Last updated: 22 January 2025

Hoarding and homelessness are intrinsically linked, so understanding hoarding and the treatments available is therefore important for homelessness prevention.

Until 2013, hoarding was considered to be a form of obsessive-compulsive disorder (OCD) which meant it received little in the way of funding and research, and there was a limited understanding of the condition. In 2013, hoarding was officially recognised as a separate diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and there is a growing body of evidence and treatments for the condition.

What is hoarding?

Hoarding is marked by three distinct features:

  1. Excessive, intentional acquisition
  2. Difficulty letting go
  3. An inability to keep things organised

Why do people hoard?

Research shows that people develop the above three features for different reasons, including:

  • Harm avoidance. Where a person is concerned that they may cause harm to themselves or another person. For example, they may worry that their used tissue will cause illness in another person, so they don’t discard it in a bin. They take it home which leads to an accumulation of 100s or 1000s of tissues.
  • Deprivation fears. Where a person is worried they will be without something they need in the future (this can often link to childhood experiences of deprivation). For example, the person may continuously buy multiple items of food, accumulating more than can be used or stored in the available space.
  • Attachment issues. Where a person has difficulties forming attachments with people and therefore form attachments with objects. The same level of feeling and emotion is present with the object as there would be with a person so for example, throwing away newspapers may feel like discarding an important relationship and this leads to large accumulations.
  • Positive reactions and soothing. Where the accumulation of items supports the individual to regulate their emotions. For example, someone may find comfort in buying and owning a particular item, such as balls of wool for knitting and this leads to large stockpiles of wool.

Although hoarding does typically happen in the home, the above behaviours can be present in other settings. For example, someone may continue to display hoarding behaviours whilst in hospital - accumulating items around their bed/cubicle. Someone who is street homeless may accumulate items at a sleep site or transport large amounts in a trolley.

Hoarding can have negative implications wherever it happens. Research shows that those who hoard experience significant levels of housing insecurity due to eviction, or threat of eviction.

Supporting someone who hoards

Hoarding is complex and often intersects with other conditions such as trauma, neurodiversity and other mental health needs. There is therefore no one specific treatment, but some points to hold in mind when supporting a person who hoards:

  • A person-centred approach is essential. It can take time to build a relationship of trust, to get to know the individual and understand what’s going on for them. Don’t be tempted to rush things, do not touch items without asking and do not discard items without permission.
  • In time, it may be possible to support the person to speak to their G.P who could make a referral to a specialist service for treatments e.g. cognitive behavioural therapy (CBT).
  • Safety is key and it may be useful to carry out regular safety assessments to consider concerns around fire hazards, risks of trips and falls and health hazards.
  • Using the Clutter Image Rating can help to articulate concerns for an individual when making referrals to other agencies such as the Fire Service or Adult Social Care.

Further guidance on hoarding