Clinicians define hoarding as:

A persistent difficulty discarding or parting with possessions because of a perceived need to save them. A person with hoarding disorder experiences distress at the thought of getting rid of the items. Excessive accumulation of items, regardless of actual value, occurs.

The reality is that hoarding has only been recognized as a mental health disorder in its own right for less than 20 years. Thus, research and practical assessments continue as to how to best address hoarding disorder. With that said, this clinician’s guide to address hoarding disorder is designed to provide you some guidance in assisting a loved one in your life afflicted with this condition.

Identifying Hoarding Disorder

An initial step in addressing hoarding disorder is identifying it in the first instance. Clinicians are in general agreement that identifying actual hoarding disorder can be easier said than done. With that noted, evaluating hoarding using a rating scale is a strategy utilized by clinicians when it comes to determining the status of a specific individual in regard to this condition.

A variety of rating systems are utilized to ascertain whether or not a person is afflicted with hoarding disorder and to what degree. One such rating structure utilizes a five level scale in the evaluation of hoarding behavior.

Level 1

Hoarding Level 1 describes what commonly is referred to a normal or standard house. This is a residence with accessible doors and stairways. There is only minor evidence of pet accidents. A relatively slight presence of insects or even rodents might exist. Some clutter might be present; however, it is not excessive. Sanitation levels are normal and there is no odor permeating the residence.

Level 2

At Level 2 of the hoarding scale, one exit to the home is blocked. One major appliance, heater, or air conditioner has not functioned for six months. Pet odor and pet waste exist at the residence. There exists moderate evidence of insects and even rodents. The proper use of more than two rooms in a house is impossible because of clutter. Passageways in the home are somewhat narrowed. The premises exhibit little evidence of cleaning, including as sweeping or vacuuming. Food preparation surfaces are soiled. Garbage cans are overflowing. The residence has odors.

Level 3

Indicators at Level 3 include clutter outside the house. There are at least two non-functioning appliances in the residence. There is slight structural damage to the house. Pets are likely to exceed limits set by the Humane Society. There exists audible evidence of rodents. There very well may be an infestation of fleas. These is likely to be a moderate amount of spider webs. Hallways and stairways in the residence are constricted. One bedroom or bathroom is unusable because of clutter. Hazardous substances exist in the residence, including broken glass. The house is not cleaned. Excessively soiled surfaces exist throughout the residence. Garbage and dirty laundry also is found throughout the house.

Level 4

By Level 4, hhe house has structural damage. There mold and mildew as well as damaged walls and electrical hazards. There is likely a backed-up sewer system. At least four animals exceed Humane Society limits. There is animal waste and pet dander throughout the house. There is even evidence of wild animals such as squirrels, bats, or raccoons in the house. There is likely to be an infestation of fleas or lice. Bathrooms are unusable. Bedrooms are unusable. Clean dishes are unavailable and there is food rotting in the kitchen.

Level 5

At Level 5, the house essentially is unlivable. Bathrooms and the kitchen are unusable. There is no water, power, or sewage service. There is obvious insect and rodent infestation. There is human waste and rotten food present throughout the residence.

Cognitive Therapy: Recommended Course of Mental Health Treatment

Different types of professional assistance are necessary when it comes to treating a person with hoarding disorder. There include not only a mental health professional but also an organizational specialist, a hoarder cleanup company, and others.

When it comes to mental health treatment, the recommended course is cognitive behavior therapy. In other words, a person with hoarding disorder benefits from talk therapy.

Post-treatment relapse prevention is vital when it comes to hoarding disorder. In other words, when a primary course of cognitive therapy comes to an end, a person with hoarding disorder is likely to still require recurring visits with a mental health professional. In addition, a person with hoarding disorder might benefit from participation in some sort of therapeutic as well as support group, during and after the primary course of therapy.

Depending on the circumstances at hand in a particular case of hoarding disorder, family counseling may be recommended. Even if family counseling is not indicated, some sort of supportive assistance from a mental health professional might be recommended to assist a person attempting to assist a person laboring under hoarding disorder.


Emily Kil

Co-Owner of Eco Bear Biohazard Cleaning Company

Together with her husband, Emily Kil is co-owner of Eco Bear, a leading biohazard remediation company in Southern California. An experienced entrepreneur, Emily assisted in founding Eco Bear as a means of combining her business experience with her desire to provide assistance to people facing challenging circumstances. Emily regularly writes about her first-hand experiences providing services like biohazard cleanup, suicide cleanup, crime scene cleanup, unattended death cleanup, and other types of difficult remediations in homes and businesses.