Hoarding obsessive-compulsive disorder (OCD) is an OCD subtype characterized by ongoing intrusive thoughts and compulsive behaviors around acquiring possessions and having difficulty discarding them. People with hoarding OCD experience frequent intrusive thoughts around either acquiring/keeping possessions (e.g., “I need to have this item. I won’t be able to handle my emotions if I don’t get it”) or throwing them away (e.g., “If I get rid of this shirt I got as a birthday gift, something terrible might happen to the person who gave it to me”).
Hoarding OCD is separate from hoarding disorder. Even though hoarding disorder was once considered part of OCD, it is now its own diagnosis. What distinguishes hoarding disorder from hoarding OCD is the reason why someone is hoarding. Individuals with hoarding disorder accumulate items because they think they are valuable, while OCD-related hoarding is generally an unwanted response to an obsessive thought and anxiety. People with hoarding OCD typically experience their accumulation of possessions stressful and unwanted. They may feel something bad will happen if they discard a particular item. Conversely, people with hoarding disorder find value in the possessions and want to keep them, and they experience distress when they are forced to discard them because they don’t want to sacrifice an item they perceive as holding value.
Hoarding OCD often revolves around items that feel central to a person’s identity. This could include personal letters, past greeting cards, invitations, souvenirs, etc. A person with hoarding OCD may fear a loss of a central part of their identity if they discard a specific item. Hoarding OCD might also include certain purchasing rituals or making sure a person has a certain number of an item in their home. For example, they may feel that they can only purchase soda in multiples of two or something bad will happen. They may develop compulsions around discarding specific items (e.g., meticulously sorting recyclables from trash and compulsively checking to ensure the sorting was done properly).
Often, people with hoarding OCD are motivated by fears of contamination. For example, someone might not want to throw away their trash for fear of having to touch the doorknob to the trash room that they believe may be contaminated. Or someone might avoid donating their books or clothes because they are worried their clothes will contaminate others’ belongings. Someone with hoarding OCD may also purchase all the items they touched in a store for fear of potentially contaminating other shoppers.
Examples of hoarding OCD obsessions
- Everything I’ve touched at the store is now contaminated. I have to buy all these items and take them home or else everyone who touches them will get sick.
- I might need this receipt one day. What if I need to know I was at this deli two years ago? It could be a problem to throw it away.
- I don’t think I need this greeting card from my classmate, but what if something bad happens if I throw it away?
- I should probably throw away the trash, but what if the trash room is contaminated? I could get sick when I go there.
- I don’t need all these glasses. But what if they break when I throw them away and the glass injures someone? I have to keep them.
- I don’t need this book anymore, but what if I regret throwing it away in 10 years? Anything can happen in 10 years, so I better keep it.
- I could donate these clothes I don’t wear anymore, but they are already contaminated. I don’t want to keep them, but I need to because I don’t want to risk contaminating someone I don’t know.
- Six is my lucky number and apples are my favorite fruit. This means I need to buy apples in multiples of six or something bad will happen.
Examples of hoarding OCD compulsions
- Buying certain foods in multiples of four (or another significant number)
- Buying items in sets. For example, making sure to always buy two sets of sponges at a time.
- Holding onto unnecessary papers or receipts out of fear that one will need them in the future
- Holding onto possessions like clothes for fear of needing to use them in the future
- Hoarding items that would otherwise be considered trash
- Storing a surplus of specific items in one’s home, like pencils or notebooks, for fear of running out
- Keeping items in a drawer because a person has decided they are contaminated
- Holding on to trash out of fear that discarding it will contaminate someone else
- Purchasing every item in a shop a person has touched
- Keeping unwanted products instead of returning them for fear of contaminating a store
Hoarding OCD ERP therapy
The best course of treatment for hoarding OCD, like all types of OCD, is exposure and response prevention (ERP) therapy. The idea behind ERP is that repeated exposure to obsessive thoughts without engaging in compulsions is the most effective way to treat OCD. When you continually reach out for the compulsions, it only strengthens your need to engage them. On the other hand, when you prevent yourself from engaging in your compulsions, you teach yourself a new way to respond and will very likely experience a noticeable reduction in your anxiety.
ERP is considered the gold standard for OCD treatment and has been found to be 80% effective. The majority of patients experience results within 12-20 sessions. As part of ERP therapy, you will track your obsessions and compulsions around hoarding and make a list of how distressing each thought is. You’ll work with your therapist to slowly put yourself into situations that bring on your obsessions. This could include going to a store or donating clothes, depending on the cause of the patient’s obsessions. This has to be carefully planned to ensure it’s effective and so that you’re gradually building toward your goal rather than moving too quickly and getting completely overwhelmed.
Examples of OCD ERP exposures
Let’s say you struggle with hoarding OCD and feel that you must buy apples in multiples of six or something bad will happen. With a therapist, you’ll work toward overcoming this compulsion, with the goal of being able to buy any number of apples. A therapist may ask you to buy only one apple as an exposure. At first, you might think, “There’s no way I can do that. I can only buy six apples at a time or something bad will happen.” If an exposure feels too overwhelming to start with, you’ll work with the therapist to find the right intensity for you.
You might start by becoming more comfortable with your intrusive thoughts that arise when you start thinking about breaking your ritual. In ERP therapy, this often involves facing your fears and discussing the worst-case scenario you are trying to prevent with the apple buying ritual. So your therapist might ask you to think about, “What would happen if you only buy one apple instead of six?” followed by, “If something bad does happen as a result, what would that mean?” This process helps familiarize you with the uncertainty causing the anxiety that is driving your compulsive behaviors. When you can discuss these fears, they begin to feel more manageable.
Once you choose a plan, you’ll work with your therapist on the emotions that come up during the exposures. It will be scary at first. It may bring up many of the fears you’ve been trying to alleviate with your compulsions (e.g., what if my therapist is wrong, and nothing bad has happened yet because I’ve never broken my ritual?). But with practice, you’ll find the intense need to engage in your compulsion will wane. You will get to a point where the anxiety subsides, and you are able to purchase the number of apples you actually want.
How to get help
Hoarding OCD may be misdiagnosed as hoarding disorder, but a mental health professional who specializes in OCD will be able to make an accurate diagnosis. If you’re interested in learning about hoarding OCD and how it’s treated with ERP, you can schedule a free call with the NOCD clinical team to find out how this type of treatment can help you. All of our therapists specialize in OCD and receive ERP-specific training and ongoing guidance from our clinical leadership team. Many of them have dealt with OCD themselves and understand how crucial ERP therapy is. NOCD offers live face-to-face video therapy sessions with OCD therapists, in addition to ongoing support on the NOCD telehealth app, so that you’re fully supported during the course of your treatment.
