As a person advances through the 5 levels of hoarding, they face increasingly more severe threats to their physical, emotional, and social wellbeing.
What Is Hoarding?
When the term “hoarding” is used is a mental or behavioral health context, it refers to the compulsive, excessive accumulation of items, to the point that a person’s health and safety may be compromised.
Hoarding isn’t simply an extreme form of collecting, nor is it an attempt to increase wealth by amassing valuable objects. The items that a person amasses typically have little to no actual value, though the individual may experience profound emotional distress at the thought of getting rid of them.
In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), hoarding disorder is included in the Obsessive-Compulsive and Related Disorders section. Other conditions in this section are:
- Obsessive-compulsive disorder (OCD)
- Body dysmorphic disorder (preoccupation with perceived physical flaws)
- Trichotillomania (compulsive hair-pulling)
- Excoriation disorder (compulsive skin-picking)
The common characteristic among these conditions is that people feel forced to engage in certain behaviors, even though these actions have a clear negative impact on their quality of life.
In other words, people who have hoarding disorder aren’t lazy, selfish, or greedy. They have a mental health condition that robs them of their ability to manage their possessions and maintain an organized, safe living environment.
What Are the 5 Levels of Hoarding?
The DSM-5 includes specifiers for people with hoarding disorder to note their level of self-awareness, and to indicate if their inability to discard items is exacerbated by excessive acquisition.
The reference book does not include entries for 5 levels of hoarding – but that doesn’t mean that this progression is invalid. It simply signifies that the mental health community has not yet established standardized criteria for these levels.
Thus, as you continue to research the 5 levels of hoarding, you will likely notice variations in their names and descriptions depending on which source you are consulting. You may also see them referred to as 5 stages or 5 phases, instead of 5 levels. None of these are necessarily right or wrong – they are just different ways of describing how the symptoms of hoarding disorder can intensify over time.
Level 1: Minimal Clutter
At Level 1, it would be virtually impossible to differentiate between someone who has hoarding disorder and someone who is simply disorganized.
The person’s living space may appear to be messy, but not to the point that it disrupts movement or otherwise interferes with typical daily activities.
Level 2: Noticeable Clutter and Early Signs of Hoarding
Level 2 is likely the stage at which an astute observer may begin to suspect the individual has a problem. The messiness and disorganization will have increased significantly from Level 1, with some surfaces (such as countertops or furniture) rendered useless due to a pileup of items.
People who are at Level 2 may feel some embarrassment about their living condition, but they will likely still continue to allow friends and family to visit them.
Level 3: Excessive Clutter and Social Withdrawal
When a person gets to Level 3, their compulsion will begin to threaten mobility, quality of life, and possibly health.
Characteristics of Level 3 can include:
- Hallways, sinks, beds, and other areas may be blocked.
- Accumulation includes obvious trash, such as food containers and paper products.
- Odors from spoiled food may be noticeable.
- The individual is ashamed, but becomes upset at the thought of removing items.
- The individual is hesitant or unwilling to allow others into their home.
Level 4: Severe Clutter and Safety Impairments
At Level 4, the hoarding behavior will pose a clear threat to mobility and health, and may be causing structural damage. Examples can include:
- Complete blockage of some areas
- Trash throughout the house
- Obvious odors from spoiled food
- Mold
- Roaches, rats, or similar infestations
- Extreme emotional distress at suggestions or efforts to clean up
- Social isolation
Level 5: Life-Threatening Clutter
When a person is at Level 5, they are facing significant threats to their health and safety. The clutter will have reached the stage at which it is a fire risk, and may also be causing respiratory problems. At this stage, some type of external intervention will likely be necessary.
Signs of Level 5 can include:
- Minimal ability to move throughout the house due to clutter
- Entrances and exits likely blocked
- Presence of animal waste (and possibly human waste)
- Extensive mold
- Lack of electricity or running water
- Structural damage to the residence
- Deep emotional distress and refusal of help
How Is Hoarding Treated?
Treatment for hoarding disorder may involve several elements, including psychotherapy, skills development, medication, and ongoing support.
According to the International OCD Foundation (IOCDF), two of the most promising therapeutic approaches for people who have hoarding disorder are:
- Cognitive behavioral therapy (CBT), which helps people identify and address maladaptive thought patterns that have contributed to emotional pain and self-defeating behaviors
- Motivational interviewing (MI), which is designed to empower people to take appropriate actions by helping them to explore their feelings and values, with the goal of identifying their own reasons for making changes
No medications have been developed specifically to treat hoarding disorder. However, many people who have this condition also struggle with depression, anxiety, and certain other mental health concerns.
The effective use of prescription medication to alleviate co-occurring mental health symptoms can be a valuable part of treatment for someone with hoarding disorder.
People with hoarding disorder may also benefit from educational sessions to improve their skills in a variety of areas, including organization, decision-making, problem-solving, distress tolerance, and basic household management.
Find Treatment for Hoarding in Atlanta
If someone in your life has been struggling with hoarding disorder, please know that help is available. When your loved one gets the help they need, they can begin to take greater control of their thoughts and actions, and live a much healthier and more hopeful life.
To learn more about treatment for hoarding disorder at North Atlanta Behavioral Health, or to schedule a free consultation, please visit our Admissions page or call us today.
