A Look Into OCD Related Hoarding

What is OCD related hoarding?

Compulsions are repetitive or ritualistic behaviours the individual feels driven to carry out, even if they are aware their actions are not based in logic. Unfortunately, compulsions don’t actually deal with the anxiety and other negative emotions the individual is feeling. Instead, they will cause the anxiety to build and will actually perpetuate the OCD cycle.

There are a wide range of themes which obsessions and compulsions can follow. Even within these themes, symptoms and experiences can vary greatly within each individual. It was once thought that hoarding was an individual obsession, driving hoarding behaviours within someone with OCD. However, we now understand that an individual with OCD can develop a variety of obsessions and compulsions which can lead to hoarding behaviours and the urge to hoard.

So what exactly is hoarding? Well, hoarding refers to accumulating a large number of items and storing them. The individual will find it very difficult to consider throwing out any of these items, even if they are useless or worn out. Someone with OCD related hoarding is likely to feel an extreme level of anxiety at the idea of getting rid of any of their hoarded possessions. They might store their possessions in a very chaotic way, sometimes to the point that it interferes with daily function and makes their home a very uncomfortable place to live. Just like all symptoms of mental illness, hoarding can affect each individual to different degrees.

This article from Beyond OCD explains: “The obsessions and compulsions associated with OCD sometimes result in an individual’s having difficulty discarding and/or acquiring items or possessions.” There are a variety of obsessions and compulsions which can lead to OCD related hoarding, which we’ll investigate further later.

Symptoms and signs of hoarding

There are a wide variety of symptoms and signs that someone with OCD is hoarding. We’ll cover some of the more common signs and symptoms:

• Buying, collecting, and keeping a lot of items to the extreme
• Amassing a large number of possessions which seem useless or worthless, or even unhygienic
• Struggling to store their possessions: there may be a lot of clutter and disorganization around the home
• Items may interrupt daily functioning and use of the home (for example preventing an individual from using a room or items within a room)
• Hoarding behaviours causing distress and anxiety
• Finding it very anxiety-inducing to consider discarding any possessions or ‘clearing out’ the home
• Feeling overwhelmed by the amount of possessions and mess around the home
• Losing important things amongst the clutter
• Feeling very embarrassed about their hoarding behaviour (they might not invite people into the home)
• Hoarding things which are ‘related’ to their other obsessions and compulsions
• Increased compulsions when confronted with the idea of getting rid of any of their items
• Worsening of their other OCD symptoms
• Withdrawing socially
• Reduced overall functioning
• Increased depression and anxiety

What type of things do people hoard?

Someone with OCD related hoarding may hoard literally anything. Often what they hoard might be related to their individual obsessions and compulsions, so will be personal to what is going on in their mind. It’s more common to hoard things which have little value, either monetarily or sentimentally.

Someone without OCD who collects items will collect things which mean a great deal to them emotionally or which are valuable, and display them proudly. In comparison, people with OCD related hoarding, hoard things which are useless or worthless, and tend to be very ashamed of their hoarding behaviours.

Some examples of items someone might hoard are included below:

• Letters and other items which come through the post
• Magazines and newspapers
• Clothing
• Empty cans or food wrappers
• Old food
• Broken items
• Old possessions from their childhood
• Containers (such as tubberware and boxes)
• Plastic bags
• Household supplies
• Books
• Toys and school reports from their childhood

How does OCD related hoarding affect an individual’s life?

OCD in any form can be very debilitating to live with. Obsessions and compulsions can take up many hours of the day, interfering with daily functioning and making it difficult to keep up with life commitments and relationships. High anxiety can overtake every aspect of your life. It can be hard to sleep, hard to find moments of happiness, and can understandably lead to depression.

OCD related hoarding additionally brings its own set of challenges. Hoarding can lead to embarrassment and shame, impacting confidence levels and sense of self. This embarrassment can lead to social withdrawal as we mentioned earlier, which can cause isolation and loneliness. Hoarding behaviours are likely to be difficult to understand for loved ones, which can cause tense family relationships.

Some individuals may be so embarrassed that they refuse to allow anyone into their home, including tradespeople to make repairs or maintain their utilities. This can leave them without appropriate heating, water supply, and other essentials. Not only does this reduce their quality of life further, it can also lead to other health problems.

