Article at a Glance:
- Hoarding is a disorder that involves a compulsive need to keep objects, trash or animals.
- The Institute for Challenging Disorganization has created a scale with five hoarding levels to rank the severity of hoarding.
- Level 1 hoarders still have all doors, windows and stairs in their home accessible, whereas level 2 hoarders have clutter that is beginning to block living areas and noticeable odor in their home.
- A level 3 hoarder has visible clutter outside their home, and a level 4 hoarder adds rotting food, excessive bugs and poor animal sanitation to the issue.
- Level 5 is the most severe hoarding level and involves extreme clutter, animals that pose a risk to people and seriously unsanitary conditions.
- The consequences of hoarding include health problems, emotional and mental health issues, and reduced quality of life.
Table of Contents
Levels of Hoarding Chart
What Is Hoarding?
Hoarding involves the compulsive need to find and keep objects, animals or trash regardless of their value. People may hoard clothing, photographs, food, household items, boxes, newspapers, magazines and much more.
Depending on the severity of hoarding, consequences can range from mild to extreme. Severe hoarding can lead to financial and legal problems, as well as a range of physical and mental health problems. Hoarding is a disorder that can exist on its own or alongside another disorder, such as obsessive-compulsive disorder (OCD), obsessive-compulsive personality disorder (OCPD), attention-deficit/hyperactivity disorder (ADHD), and depression.
What Are the Levels of Hoarding?
There are five levels of hoarding. Different levels of hoarding identify the severity of a person’s disorder. Not everyone who hoards does so to the extreme. The Institute for Challenging Disorganization (ICD) publishes a scale that describes five different severity levels of hoarding. Understanding each level of hoarding disorder can help people learn how to help those affected by the condition.
- Hoarding Level 1
The first level of hoarding is the least severe. The residence of a level one hoarder may include:
- Light amounts of clutter and no noticeable odors
- Accessible doors, windows and stairways
- Safe and sanitary conditions with no odors
Hoarding level one involves few signs that an individual has a hoarding disorder. The lack of clutter might hide the condition, but the individual may still have difficulty discarding items and shop excessively for objects they do not need.
- Hoarding Level 2
Hoarding level two is slightly more severe, with at least one household appliance, such as a stove, not functioning and at least one major exit to the house blocked. Compared to level one hoarding, level two hoarding occurs when clutter begins to build up in the home. Housekeeping becomes inconsistent, involving an odor from dirty dishes and a lack of cleaning. Additional signs of hoarding level two include:
- Visible animal waste or odor from waste
- Some evidence of household pests
- Congestion in household entrances, exits, hallways and stairways
- Carbon monoxide detectors non-functional
- Some presence of mildew
People within hoarding level two may avoid inviting people to their house or feel embarrassed by their home’s state. This level of hoarding may cause anxiety or a depressed state and lead to the person withdrawing from social interaction.
- Hoarding Level 3
Residences within hoarding level three have visible clutter outside their home because items that are usually indoors have made their way outdoors. Multiple household appliances are non-functional, and one area of the house has light structural damage. The number of pets exceeds regulations, and animal control and sanitation are inadequate. Other characteristics include:
- Clutter makes certain areas of the home unusable, and at least one space in the home, such as a bathroom, is not functional.
- Heating and air-conditioning devices are not usable for more than one season.
- Evidence of improper sanitation, such as overflowing garbage cans, dirt and debris throughout the house, and obvious, irritating odors.
- There is a light bug infestation and/or moderate evidence of spiders in the home.
A person within this level often has poor personal hygiene and weight issues due to an unhealthy diet. An individual in this level of hoarding may become dismissive or angry when approached by friends or family members about the state of their home.
- Hoarding Level 4
Residences within hoarding level four have noticeable mold and mildew throughout the building, structural damage that is at least six months old, odors and sewage buildup, and evidence of water damage, damaged walls or broken windows. The number of pets in the home exceeds regulations, and animal sanitation is poor. There is so much clutter in the home that doorways, hallways and stairs are inaccessible. The following are additional indicators of hoarding level four:
- Rotting food in the home
- Expired cans and bottles
- No usable dishes and utensils
- Infestation of beds and furniture
- Excessive presence of spiders and webs
- Hearing bats and other rodents in the attic and walls
- Flammable substances stored in the living room
People within hoarding level four tend to have poor hygiene and may not bathe for weeks. These individuals often have worsening mental health and focus their emotional energy on grandiose plans or nostalgic memories.
