OCD and Hoarding: How Are They Related?

Compulsive hoarding used to be considered a type of OCD.

Some have estimated that up to 1 in 4 with OCD also struggle with compulsive hoarding. And up to 1 in 5 compulsive hoarders have non-hoarding OCD symptoms.

Like many other comorbidities (such as OCD and depression, or OCD and BDD), there is a distinct overlap between the two disorders.

You can be diagnosed with hoarding disorder without an OCD diagnosis. A hoarding disorder with an OCD diagnosis is known as hoarding OCD.

Like many OCD subtypes (and mental health disorders in general) hoarding and hoarding OCD are greatly misunderstood. Both hoarding and hoarding OCD are great sources of pain and stress; they are not enjoyable and they do not bring pleasure to one’s life.

It can have a huge impact on quality of life which, to those who do not understand the disorder, can appear as a way of living that the sufferer may even enjoy.

This is simply not true.

Let’s look at OCD and hoarding separately and together to understand the differences between the two.

OCD: A Recap

People with OCD will suffer from obsessions in the form of thoughts, images, feelings, urges, or sensations. Intrusive thoughts will pop into their head, causing an immense amount of stress and discomfort.

These unwanted and intrusive thoughts are disturbing or fearful in nature and conjure tortuous feelings of uncertainty and distress. 

These intrusive thoughts are constant, persistent, and all-consuming and the sufferer will try desperately to alleviate their distress. 

This distress leads to a physical or mental compulsion; a ritualistic behavior aimed at soothing the anxiety and uncertainty brought on by distressing thoughts. 

Anxiety felt around any uncertainty and thoughts of “what if?” brings with it cravings and urges for certainty. 

We do compulsions to try to solve that uncertainty and mitigate any potential consequences of not addressing the obsessions.

In doing this, our brain learns that the physical or mental ritual is needed in order to navigate the uncertainty and anxiety. We learn that we cannot tolerate those feelings without doing compulsive behaviors.

But, the relief this offers is only fleeting and allows OCD to thrive. This is known as the OCD cycle and it acts to perpetuate long-term feelings of distress.

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What is hoarding

Hoarding is characterized by the persistent gathering and saving of an excessive number of objects. The ‘excessive’ part comes into play as the sheer volume is unmanageable, storage is chaotic and the behavior has a detrimental effect on everyday life. 

The items will likely have no monetary value and will create clutter to the point that access to a person’s home is compromised. 

People who experience hoarding feel greatly distressed at the thought of discarding the items they have hoarded.

When is hoarding considered a problem?

Hoarding is considered a problem when:

• It starts to affect someone’s ability to look after themselves or their family. For example, if access to the kitchen or cooker is blocked, individuals with hoarding disorder will stop feeding themselves or their families properly, choosing to work around the clutter by skipping meals or eating out, despite sometimes not having the financial resources to do so.

 

• The idea of parting ways with the clutter brings on significant distress. They can become upset if someone tries to tidy up or remove items and this can have an adverse effect on relationships.

 

• People who struggle with hoarding can also find themselves isolated from friends or family, and be unwilling to have anyone else enter their homes.

 

• In extreme cases of hoarding, an individual’s safety is at risk as fire and tripping hazards are littered about their home. 

Why might someone be hoarding?

Individuals with hoarding disorder might save items because:

• They believe these items will be needed at some point in the future
• They have ‘a great find’ believing the item to be unique and interesting
• The items have significant sentimental value, representing a lost loved one or a previous time in their life that brought great joy
• The things that they save bring reassurance or comfort
• The thought of missing out on the opportunity to benefit from the items is distressing

Often, someone with hoarding OCD has a fear of contamination. Contamination fears are not the only type of obsession in hoarding OCD, but it is very common.

The difference between hoarding and collecting

Collectors will typically take great joy in organizing or filing their collection for admiration. 

The presentation will be neat – think stamps in a scrapbook – and the collection will be carefully considered and follow a theme. Collections can be large but they are not disorderly and their existence does cause a detrimental effect on lives.

Hoarding is impulsive and follows no discernible theme. Presentation, in order to admire, isn’t considered and the clutter can often be a source of embarrassment or shame.

A collector will have the presence of mind to budget money and space for their items, whereas the impulsivity of individuals with hoarding disorder means that their items can cause financial strain or debt.

Signs of hoarding disorder

Here are some key signs to look out for when identifying hoarding disorder:

• An individual’s home, car, or office space is so cluttered that it is difficult to navigate

 

• Storage units are rented to accommodate the sheer volume of possessions

 

• The individual flat-out refuses or has difficulty discarding possessions

 

• Discussing the removal of cluttered items is met with dismissive or aggressive behavior due to anxiety

 

• The individual struggles with the organization and order of their possessions

 

• Showing signs of shame over the amount of clutter in their home

 

• Overly possessive feelings towards their possessions, i.e. an individual won’t allow others to touch their things

 

• Signs of obsessive thoughts and behavior towards items such as looking through trash or showing distress when they believe something has been disposed of.