The hoarding itself can cause many issues, including many problems with the living environment. If the individual is unable to clean certain areas of their home, this can have a big impact on quality of life. For example, some people may fill their bedroom so full of hoarded possessions that they need to sleep on the sofa. Alternatively, some people may have so much clutter in their kitchen that they are unable to cook for themselves. It’s easy to see how this type of occurance can lead to potential health issues.

Hoarding can also lead to problems with hygiene in the home. It’s likely that clutter will prevent the individual from cleaning their entire home, and they may be very distressed at the thought of even moving items to clean: this can lead to a buildup of dust and dirt. If they are unable to access their bathroom to wash themselves, get to their sink to clean dishes, or use their washing machine to wash clothes, more hygiene issues come into play.

Depending on their specific hoarding behaviours, some individuals may hoard things which are unhygienic, such as old food containers, the food itself, or even rubbish. This can rot, causing a smell and an unhygienic living situation, along with potentially attracting flies and rats. This can easily lead to a range of health problems.

For some people, particularly those who are older or have mobility issues, the clutter in their home can cause tripping hazards. This puts them at risk for injuring themselves. The clutter can also increase the risk of fire spreading and other issues within the home. The International OCD Foundation states: “Severe clutter threatens the health and safety of those living in or near the home, causing health problems, structural damage, fire, and even death.”

Depending on where the individual lives and whether they own their home or rent, they may face housing issues if their hoarding is severe. For example, if their landlord is unhappy with how they are keeping the home, they may be evicted. If there’s damage to the home, they could be taken to court. Social services may get involved if an individual is living in a dangerous living environment. All of these situations can be highly stressful, frightening, and frankly devastating for the individual and their loved ones.

OCD related hoarding vs hoarding disorder

While someone with hoarding disorder often experiences excitement and happiness when they acquire new items to their collection, someone with OCD related hoarding does not experience any positive emotions in relation to their hoarding. In fact, someone with OCD will find their hoarding very distressing.

Someone with hoarding disorder will feel that their items are useful or have sentimental value, even if they seem like rubbish from an outside perspective. They will form an emotional attachment to their hoarded items. In contrast, someone with OCD related hoarding does not have an emotional attachment to their hoarded items and does not feel that they are useful. This article from Beyond OCD explains that someone with OCD, “shows no interest in most of the saved items – they have no sentimental or intrinsic value.”

An individual with OCD related hoarding behaviours is driven to hoard as a result of intrusive, distressing obsessions. They’re doing so because they feel it will help to ‘prevent’ something bad happening or because they feel forced to as a result of their obsessions. They are trying to lessen their anxiety and cope with their OCD. Whereas, someone with hoarding disorder is not driven by a need to deal with intrusive thoughts. This article on the topic explains that there is no ritualistic component for someone with hoarding disorder. The article goes on to state that for someone with hoarding disorder, “it’s not an active attempt to neutralize unwanted thoughts, images, or impulses.”

An individual who displays hoarding behaviours should be properly assessed by a mental health professional: they will be able to tell the difference between hoarding disorder and OCD related hoarding. The charity OCD UK explains that according to the DSM, hoarding disorder should only be diagnosed if, “the hoarding is not better explained by the symptoms of another mental disorder (e.g., obsessions in obsessive-compulsive disorder).” It’s important to note that it is possible for an individual to have both hoarding disorder and OCD related hoarding.

What causes OCD related hoarding?

Fear of something bad happening

OCD centers around many fears, one of the primary fears being that something bad is going to happen if you don’t carry out compulsions. Some people are terrified that something terrible is going to happen to themselves or to their family if they don’t carry out hoarding behaviour. They might fear that if they discard something, something awful will happen as a result. Some people may fear that they are going to act on other obsessions, such as harm or sexual obsessions, if they don’t act on hoarding related compulsions.

Feeling incomplete when something is thrown away

It’s common for someone with OCD to feel as though themselves as a person, or their lives or home, are incomplete if they throw something away that they have hoarded. They might fear this feeling of incompleteness. They may worry that it is going to worsen their anxiety and other OCD symptoms. This article explains that this fear of incompleteness can lead to an individual feeling that they need to, “document and preserve all of their life experiences (e.g., keeping all of the toys they owned as a child).”

