My friend A doesn’t want to go home for the New Year.
She has a chronic source of stress that is hard to explain to outsiders: her elderly family members are obsessed with hoarding.
Every time she returns home, she is confronted with stacks of packaging boxes, cartons, and piles of rice, oil, and grains lining the walls. These items seem to carry an unspoken vow to turn every home into a cluttered, dilapidated space. She can only secretly throw things away when no one is looking. For over a decade, she has struggled to understand this behavior—now, she no longer wants to.
Recently, their hoarding has become even worse. Every drawer is packed to the brim. The countless plastic bags they keep “for future use” are filthy and only add to the already scarce storage space.
But what shocked A the most was one particular New Year’s visit when she discovered a stretch of elastic rope strung across the living room, hung with sheets of plastic wrap that had been washed the night before.
Does poverty mean reusing plastic wrap? Is my family really this poor?
Not at all. Otherwise, how could she explain the overflowing storage cabinets, the snack jars, and the clothes and shoes that still have their tags on after more than a decade—far too many to ever wear?
When A was younger, her elders were not like this. They were efficient and tidy. Even if the house was sometimes messy, they never displayed such an obsession with accumulating things, nor did they turn their home into a one-way storage unit.
In A’s memory, reluctance to throw things away was often seen as a harmless habit, even a virtue of thrift. Yet hoarders sometimes make the news. More than a decade ago, a 67-year-old American “hoarding king” was found buried under his own belongings. It took rescuers two days to reach his body by cutting through the roof. The thought of this still haunts A.
She is confused. Is hoarding really just a “normal problem of aging”? At what point does it meet the DSM-5’s definition of compulsive hoarding disorder?
Today, we address A’s concerns with this article.
### **Grief Hoarding: A Response to Trauma or Major Stress Events**
Hoarding only enters public awareness through extreme cases. Recently, *People* magazine reported on an elderly woman living alone in Tianjin, whose home was overrun by thousands of cockroaches, rats, and live maggots.
This grandmother hoarded everything (or rather, she never threw anything away)—leftover food, plastic bags, even garbage she picked up. She also hoarded over a dozen stray cats and dogs. The floor of her home was covered in layers of rotting debris, making it impossible to discern the original material or color beneath. When she slept, cockroaches crawled into her ears.
Her children sought help from a professional cleaning crew. In the team’s footage, the stench permeated even through gas masks. Experienced cleaners retched and had to remove their masks to vomit.
A typical hoarder struggles with basic daily life.
For example:
- They can’t sleep in their own bed.
- The kitchen is unusable for cooking.
- The bathtub is inaccessible for bathing.
- Clutter obstructs movement through the home.
In the novel *Paper Cranes*, a character observes:
> “My friend takes 10 seconds to walk from the living room to the bathroom. In my house, it takes a full minute.”
### **Common Misconceptions About Hoarding**
Many assume hoarding is a form of self-care.
In reality, pathological hoarders often neglect themselves. A study on elderly populations found a significant link between hoarding, poor health, and self-neglect (Dong et al., 2012).
Others believe hoarding is caused by poverty.
While some hoarding behaviors do stem from past experiences of scarcity, research shows that pathological hoarding (i.e., compulsive hoarding disorder) is more strongly linked to trauma or major stress events, such as grief after losing a loved one. For some, attachment to possessions may increase with age, especially following repeated stress events.
One cleaning professional noted that they have frequently observed hoarding behavior following a loved one’s death, including cases of animal hoarding (keeping excessive pets without the ability to care for them).
This phenomenon is known as **“grief hoarding.”**
The *People* article also mentioned:
> “The turning point for this home was when Grandpa passed away.”
Before that, the grandmother had not exhibited such behavior. It all spiraled out of control after his death. She suddenly began collecting hundreds of potted plants.
### **Distinguishing Between Collecting and Pathological Hoarding**
As a mental disorder, hoarding has **two key features**:
1. Persistent difficulty discarding personal belongings, regardless of their actual value. Hoarders feel a strong need to keep things and experience extreme distress when discarding them.
2. The hoarding causes clinically significant distress. It not only affects the living space (and may only be managed due to third-party intervention, such as family or cleaning services), but also impairs social, occupational, or other important functions (such as home safety or fire hazards).
### **Are Older People More Prone to Hoarding?**
#### **1. Hoarding Worsens Every Decade, Not Just in Old Age**
The estimated prevalence of hoarding disorder is **2%–6%**. It is more common in men, though clinical samples often include more women. **80%–90% of hoarders also engage in excessive collecting**, most commonly compulsive shopping, followed by collecting free items (e.g., junk mail, discarded objects).
Older adults exhibit hoarding symptoms nearly **three times more often** than younger adults (aged 34–44 vs. 55–94). A study found that **23% of psychiatric inpatients** in geriatric units exhibited hoarding behaviors.
However, hoarding **usually begins early in life** (around ages 11–15) and worsens with age.
- In their 20s, hoarders experience inconvenience (e.g., avoiding visitors).
- By their 30s, clinical impairments emerge.
- By their 50s, symptoms are often severe enough to warrant clinical intervention.
Besides stress and trauma, **genetics** is another major risk factor. About **50% of hoarders have a family history** of hoarding.
#### **2. Hoarding as a Sign of Cognitive Decline**
Hoarding can be triggered by **brain injury** (Anderson et al., 2005). Some elderly hoarders may be experiencing early **strokes or undiagnosed vascular diseases**. Hoarding is also **common in mild Alzheimer’s disease**.