 

• Feeling overwhelmed at the amount of clutter and feelings of deep shame

 

• In extreme cases, a hoarding disorder will inhibit someone’s ability to work, take pride in their appearance, and have financial stability and it will affect relationships with friends and family.

 

• Wanting to save items for fear of needing them at a later date but then, when the time comes that they need the item they can’t even find it.

Difference between hoarding disorder and hoarding OCD

The best way to differentiate between hoarding OCD and hoarding disorder comes down to the reason why the sufferer is hoarding.

For a long time, hoarding disorder was considered to be a part of OCD. In recent years, hoarding disorder has been given its own diagnosis and what separates the two is mainly down to the reasons for the compulsive behavior.

Individuals with hoarding disorder accumulate items because they perceive them to be valuable, and unique or believe that one day they will have a use for them. 

Distress is experienced when faced with the prospect of throwing possessions away because of this perceived value. 

Whereas hoarding OCD is an unwanted behavior done in response to an obsessive thought.

For those with hoarding OCD, the accumulation and retention of objects are often very stressful as they find themselves ruminating on the potential consequences of what might happen if they were to get rid of said items.

A helpful distinction between hoarding OCD and hoarding disorder is that those with hoarding disorder hang on to items they feel are valuable and feel distressed at the idea of getting rid of them. Whereas hoarding OCD, people are holding onto items because they fear what will happen if they don’t.

Example of hoarding OCD obsessions

Hoarding OCD obsessions could sound like:

• I need to buy six of these cans of soup as the labels match up with those I already have at home and these six cans will fit perfectly in the cupboard

• I don’t need this sweater anymore and should donate it to a thrift shop, but they might be contaminated and I don’t want to make anyone ill

• I should throw out these plates but what if they break in the bin and someone cuts themselves on the sharp edges?

• The trash has been sitting by the door for ages now but I don’t want to touch the outside garbage bin in case I catch anything that could make me ill

• These wedding favors were left by the guests after our wedding. I’ll hold onto them in case throwing them away is a bad omen

• I need to keep this because it feels wrong to get rid of it/this item feels right to keep.

• I see other people are throwing this out and doing so damages the environment so I have to keep this to save the planet.

Examples of hoarding OCD compulsions

Hoarding compulsions might look like:

• Waiting until the same register clerk is available to scan your groceries

• Purchasing items in specific sets, i.e. only ever three bananas, only ever six cans at a time, two cartons of milk even though there is only the need for one

• Purchasing items that have been touched, even if you don’t want/need them

• Storing dirty items in a specific drawer or cabinet for fear of contamination

• Keeping hold of items that could be considered ‘trash’

ERP therapy for Hoarding OCD

Cognitive behavioral therapy (CBT) with exposure response prevention (ERP), is the gold-standard treatment for OCD disorders, including hoarding OCD.

Through repeated exposure to obsessive thoughts, wilfully tolerating the anxiety and uncertainty, and resisting the urge to do compulsions (hoarding in this instance) we teach our brain that we are capable of navigating the uncertainty without those safety behaviors.

Falling into an OCD cycle is all too easy but by changing our response to those obsessions we provide our brains with new tools that can be used to soothe our anxieties, away from the detrimental and compulsive behavior we may have exhibited in the past.

ERP exposures for hoarding OCD

ERP works by gradually exposing yourself to your obsessions and taking small steps toward changing how you think and behave toward them.

With hoarding OCD in mind, you will work closely with your therapist to break away from your compulsions, for example, going to a grocery store and only buying one item instead of multiples. 

With your therapist, you’ll first come up with a hierarchy of exposures you are willing to do and be given education on how to reduce compulsions such as mental compulsions, avoidance compulsions, reassurance compulsions, and hoarding compulsions.

You will also discuss your feared outcome and address ways in which you can expose yourself to those fears.

Along with exposure to only accumulating one item at a time, the therapist and client will also work at exposing the client to getting rid of the hoarded items in the house. This is done in a step-by-step manner where the client themselves get to choose what they are willing to get rid of.

When the degree of clutter is so much, the client and therapist may consider the option of hiring cleaners to discard the items to help the client maintain a degree of safety in their home, if they are unable to do it at a pace that reduces the safety risk.

The aim is to become more comfortable with obsessive thoughts, to identify them, and break away from the compulsive, ritualistic behavior that follows. 

If we familiarize ourselves with uncertainty and discomfort, we’re far less likely to fear it. And if we no longer feel apprehensive in the face of the unknown, we’re far more likely to live full and satisfying lives.