Fear of making the wrong decision

Self doubt is a very common feeling for someone with OCD. Doubt is what drives many compulsions, for example checking compulsions. In this example, we’ll use an individual checking that they’ve locked the door compulsively. The individual doesn’t trust their own mind and memory that they have locked the door, so they need to go back and check it again to ensure it has been done.

Many people with OCD don’t trust their own senses and their own mind. They lack confidence and self-assurance, and often over time lose their sense of self. This can easily translate into someone with OCD fearing making the wrong choice. They doubt their own abilities to make the right or ‘safe’ decision. Their obsessions and an exaggerated sense of responsibility can also make them very fearful that something awful will happen if they do make a wrong choice.

This fear can lead to an individual refusing to throw anything away, because they’re worried they’ll need it later or that they will have made a mistake. They have intense fear of what will happen if they do throw away something that is later needed. In their fear, even if they know it isn’t logical, they will hoard items to avoid having to make that choice and potentially getting it wrong.

Fear of the unknown

Just as someone with OCD typically suffers with self-doubt, they also fear the unknown. Not knowing what is going to happen leaves a lot of room for anxiety when you live with OCD. Uncertainty can exacerbate compulsions and increase fear of something bad happening. In the mind of someone with OCD, not knowing what is going to happen or having definite answers means that you can’t prepare. You can’t ensure that everything is safe and sticks to the rules that your OCD has set out.

This fear of the unknown can lead those with OCD to avoid throwing things away, in case they might need them in for an unknown situation at a later date. Even if the items they hoard are very unlikely to be useful in any situation, they will still feel this urge to keep them ‘just in case’.

Obsessions and compulsions which can lead to hoarding

Contamination

Contamination obsessions focus around fears of the individual or their loved ones becoming contaminated. This may involve a fear of dirt, germs, bodily fluids, illness, or other contaminants. Someone who struggles with these obsessions might display hoarding behaviour for a number of reasons.

One example is an individual displaying hoarding behaviour because they want to buy many cleaning or washing supplies to carry out cleaning compulsions around the home. It’s common to excessively wash and clean themselves, their belongings, and their environment, often multiple times a day. They may fear that they will run out of cleaning supplies and so will buy in excess to ensure they are always able to clean when they feel that urge.

Alternatively, they might buy everything in a shop that they have touched to prevent others potentially being contaminated by their own germs. Once they bring the objects home, they may set them aside, either because they are not useful to them or because they are now contaminated. If they do this every time they go shopping, they may gradually end up with an excessive amount of possessions.

In some cases, an individual might end up with a lot of items around the home because they don’t want to touch them for fear they are contaminated. This article on the topic explains this example further: “Due to fears that items on the floor are contaminated, for example, an individual may be unable to touch them in order to throw them away. As a result, the floors in one’s home may be covered with items that should be discarded.” The individual might even set aside items contaminated in a draw or specific area of the home where they should not be touched.

Superstitious

Someone with superstitious obsessions might feel that certain things are lucky, such as lucky phrases, numbers, words, and colours. Likewise, they may feel that certain things are unlucky. They will deliberately gravitate towards things which feel lucky and away from those which are perceived to be unlucky. They might feel that lucky things help to prevent something bad happening, whereas unlucky things increase the changes of something terrible occurring.

Someone with these superstitious obsessions might buy, collect, and keep anything which is ‘lucky’. For example, if their lucky colour is purple, they may buy or keep everything they come across which is purple. If they see an item in a shop, in a newspaper, or in a magazine with their lucky word or phrase on it, they may buy it or keep it. Similarly, they might buy items in multiples of their ‘lucky’ number. This means over time they will acquire an excessive number of items and find it very difficult to discard them.

Checking

Checking compulsions involve checking anything physically or visually, for example checking an appliance is turned off multiple times. This checking can go on for minutes or hours at a time and can be debilitating. Someone with checking compulsions might avoid throwing things away, to avoid potential checking compulsions stemming from worry that they have discarded something important. They may avoid organizing items, for fear that this will trigger an onset of checking over and over again what is rubbish and what they want to keep.

