Hoarding OCD: Symptoms, Causes, and Treatment

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Written by:Jill E. Daino, LCSW-R

Published On: July 17, 2023

Medically reviewed by: Bisma Anwar, MA, MSc, LMHC

Reviewed On: July 28, 2022

Updated On: July 17, 2023

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Overview

Hoarding OCD happens when individuals feel compelled to acquire and/or save items that generally have little to no value to others. Unlike collectors, hoarders tend to overdo it, and they rarely display their items or take any sense of pride in them. The sheer mass of possessions over time can make a home virtually unlivable, and sometimes even unsafe.

There’s some confusion over the difference between hoarding disorder (HD) and hoarding OCD. It’s important to understand that these two conditions are distinct from one another. People living with HD think there’s value in the things they collect (hoard). OCD hoarding, like other forms of obsessive compulsive disorder (OCD), is a response (most times unwanted) to obsessive thoughts and anxiety. The action of hoarding is an attempt to quell or stop their obsessive thoughts.

People with hoarding OCD feel extreme anxiety at the thought of getting rid of their possessions. They may even believe that things are contaminated and would harm others if they were cleaned up or donated.

The good news is that there’s help available for people living with hoarding OCD. While the cause of OCD hoarding is unknown, there are several effective therapies that can help people with this disorder live enjoyable and productive lives.

Read on to learn more about what hoarding OCD is, what can cause it, its symptoms, and the OCD treatment options that are effective for this common subset of obsessive compulsive disorder.

What is Hoarding OCD?

Hoarding obsessive compulsive disorder is a type of OCD, where people have strong emotional responses to acquiring and keeping possessions. The urge to collect things is generally coupled with intensely negative feelings about discarding anything they hoard.

It’s not uncommon for hoarding OCD to occur after the death of a family member or close friend, when someone feels that throwing away an item that belonged to the deceased would dishonor their memory.

How Are OCD & Hoarding Related?

OCD and hoarding can be closely related. While a person can have one disorder without the other, they’re often found in tandem.

Can OCD cause hoarding?

Hoarding is generally believed to be one type of OCD. Not all people with OCD exhibit signs of hoarding, but many people who hoard also have strong obsessive and compulsive thoughts about acquiring, storing, and discarding possessions.

Symptoms of Hoarding OCD

Some OCD hoarding symptoms are similar to those of non-OCD hoarding. This can include the afflicted person increasingly isolating themselves and rarely inviting anyone over to their house. They may even fail to answer the door if someone visits unannounced. Inside the person’s home, there may be entire rooms that are unusable due to the number of possessions piled in them. Sometimes these piles reach the ceiling.

Distinct to OCD hoarding are intense feelings of anxiety that can be associated with discarding items, along with a compulsive need to acquire more things someone likely has little need for. OCD hoarding might result in a belief that something bad will happen if items are discarded.

Obsessions

Obsessions related to OCD and hoarding can manifest in a number of ways. For example, someone may obsess over whether they’ll one day need an inconsequential item, like a receipt for lunch at a diner, so they may begin keeping all receipts.

They also may strongly feel that they have to go out and buy things they truly don’t need, like something at an auction or a flea market. Another common obsession typical with hoarding OCD is feeling that items are contaminated, and that donating them would put others in harm’s way. Other examples of hoarding OCD obsessions can include:

Believing everything you touch at a store is contaminated so you have the urge to buy everything so no one else becomes cross contaminated
Thinking that getting rid of an old birthday card might result in something bad happening
Understanding that you don’t need all the glassware you have, but worrying that if you throw them away, they’ll break and someone will be hurt
Refusing to donate clothes because you’re worried you’ll contaminate someone else
Having a lucky or favorite number and thinking you need to purchase that number of items

Compulsions

Compulsions associated with OCD hoarding include things like insisting on buying items in pairs or in sets or keeping things that most people would consider trash. Other examples of OCD hoarding compulsions can include:

Buying items in a significant number
Keeping papers you don’t need out of fear you might need them in the future
Storing surplus of materials because you worry you might run out of them
Keeping various possessions because you’re afraid you might need them in the future
Refusing to throw away trash because you believe it will contaminate someone
Believing you might contaminate a store or person if you return items, so you keep things you don’t want or need

“The symptoms of hoarding OCD can be overwhelming. It’s important to know that there’s treatment available and you do not have to suffer alone. Licensed mental health professionals can help with hoarding OCD and provide support for these challenging symptoms along with the underlying anxiety.”

Licensed Clinical Social Worker (LCSW-R), BC-TMH Jill Daino

What Causes Hoarding OCD?