Thus, a diagnosis of hoarding disorder must **rule out cognitive decline** and distinguish it from other mental disorders, such as obsessive-compulsive disorder (OCD) or depression-related inaction.
#### **3. Emotional Disorders in the Elderly**
Aging often brings **major social changes**—loss of family and friends, social isolation, and struggles adapting to new roles (e.g., retirement).
Among hoarders, **mood disorders are the most common psychiatric comorbidity**, followed by anxiety disorders.
People cope with emotional pain in different ways—some drink, some seek therapy. **Hoarders tend to extend their sense of self into their belongings**, deriving **comfort and identity** from their possessions.
### **Why Urging Hoarders to Clean Rarely Works**
Hoarding is a serious fire hazard, can lead to food contamination, and increases the risk of falls—the leading cause of **injury-related death** among seniors in China.
However, efforts to persuade hoarders to clean up **rarely succeed**.
Even in clinical settings, hoarders respond poorly to treatment. This is because hoarding itself **brings them joy**—the distress often comes not from the clutter, but from conflict with family.
For A, understanding this may not change her family, but perhaps, it will help her find some peace.
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If you, like A, have an elderly family member who cannot stop hoarding, you may find some of the following tips useful (based on literature and various empirical evidence).
### 1. Listen to them and focus on what truly matters to them
In many ways, objects are merely symbols.
In the documentary *Hoarding: Buried Alive*, Kerry had filled their home with everything related to "Elvis Presley." However, the therapist discovered that the real emotional hurdle was the *bedroom*. Whenever the topic of cleaning the bedroom came up, Kerry would become emotionally overwhelmed.
**Therapist**: "Kerry, tell me, what is underneath this pile of items?"
**Kerry**: "It’s my mother’s bed. She slept here before she passed away."
The therapist picked up on this key emotional connection and responded gently: "Your mother is no longer here, but she would want you to have a good life."
Kerry didn’t reply, but their willingness to declutter had begun to shift. Sometimes, change seems impossible, yet other times, it happens in an instant.
### 2. Avoid arguments and always respect the person's decisions regarding their belongings
"It’s because they refuse to throw things away that the situation has gotten this bad. If we let them decide, will we ever be able to clear anything out?"
Empowering the individual is crucial. One of the biggest concerns for people with hoarding behaviors is: *Do I have control over my own possessions?*
Always seek permission, avoid arguments, and never threaten or dispose of items without their consent. Large-scale cleanups can cause immense distress, and if everything is forcibly removed, they often start hoarding again.
This may be difficult and counterintuitive. But think of these resistance behaviors as similar to the *Devil’s Snare* from *Harry Potter*—a vine that tightens its grip the more you struggle. Only by relaxing can you break free.
### 3. Understand the psychological significance of "home" as a physical space
Studies have found that for elderly individuals with hoarding behaviors, *staying in their current residence* is critical.
Severe hoarding often leads to social isolation, criticism, and even eviction. A semi-structured interview with five individuals exhibiting hoarding behaviors found that the most supportive measures were: allowing them to stay in their homes and helping them reduce safety risks.
### 4. Sometimes, helping them *see* the deteriorated state of their items can be effective
This insight comes from case-based experiences.
Many individuals with hoarding disorder cherish their possessions and refuse to acknowledge their deterioration. Examples include:
- Stored clothing that has been moth-eaten or molded.
- Expired food that is no longer safe to eat.
- Unopened items that have been damaged over time.
Seeing a beloved item ruined—or even witnessing the death of a pet due to hoarding conditions—can sometimes prompt change.
In a *People* magazine report, a key turning point in persuading an elderly woman to accept a cleanup was when the workers discovered a dead kitten in the corner of her couch.
### 5. Seek to understand their hoarding behavior rather than passing judgment
Hoarding is multifaceted, involving social, environmental, familial, and personal factors. Even professional cleanup teams spend much of their time addressing the *emotional* aspects of the problem.
Be mindful of your language—avoid judgmental remarks such as:
- "This place is disgusting!"
- "How can you live like this?"
- "Are you this poor?"
Instead, use neutral language and share educational insights about hoarding disorder.
A good approach is to ask curious and empathetic questions. For example:
- "Grandma, if you had to choose three items to represent Grandpa’s life, which ones would they be? Let’s *keep* these three to remember him." (*Emphasizing keeping rather than discarding*)
### 6. Current research suggests that multi-modal intervention is relatively effective
In clinical and psychological counseling, a *multi-modal intervention* approach has shown promise. This includes:
- **Motivational interviewing** (to address ambivalence and low self-awareness).
- **Cognitive Behavioral Therapy (CBT)** (to reduce clutter and curb the urge to hoard).
- **Cognitive restructuring** (to ease the fear of discarding items).
However, this process is lengthy, and success ultimately depends on the individual’s willingness to change.
Hoarding disorder researcher Grisham, who has studied the condition for over a decade, advocates for eliminating stigma and misconceptions about hoarding disorder in public discourse.
Hoarding disorder is a *treatable mental health condition* that can affect anyone, regardless of age, gender, or financial status. Not all hoarders are unaware of their behavior. However, even those with good self-awareness may avoid seeking help if they feel ashamed.
Psychologist once described two key conditions necessary for someone to change:
1. They must feel loved .
2. They must have the freedom to not change.
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