Referring Providers

pile of old dolls

It is incredibly and overwhelmingly easy to accumulate “stuff.” Everywhere we go, people are handing out free and useless junk: pens, keychains, water bottles, stickers, brochures. Every store we visit has beautifully designed displays luring us in and convincing us that we need brand new, seasonally appropriate stuff in order to feel happy. Most of us are over-consumers and have way too many material things. They overflow our closets, garages; oftentimes we even buy bigger houses and invest in storage units just to hold our growing pile of junk. But at what point does it become a problem? At what point does someone cross the line into having a hoarding disorder? As is the case for most mental health concerns, the answer depends on the person, and it is a very individualized issue. It is not merely the amount of stuff that matters—it is the mentality that goes with it.

Hoarding Disorder is classified as a mental illness, outlined in the Diagnostic and Statistical Manual of Mental Disorders: 5th Edition. The specific criteria include the following:

  • Persistent difficulty discarding or parting with possessions, regardless of their actual value.
  • This difficulty is due to a perceived need to save the item, and to some amount of extreme distress associated with discarding them.
  • The difficulty discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use.
  • The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others).
  • The hoarding is not attributable to another medical condition and is not better explained by the symptoms of another mental disorder.

Contrary to popular belief, just being “messy” or collecting things does not constitute a hoarding disorder. Most of the time the disordered behavior is the accumulation of things that cause significant distress or safety concerns. The person with the hoarding disorder may have good insight, meaning that they are very aware of the problem and understand the illogical nature of some of the beliefs and/or behaviors surrounding the hoarding; or they may have poor insight and even delusions, unable to recognize that their beliefs and/or behaviors are problematic. As you can imagine, the better insight someone has, the more likely they are to seek or accept treatment.

man alone standing at a window

About 2%-6% of the population struggles with hoarding disorders. It tends to run in families, and it tends to start in adolescence and become progressively worse over a lifespan. Consequences of hoarding disorder can be social isolation, strained interpersonal relationships, safety concerns, financial issues, legal issues, and property damage. There are several factors that make someone vulnerable to developing a hoarding disorder, including a family history of hoarding disorder, other mental health issues (depression, anxiety, etc.), physical constraints, and traumatic and/or stressful events.

There are a variety of different thought patterns that can contribute to hoarding behavior, including, but not limited to the following:

  • Sentimental: “It’s a part of my history,” “it would be like throwing away a part of my loved one.”
  • Utility: “I might need it,” “someone else may be able to use this.”
  • Beauty: “It is so beautiful,” “I couldn’t possibly let something like this go in the trash.”
  • Memory: “It helps me to remember time with a loved one.”
  • Comfort/Safety: “Having these things around help protect me.”
  • Identity: “Getting rid of it makes me feel like I am losing part of who I am.”
  • Mistakes: “Well, it won’t be in the way once I figure out a perfect system, or once I find a way to organize everything.”
  • Control: “No one will take good care of it like I have,” “no one will appreciate it like I do.”
  • Responsibility/Waste: “It would be terrible to waste it.”

At one point or another, we have probably all used one of these reasons to rationalize keeping something, whether it be rational or irrational. For most people, this type of thinking is not a problem. For people with hoarding disorder, the rigidity of this type of thinking leads to distress and many of the consequences listed above.

woman enjoying shopping

Emotions also play a huge role in this disorder; typically, very strong emotions are tied to the desire to keep certain items. These emotions can be positive or negative. Examples of positive emotions would be excitement and joy derived from buying something new (and subsequently bringing it home and storing it), or the safety and comfort of being surrounded by many possessions. Examples of negative emotions would be guilt or sadness related to getting rid of something reminding one of a loved one, or the fear and anxiety related to getting rid of something. Because the emotions involved in hoarding are typically so strong, the beliefs and behaviors can be very difficult to challenge.

If you think you or someone you love may have a hoarding disorder, the good news it that they tend to be very responsive to treatment. Treatment for hoarding disorders tend to include cognitive behavioral therapy, a steady process that starts with addressing thoughts and feelings and ends with working toward actual behavior change. Contrary to common belief, simply cleaning out and cleaning up the living space of someone with a hoarding disorder is not the answer! The underlying problems have to be addressed, and taking it out of their control will not help them, and might even make the symptoms worse.

If you would like more information about hoarding disorder, below are a list of websites that may be helpful:

By: Julie Killion, MA, LPC, LCAS, NCC
Licensed Professional Counselor – Wake Forest


Carolina Partners has several hoarding specialists across North Carolina and through our telehealth platform.


Megan Comer, PA-C

Charlotte, NC

Ms. Comer’s goal is that her patients feel supported. Noted for her empathy and insight, she prioritizes treating all her patients with dignity and aims to provide a safe place where all clients can feel heard and cared for. Megan encourages everyone who she works with to feel free to discuss what is really going on in their lives so that she can help improve their overall quality of live. She has a strong background helping people who have chronic pain issues

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