approaches, the family begins its annual tradition of cleaning, dusting, and discarding unwanted items. But when Kishore returns from the market and notices the bags of discarded possessions outside, he’s enraged. He storms in, demanding to know why his belongings have been thrown out. The ensuing argument isn’t just about the discarded items — it’s a clash of emotions, memories, and the boundaries of shared space.

A mental struggle

Hoarding is more than a habit; it is a complex mental health condition. It is often misunderstood as simple cluttering but can be linked to neuropsychiatric disorders, such as obsessive-compulsive disorder (OCD), ADHD, dementia, and schizophrenia. Hoarding develops slowly over time and can impact a person’s emotional well-being.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), hoarding is categorised as a disorder, falling under the umbrella of obsessive-compulsive and related disorders. The condition causes distress in social and occupational settings, and though interventions by family or professionals can help, each case is unique.

Dr Shilpi Sarawat, a clinical psychologist at Sakra World Hospital, explains, “Hoarding is when someone collects unnecessary objects, believing they will have future use. It’s rooted in obsessive-compulsive tendencies and often leads to intrusive, obsessive thoughts.” She adds, “This behaviour severely affects personal relationships, both within the family and socially.”

The symptoms

Hoarding can be identified through clinical evaluations using the DSM-5 criteria. Key symptoms include a strong attachment to possessions, difficulty discarding them, and discomfort when letting go. A cluttered living environment and frequent conflicts with family members are also common signs. Mental health professionals use tools like the Hoarding Rating Scale (see box) to assess the severity of the disorder.

Buried under emotional weight

For those struggling with hoarding, the physical clutter is often a manifestation of emotional turmoil. Anxiety, depression, and shame are common emotions that arise from the inability to part with possessions. The cluttered environment can become a breeding ground for mould, dust, and pests, creating health hazards such as respiratory problems and falls. Vijay (name changed), 54, suffers from insomnia, hypertension, and chronic pain due to his inability to discard items.

The social stigma surrounding hoarding contributes to feelings of shame and isolation. Dr Shilpi further explains, “Hoarders experience intense anxiety when asked to part with their items. This distress is often rooted in a neurotransmitter imbalance in the brain, exacerbating the hoarding behaviour.”

The neurobiological connection

Research indicates that hoarding is not just a psychological condition but also involves neurobiological and genetic factors. Studies show that the anterior cingulate cortex, a part of the brain associated with decision-making and emotional regulation, may function abnormally in those with hoarding tendencies.

Genetic factors also appear to play a role. While specific genes linked to hoarding haven’t been identified, studies suggest that families with severe OCD cases may share common genetic markers. However, much more research is needed to fully understand the genetic influences on hoarding and OCD.

Why do people hoard?

For some, hoarding may stem from a need for emotional security or an attempt to preserve memories. Raj (name changed), 25, shares, “I keep items like old clothes and restaurant boxes because they remind me of good times and might be useful later.” While his peers criticise the crowded state of his room, Raj feels an emotional attachment to his possessions, reluctant to let go.

Declutter for healing

While hoarding can feel insurmountable, recovery is possible. Decluttering is not merely about minimising possessions — it’s about regaining control over one’s life and addressing the underlying emotional struggles. Experts suggest that therapy plays a crucial role in treating hoarding disorder. Through therapy, individuals often confront guilt, shame, past trauma, and feelings of depression. However, societal stigma can prevent many from seeking the help they need, leading to isolation.

Cognitive Behavioural Therapy (CBT) is frequently recommended as a method to challenge the obsessive thoughts tied to hoarding and develop healthier coping mechanisms. According to Sana M Joseph, a counselling psychologist, “CBT helps individuals reframe their beliefs about hoarded items and replace unhealthy behaviours with new, functional ones.”

Trauma-informed therapies such as Eye Movement Desensitisation and Reprocessing (EMDR) and Trauma-Focused CBT (TF-CBT) are also effective in treating hoarding.

For long-term well-being

Hoarding is not simply about collecting objects; it’s about addressing deep-seated emotional issues. By tackling the root cause of hoarding behaviour, individuals can break free from the weight of excessive possessions. Therapy, mindfulness, and support groups can help prevent hoarding from becoming a lifelong struggle.

Experts recommend small, consistent steps such as evaluating emotional attachments to possessions, setting decluttering goals, seeking professional support, and focusing on quality over quantity. Addressing underlying mental health conditions, like anxiety or trauma, is also essential in preventing hoarding behaviour. Sana adds, “Support groups can offer crucial encouragement and practical advice, helping individuals navigate their hoarding struggles while providing a sense of community.” While the journey towards healing is challenging, it can ultimately lead to a lighter, freer, and more controlled life.

Small steps of prevention

• Assess emotional attachment to possessions.
• Maintain consistency in decluttering.
• Seek professional support when needed.
• Adopt a minimalist mentality.
• Address underlying mental health conditions like anxiety and trauma.

What’s the Hoarding Rating Scale?

The Hoarding Rating Scale (HRS) is a semi-structured questionnaire that assesses hoarding severity by asking about clutter, difficulty in discarding items, excessive collections, and the distress caused by hoarding. A score above 14 typically indicates the presence of hoarding disorder.