Co-authored by Shontai Cameron.
Approximately 2 to 6 percent of the general population meets criteria for hoarding disorder (HD), with similar rates found in men and women in developed countries. Hoarding behavior often emerges in adolescence or early adulthood and worsens over time.
This disorder involves difficulty letting go of material possessions, excessive or compulsive accumulation of new items, and disorganization that leads to excessive confusion. This disorder is associated with greater social isolation, various medical problems, and significantly lower quality of life. Unfortunately, it is a chronic, progressive condition that can cause significant distress and lead to serious complications, including falls, withdrawal, self-neglect, malnutrition, food contamination, medication mismanagement, and even death.
Hoarding disorder is often misunderstood and overlooked as a common over-hoarding disorder. However, while hoarders focus on acquiring, organizing, and displaying specific objects, individuals with the disorder tend to collect various objects randomly without any clear purpose or system.
Hoarding disorder was officially recognized as a single diagnosis in 2013 in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Previously, it was considered a subtype of obsessive-compulsive disorder, although due to key differences such as core differences, but now it is associated with lack of class as an intellectual disability. isolated disorder.
With this, people often have different levels of awareness of the reality of their condition. Many struggle to recognize the impact of their hoarding, even though it causes significant distress. Lack of insight contributes to many people not seeking treatment for their symptoms, which can lead to adverse outcomes, including an increased risk of suicide.
A 2025 study by Stanford University researchers found that these individuals reported higher rates of suicidal thoughts and behaviors than the general US population, with 13 percent having a history of suicide attempts, compared to about 0.7 percent of the general adult population. Comorbidity with other mental health conditions is also common, with about 50 percent meeting criteria for major depression.
Lead author Dariana Gil-Hernandez at Yale School of Medicine explained that the high rate of suicidal thoughts and behaviors in individuals with hoarding disorder may be related to co-factors such as hopelessness, as well as the severity of the disease, its comorbidity, and poor functioning.
Research distinguishes between passive and active suicide to better assess different levels of risk. Gil-Hernandez emphasizes that this distinction is important because “passive ideation covers thoughts about death or survival, without thoughts of ending one’s life by suicide. Whereas active ideation includes suicidal thoughts, with or without details about methods, intent, or plan.” By making this distinction, researchers and practitioners can more accurately assess the severity of suicidal thoughts, identify individuals at higher risk, and provide more targeted and effective interventions.
Hannah McCabe Bennett, an expert in the treatment of anxiety disorders, as well as hoarding, explained that hoarding disorder is complex and requires continuous effort to improve, often taking months or even years. Depression, which occurs frequently, can be a major obstacle, affecting energy and motivation, creating a vicious cycle that leaves people feeling tired and exhausted.
McCabe-Bennett points out that hoarding is more common than many realize, and it can feel embarrassing and embarrassing to discuss. He also emphasizes the importance of clinicians recognizing the interaction between depression and the underlying behaviors associated with hoarding disorder, as this relationship is critical in formulating treatment strategies. “Depression often exacerbates the problems these individuals have in letting go of things, with feelings of hopelessness or a lack of motivation making it more difficult to deal with the mess, which in turn interferes with the safety and functioning of their homes.” Understanding how depression interacts with these behaviors is vital, as these factors directly inform treatment approaches.
Cognitive behavioral therapy (CBT) is considered the most evidence-supported intervention for this problem. This approach focuses on challenging unhelpful beliefs about the need to keep things, teaching strategies for coping with emotions such as guilt, and providing letting go and coping techniques. Additionally, it targets motivational barriers using empowerment techniques. The goal is to help individuals build confidence in managing intense emotions while reducing the impact it has on their lives.
While CBT has proven effective in treating hoarding behaviors, a more tailored approach may be needed for individuals with both hoarding disorder and major depression. Karen Rowa, clinical director of anxiety treatment and research at St. Joseph’s Health Care in Hamilton, Canada, says: “When symptoms are severe and there are major risks such as the risk of eviction, fire, or homelessness, or when other disturbances are involved, individuals in these difficult situations may not be able to provide the personal support they need. Circumstances.”
Gil-Hernandez believes more research is needed to understand the role of suicide in hoarding disorders. This will improve the diagnosis and management of the symptoms of the disorder.
While the condition can be difficult to manage, recovery is possible with the right support and intervention. By recognizing the complexities of the disorder and tailoring treatment to individual needs, meaningful progress can be made.
Shontai Cameron is a student at York University.
If you or someone you love is thinking about suicide, get help right away. For 24/7 help, dial 988 for the Suicide and Crisis Lifeline, or reach the crisis text line by sending TALK to 741741. Outside the United States, visit International resource page for suicide hotlines in your country.
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