As a person advances through the five levels of hoarding, the condition will begin to pose an increasingly greater threat to their physical health, psychological wellbeing, and overall quality of life.
What Is Hoarding?
Hoarding disorder is a widely misunderstood mental health condition that is characterized by the overaccumulation of possessions, not because they have monetary value or great personal meaning, but simply because the individual is incapable of throwing them out.
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes hoarding disorder in the Obsessive-Compulsive and Related Disorders section.
The DSM-5 criteria for this condition include:
- Continued difficulty getting rid of possessions, regardless of their actual value.
- The inability to part with possessions is due to a perceived need to save the items and/or to the distress associated with discarding them.
- The difficulty discarding possessions results in an accumulation that congests and clutters active living areas and substantially compromises their intended use.
- The hoarding causes clinically significant distress or impairment in important areas of functioning. It can also make the individual’s living environment unsafe for themselves and others.
Hoarding and Related Mental Health Concerns
When assessing a person for hoarding disorder, diagnosticians must confirm that the problem isn’t the results of a medical concern or other mental illness:
- Medical problems that could contribute to hoarding-like behaviors include traumatic brain injury (TBI) and Prader-Willi syndrome.
- Mental illnesses that may cause these types of behaviors include major depressive disorder, obsessive-compulsive disorder (OCD), schizophrenia, and major neurocognitive disorder.
Finally, the DSM-5 also includes four specifiers to provider further insights into the individual’s behaviors and awareness.
- With good or fair insight: The person understands that what they’re doing is problematic.
- With poor insight: The individual may acknowledge some concerns, but will hold fast to the belief that they don’t have a problem.
- With absent insight/delusional beliefs: The person will feel completely justified in their actions and reject suggestions that they need help.
- With excessive acquisition: In addition to refusing to throw anything away, many people with hoarding disorder also can’t stop acquiring new items.
5 Levels of Hoarding
Though the five levels of hoarding aren’t included in the DSM-5, experts have noted that the condition typically progresses through these distinct stages.
Level 1: Early Signs
At first glance, the earliest signs of hoarding may appear to little more than overenthusiastic enthusiastic collecting or evidence of poor organizational skills.
Level 1 hoarding may involve some minimal clutter, but not to the point of impeding a person’s movement or posing a threat to their safety. While the individual may be acquiring items that they have no need for, they will be able to keep the items in some semblance of order.
At this level, key differences between hoarding and collecting include:
- Collectors accumulate items that are related to a specific period, topic, or interest. Hoarders don’t curate their possessions, they simply continue to add to them.
- Collectors are usually motivated at least in part by the joy of adding new items to their collections. Hoarders are motivated more by emotional distress at the thought of giving up any of their items.
Level 2: Accumulation of Clutter
Level 2 is the point at which friends and family members may begin to notice that something is amiss.
Characteristics of Level 2 hoarding include:
- Clutter beginning to amass in areas such as the living room and kitchen
- Buildup of unwashed laundry or dirty dishes
- Items starting to accumulate in doorways, stairwells, and hallways
- Mildew, pet-related odors, and noticeable presence of insects or pests
Level 3: Noticeable Negative impact
This is the stage at which the impact of the clutter will no longer be limited to the appearance of the individual’s living space.
At Level 3, their accumulation of items will have begun to impede their movements, including preventing them from accessing certain rooms or using certain stairs or doorways. The clutter may also start to affect their relationships by preventing them from inviting friends or family into their home.
Pet odors, insects, and inoperable appliances will also be more prevalent and problematic at this level.
Level 4: Potential Health Concerns
At Level 4, the clutter will pose a threat to the individual’s health and may also start to undermine the structural integrity of the house.
Characteristics of Level 4 hoarding can include:
- Clutter preventing the person from accessing several parts of their home
- Spread of clutter onto the porch and in the yard
- Obvious mold, mildew, and/or pest infestation
- Non-functioning stove, sinks, toilets, and/or showers
- Presence of expired, rotting food
- Dangerous use of space heaters or fans due to inoperative appliances or cutoff of services
At this level, the individual may have begun to withdraw and isolate themselves. They may also have ceased to pay appropriate attention to their appearance, grooming, and personal hygiene.
Level 5: Serious Health Risks
At Level 5, the hoarding shifts from threatening the individual’s health to endangering their life.
The clutter will have reached a point of severely limiting the person’s movements, possibly preventing them from escaping in case of fire or making it difficult for first responders to reach them in case of an emergency.
There will be obvious structural damage to the house, and most or all of the appliances will no longer function. Concerns such as pet waste, mold/mildew, and insect infestations will have reached a critical level.
At this point, the individual may be exhibiting a decline in mental health and/or cognitive difficulties. As bad as things have become, they will continue to deny that there’s a problem and reject offers to help.
Find Treatment for Hoarding Disorder in Atlanta
Time Wellness Georgia offers personalized outpatient care for individuals with hoarding disorder, other mental health concerns, and co-occurring addictions.
Treatment options at our center in Atlanta, GA, include a partial hospitalization program (PHP), an intensive outpatient program (IOP), a virtual (online) IOP, and an evening IOP for adolescents.
To learn more about how we can help you or a loved one, or to schedule a free assessment, please visit our Contact page or call us today.
Michelle Rubio is our Clinical Director at Time Wellness in Atlanta, Georgia. She is a Licensed Clinical Social Worker (LCSW) with a passion for helping those in need.
If you or a loved one need mental health treatment in Atlanta, we’re here to help. Contact Time Wellness Centers today to get started.