Harm

Someone with harm obsessions may fear harming themselves or others, even though this doesn’t reflect their true feelings. They might avoid throwing something away for fear that discarding the item will cause them to act on their obsessions or will lead to harm coming to their loved ones. Likewise they might buy random items to keep their loved ones safe or to prevent themselves from causing harm. Even though this logically doesn’t ‘make sense’ or seem related to the obsession, there will be a strong correlation in the individual’s mind.

Someone with harm obsessions may display reassurance seeking compulsions, meaning they actively seek ‘evidence’ that they wouldn’t harm someone. In this case, they may keep items which they feel provide this evidence, such as old photos which show them being happy or being around family, or school reports which mention good behaviour.

Religious

Religious obsessions focus on fears and concerns about not being religious or devout enough. The individual may fear punishment from a religious figure or think they’re going to hell if they are not sticking exactly to strict religious morals their OCD has set out for them. Someone with these obsessions may fear throwing anything related to their religion or moral beliefs away, even if it’s old or no longer useful. They may also be drawn to collect or keep large amounts of religious texts or religious items to prove that they are ‘good enough’ to God.

Losing control

Losing control is a common obsession in OCD. This may involve fears around losing control and acting on another obsession, or losing control and doing or saying something they will later regret. It’s easy to see how this obsession could drive the urge not to throw anything away, in case it’s something they might regret in retrospect. Accumulating items can also give a sense of control, as the individual is solely in charge of what they buy and what remains in their home.

Repeating

Repeating compulsions involve the individual needing to repetitively carry out an action until it ‘feels right’ or until they have repeated the action a specific number of times. Someone with repeating compulsions may feel that they need to repeatedly buy a specific item until the amount they have in their home ‘feels right’. They might feel they shouldn’t throw items away until it ‘feels right’, or because discarding them ‘feels wrong’. They may keep items because their compulsions involve repeatedly moving and rearranging the items each day.

What can I do if I have OCD related hoarding?

Understand you do not need to be ashamed

The first thing to know is that you don’t need to be ashamed. While OCD and any hoarding behaviour can be incredibly shame filled, it’s vital you know that you are not alone. These behaviours are caused by your mental illness, which is completely valid, and not by you.

Do some research

If you think you’re struggling with the symptoms we’ve discussed, a great place to start is doing some research. Learning about what is causing your symptoms and how you might be able to deal with them allows you to come from a place of knowledge and power. It also helps you to feel less isolated and to figure out how to start seeking treatment.

Monitor your symptoms

Keeping track of your symptoms is always a great way to get started. You should note them down each day, including how severe they are; how they affect you; if they change in reaction to anything; and anything else you notice which might be important. This allows you (and your doctor or mental health specialist) to see patterns in your symptoms and to get a deeper insight into how your disorder is affecting you.

Seek treatment

The next, very vital step is to seek treatment. It can be really scary to reach out for help, but it’s so important that you do because that’s how things can start to get better. You can find treatment by talking to your doctor and being referred to a mental health professional, or by talking to your mental health team if you are already under their care. Alternatively, you can choose to seek treatment privately, or use online OCD treatment. We’ll discuss types of treatments later on.

Find support

Aside from professional treatment, it’s also really important that you have personal support. Reach out to loved ones and allow them to be there for you. You don’t have to do this alone. Support from others who are going through similar struggles can also be incredibly helpful. You could find a local support group or find other people with similar experiences online.

Practice self-care

Self-care refers to anything you do to take care of your physical and mental health. Sometimes when you’re going through a really difficult time with your mental health, self-care can be the last thing on your mind. However, it really can make a big difference. Try to keep a regular sleep schedule; keep up with personal hygiene; make time for some exercise; eat regular meals; and make time to relax.

How can I help a loved one with OCD related hoarding?

Understand they may not initially accept your help

It’s important to first realise that your loved one may not want or accept your help at first. The idea of accepting help and knowing that this will mean parting with their hoarded items will be absolutely terrifying for them. You can’t force them to accept help until they are ready to do so. While this can be hard to understand, it’s vital to realise that maintaining a good relationship with them despite their hoarding is going to be more productive in helping them than trying to push them when they aren’t ready.