It isn’t yet fully understood what causes OCD hoarding, but experts do recognize that the disorder can be exacerbated by stress, loneliness, or the death of a loved one. There also seems to be a hereditary element to hoarding.

Genetics

Up to 85% of people with OCD hoarding have at least one family member with the disorder.

Brain function

Some experts believe that this disorder might be a result of brain dysfunction, where serotonin and other “feel good” hormones are released by the activities of gathering and storing possessions. This is supported by multiple studies and the fact that many cases of hoarding begin after a brain injury, surgery, or stroke.

Environmental factors

Other factors that likely contribute to OCD hoarding are heredity, having grown up in poverty, and stressful life events.

“Working with a licensed mental health professional can help you understand your thoughts and behaviors while at the same time work to decrease the symptoms. It may seem overwhelming at first, but over time, you can learn to decrease your hoarding OCD symptom and manage intrusive thoughts and anxiety.”

Licensed Clinical Social Worker (LCSW-R), BC-TMH Jill Daino

Treatment for Hoarding OCD

There are a number of OCD therapies that can reduce the anxiety and depression associated with hoarding and help people learn to live a more satisfying life. Some common, effective OCD treatments can include:

CBT therapy. Cognitive behavioral therapy (CBT) is a therapy for OCD that’s been used to help people manage OCD symptoms for decades. This type of online therapy strives to help you understand why you hoard and gain skills for organizing and making smart decisions about your possessions. There’s also time for practicing sorting and discarding possessions. CBT has been shown in research to be effective in treating compulsive hoarding symptoms in children and adolescents with OCD.
ERP therapy. Exposure and response therapy (ERP therapy) is based on the idea that exposing you to obsessive thoughts can help you overcome them. The focus is on not giving in to corresponding compulsive hoarding actions. Thus, you’ll learn a new way to respond to obsessive hoarding thoughts without filling your living spaces with possessions. ERP therapy has been found to be 80% effective in curbing and/or eliminating compulsive behaviors.
Medication. There are several OCD medications that can help ease the anxiety and depression that’s often associated with hoarding OCD. However, medication alone is not likely to be very effective. Instead, medication is best used in conjunction with other therapies and in situations where failing to someone would likely make their hoarding situation worse. Common medications used to treat hoarding OCD might include:
- - Selective serotonin reuptake inhibitors (SSRIs): Antidepressant and first line of treatment, but may not work for everyone.
  - Tricyclic antidepressants (TCAs): Originally intended to treat depression, TCAs might be effective when SSRIs haven’t been. However, TCAs often have more side effects, which is part of the reason why they’re not typically used at first.
  - Benzodiazepines: Benzos, as they’re often referred to, work to relieve anxiety. Due to a higher potential for addiction and intense withdrawal symptoms, they’re generally not used long-term, but they might be an option in addition to an SSRI while you’re waiting for the antidepressant to become effective.
OCD hoarding symptoms don’t have to overtake your life. It’s important to know that help is available. Learning more about therapies for OCD hoarding is the first step you can take to manage and live with the condition you’re facing.

Talkspace offers online therapy that can help you learn to manage and navigate OCD hoarding so you can get back to life. You don’t have to live with the anxiety and stress you feel as a result of hoarding tendencies related to your OCD. Learn more about Talkspace online therapy today.

See References

Matthews C. Hoarding Disorder: More than just a problem of too much stuff.
2014 Aug; 75(8): 893–894. doi: 10.4088/JCP.14ac09325. Accessed June 1st, 2022.
Tolin D, Stevens M, Villavicencio A et al. Neural Mechanisms of Decision Making in Hoarding Disorder. Arch Gen Psychiatry.
2012;69(8):832. doi:10.1001/archgenpsychiatry.2011.1980. Accessed April 22, 2022.
Rozenman M, McGuire J, Wu M et al. Hoarding Symptoms in Children and Adolescents With Obsessive-Compulsive Disorder: Clinical Features and Response to Cognitive-Behavioral Therapy.
Journal of the American Academy of Child & Adolescent Psychiatry. 2019;58(8):799-805. doi:10.1016/j.jaac.2019.01.017. Accessed April 22, 2022.
Foa E. Cognitive behavioral therapy of obsessive-compulsive disorder.
Dialogues Clin Neurosci. 2010;12(2):199-207. doi:10.31887/dcns.2010.12.2/efoa. Accessed April 22, 2022.

Jill E. Daino, LCSW-R

Jill E. Daino, LCSW-R, BC-TMH, is a clinical social worker with over 25 years of experience as a therapist, clinical supervisor, and program director. She works to support quality clinical care at Talkspace. Her work as a clinician and trainer focuses on the mental health impact of body image concerns and eating disorders across the lifespan.