For most of us, the concept of hoarding brings to mind one of two things: 1. The 11-season A&E reality show Hoarders, which “features a team of experts working to tackle some of the biggest, most extreme and most challenging hoards in America,” or 2. Friends who remark of their organized collections—vinyl records or Barbie dolls or whatever—“I’m such a hoarder.”

The former makes for good television but doesn’t reflect most real-life hoarding issues, and the latter isn’t actually an example of hoarding. “That’s a normal-range behavior,” UNLV psychology professor Stephen Benning says of collecting. “We allow people to be quirky without being diagnosable.”

So what exactly is hoarding? According to the American Psychiatric Association, “People with hoarding disorder excessively save items that others may view as worthless. They have persistent difficulty getting rid of or parting with possessions, leading to clutter that disrupts their ability to use their living or work spaces.”

It’s normal to save things for their sentimental value. The problem arises when somebody faces so much distress at discarding objects that they accumulate to a point where their house becomes unlivable, Benning says.

Causes of hoarding

Hoarding was first thought to be a form of obsessive-compulsive disorder (OCD), but has been found to be a stand-alone issue. As with many psychological conditions, there’s no single “hoarding gene” or specific childhood experience that causes it. People who hoard tend to have an emotional attachment to their possessions, finding comfort and security in them. They might be worried about wasting resources or losing important information if they throw things out.

Hoarding affects up to 6% of the population, and there’s no clear gender divide. But it does get worse with age, as things accumulate over the years.

“Fixing” hoarding

Benning says solving someone’s hoarding disorder generally requires professional help from a therapist. Cognitive behavioral therapy can help people examine their perceived need to save objects, alter those thoughts and ultimately minimize the distress around discarding possessions.

“It is very difficult to change emotions directly, but we can do so indirectly, through people’s thoughts,” Benning says.

In addressing the behavioral aspect of hoarding, a therapist will actually go into a client’s home and help him or her deal with the stuff that has already accumulated. A therapist might create a hierarchy of the person’s things. At the bottom are objects most easily discarded, and at the top are those a person holds most dear. The therapist and the client start at the bottom of the ladder and work their way up.

Throughout the process, the therapist will help with additional techniques to deal with the stress of discarding, such as progressive muscle relaxation and diaphragmatic breathing. “The behavioral and the cognitive work hand in hand to allow someone to slowly get rid of their stuff, while also helping them to perceive the stuff they have in a different way,” Benning says.

The challenge of DIY help

Unlike just getting more organized, Benning says it’s very difficult to overcome a hoarding disorder without professional help. “People may have spent years or even decades perfecting a behavioral style of avoidance of disposing of this kind of stuff,” Benning says. Inviting a friend to help be a “throwaway buddy” is more likely to ruin the friendship than solve the problem. Because hoarding is now considered an official mental disorder by the medical community, insurance should help cover treatment.

Helping a loved one

If someone you love has a hoarding problem, “you can’t expect to be the one who solves it,” Benning says. And getting frustrated with them can only make things worse. (Unless you’re a professional, you can’t diagnose hoarding anyway.)

Benning says it’s better to “start with an open-ended exploration of a person’s experience,” with the goals of forming an empathetic connection, trying to understand a person’s mindset and eventually “helping the person start thinking about their own reasons for change, rather than reasons you might want to impose on someone.”

It might be tempting to hire a cleaning service to empty out your loved one’s stuff. Don’t. “If you don’t have the buy-in from the person that you’re helping, it will often be perceived more as a betrayal or an interpersonal violation,” Benning warns.

Does money matter?

To an extent, wealthy people are less likely to become hoarders. Benning says to imagine two people with the same amount of stuff, one living in a studio apartment and the other in a mansion. The former would have their space “substantially compromised,” while the latter could shove their junk in a spare room, keeping their hoarding tendencies undetected for longer. But no matter the size of the space, a hoarder can eventually overfill it.

“We have to be careful in the notion of over-pathologizing people with lower socioeconomic status,” Benning says. “This may be a way in which higher socioeconomic status gives you a buffer against the consequences of the same underlying process.”

Pandemic hoarding?

It’s annoying when there’s no toilet paper because some jerk bought it all, thinking it was the end of the world. But according to Benning, that type of hoarding is not hoarding disorder. Instead, Benning calls it a “temporary response to an extreme social stressor.” Empty store shelves actually reflect a “tragedy of the commons,” in which a perceived scarcity becomes a real one when what’s good for the individual is bad for the group at large.

Additional resources

• The Practice. UNLV’s training clinic provides low-cost mental health services for the community. unlv.edu/thepractice

• Stuff: Compulsive Hoarding and the Meaning of Things by Gail Steketee and Randy Frost.

• Buried in Treasures: Help for Compulsive Acquiring, Saving and Hoarding by David Tolin, Randy Frost and Gail Steketee.

• Digging Out: Helping Your Loved One Manage Clutter, Hoarding and Compulsive Acquiring by Michael A. Tompkins and Tamara L. Hartl.