Know that forcing ‘clearing out’ upon them will not help

Another vital thing to realise is that forcing them to clear out their home will not help them, even if you have good intentions. In fact, this can make things much worse. Clearing out an individual’s home without them actively being in professional treatment can actually send them backwards in regards to progress. It can make them more reliant on their hoarding behaviour and more afraid to try to change things.

Likewise, cleaning their home without their consent can be devastating. The International OCD Foundation explains that, “Hoarders whose homes are cleared without their consent often experience extreme distress and may become further attached to their possessions.” They also explain that the problem will resurface and clutter will be built back up, so this isn’t a sustainable solution. Also, the trust within the relationship will be broken and it’s likely they will no longer be open to your help. It may even lead to them shutting themselves off to any type of help from others.

Be there to listen

So if you can’t encourage them to clean up their environment or get help, what can you do to help your loved one? One of the simplest and most effective ways you can be there for someone with hoarding behaviours, is to simply be there for them. Be there to listen when they need to talk and build up a solid relationship based on trust. This means they are likely to come to you when they are ready to get help.

Offer alternative practical help

You can offer practical help which isn’t going to push them about their hoarding behaviours. For example, if you notice there is clutter in their kitchen, you could offer to drop round a nice home cooked meal. If they’re struggling with cleaning, you could offer to help them clean their home around their hoarded items, without moving them. If you notice they aren’t able to access their bedroom due to the clutter, you could offer to set up a bedroom in a more clear room so they have a safe place to sleep, and so on. Respect their boundaries if they say ‘no thank you’ to any of your ideas.

Be there when they’re ready to accept help

If you’ve built trust between you, it’s far more likely that they will come to you when they need help. Be there when they’re ready to accept help. If they seem to be asking for help or seem more open to the idea, you could ask them if there’s anything you can do for them. You could offer to help them find treatment or to go with them to appointments for moral support.

Get involved in treatment

If your loved one is comfortable with it, you might be able to get involved in treatment. This can allow you to understand their disorder further and learn how to help them. You might be able to help with ‘homework’ between sessions. You might even learn how you can better communicate with your loved one and be there for them more effectively going forward.

Treatment for OCD related hoarding

Medication

In some cases, your doctor might prescribe medication to help ease your symptoms. This tends to be antidepressants known as Selective Serotonin Reuptake Inhibitors (SSRIs), which are thought to help correct the chemical imbalance within the brain.

While medication on it’s own isn’t going to take away your OCD, it can lessen your anxiety and make engaging in psychological treatments more effective. This can be particularly useful for someone with hoarding behaviours who is working on clearing out their home.

Cognitive behavioural therapy (CBT)

CBT is the primary recommended treatment for OCD. CBT can help to break the cycle of OCD by teaching you better coping strategies. You’ll learn to replace negative thoughts and behaviours, with more positive and productive ones.

CBT has been found to be the most effective treatment for those with hoarding symptoms. During therapy you will be given practical tasks and encouraged by your therapist, to help you tackle your hoarding behaviours. OCD UK states that: “The goal is to improve the person’s decision-making and organisational skills, help them overcome urges to save, and ultimately clear the clutter, room by room.”

This, of course, will feel really scary at first, but it’s done in a gradual way with lots of encouragement. As you see that nothing terrible happened when you discarded things, your anxiety will lessen and the cycle is gradually broken over time. The therapy will also teach you how to cope with your symptoms going forward, so that you can regain your quality of life.

Mindfulness

Mindfulness techniques are all about reaching a state of relaxation, actively reducing stress and anxiety. This can be very useful for someone with OCD. These techniques might involve meditation, visualization, breathing exercises, or mindful movement. Mindfulness allows you to be present in the moment and keep you grounded.

The ability of these techniques to reduce anxiety and help an individual regain emotional control can be extremely useful when combined with CBT to tackle hoarding. It can make the experience of therapy less stressful and aid you in moving forward. Once you’ve learnt the skills of mindfulness, you can use them in the future to help you stay in control.

References

Beyond OCD, (2019), “OCD Symptoms: OCD-Related Hoarding”.

International OCD Foundation, (2009), “Hoarding Fact Sheet”.

OCD UK, (2020), “Hoarding Disorder”.