A 2015 study published by the American Psychiatric Association found that mental health conditions like depression, ADHD, and generalized anxiety disorder are common among individuals with hoarding disorder. Study results showed that obsessive-compulsive disorder (OCD) and social anxiety were common among men with hoarding disorder. In general, those who rise to hoarding level four are likely to experience another mental disorder.
- Hoarding Level 5
Hoarding level five, the most severe type of hoarding disorder, involves severe structural damage to the residence. Broken walls, no electricity or running water, fire hazards, and visible rodents and other non-pet animals are a few of the characteristics of homes within hoarding level five. Other signs include:
- Clutter filling bathrooms and kitchen, to the point that no rooms are usable
- Animals at the property present a risk to people due to their poor health and behavior
- Heavy infestation of spiders, rodents, bed bugs, fleas, cockroaches etc.
- Noticeable human feces
- Rotting food on surfaces and inside a non-working refrigerator
People within hoarding level five often do not live at their residence because of the clutter. Instead, they may stay at a friend or family member’s house. They may also discharge their waste into bottles or buckets that remain inside the home. Individuals within this level of hoarding usually have noticeable symptoms of depression. At this stage of hoarding, people often find themselves involved in legal proceedings to condemn their properties.
What’s Measured in Hoarding Levels
The ICD ranks the severity of a person’s hoarding disorder by evaluating factors such as:
- Whether household appliances are functioning
- The accessibility of windows and doors
- The level of animal control
- The level of clutter in the home, including whether it blocks living areas
- Whether rooms in the house are usable
- The degree of bug infestation in the home
- Whether there are health hazards in the home, such as mold and mildew, rotting food, improperly stored medications and feces/urine
- The degree of clutter present outside of the home
What the ICD hoarding levels chart does not capture is the degree of anxiety associated with hoarding. Research suggests that hoarding is linked to low tolerance for distress and high anxiety sensitivity. Individuals who engage in severe hoarding behavior may do so to manage distress and anxiety.
How Common Is Hoarding?
While it is difficult to determine how common different levels of hoarding are, experts have collected data on hoarding disorder in general. According to estimates, anywhere from 2–6% of the population lives with hoarding disorder. Men may be more likely than women to experience hoarding disorder, and older people aged 55–94 are three times more likely than those aged 34–44 to be hoarders.
How Is Hoarding Disorder Diagnosed?
Hoarding disorder is an official mental health diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), meaning that a licensed mental health professional will diagnose the condition. This could be a psychologist, psychiatrist, clinical social worker, or professional counselor.
Diagnostic criteria for hoarding disorder include:
- Ongoing difficulty with getting rid of possessions, even when they are not valuable
- Belief that items need to be saved, leading to distress over parting with them
- Distress over getting rid of possessions leads to clutter and congestion that makes living areas unusable.
- Hoarding results in significant distress and leads to difficulty functioning in daily life, such as in social situations, at work or regarding their personal safety.
- The hoarding is not a consequence of another medical problem, such as a brain injury, and it is not a direct result of a mental health condition, such as low energy with depression.
About 80–90% of individuals with hoarding disorder will meet the criteria for “excessive acquisition.” This means they will hoard an unreasonable amount of items that are unneeded or that they don’t have space for.
There are also various levels of insight associated with hoarding disorder. For instance, some hoarders may have good insight, meaning they recognize their hoarding behaviors are problematic. Others will have poor insight: they’ll mostly deny that hoarding is a problem, despite mounting evidence. In the worst case, someone may have delusional or absent insight, in which they are entirely sure that their hoarding behavior is not a problem.
What are the Consequences of Hoarding?
Hoarding can have severe consequences for the individual and their loved ones. Excessive shopping that fuels the hoarding commonly leads to financial strain. Relationships become strained. People with hoarding disorder also risk possible loss of housing due to eviction or condemnation, depending on the severity of the disorder.
Children of people with a hoarding disorder may experience depression or another mental condition due to their living situation. Adolescents and teenagers may avoid inviting peers to their house out of embarrassment. Some children become resentful of their parents, unhappy with the unhealthy lifestyle the hoarding creates. Others may be removed from the home to escape health hazards.
How Is a Hoarding Disorder Treated?
Hoarding disorder is a diagnosable mental health condition, and treatment is necessary to help people recover from hoarding behaviors. Individuals who hoard may be resistant to treatment, especially if they have poor or absent insight. In some cases, their capacity to refuse treatment may be limited if they are a hazard to themselves or others.
If a person refuses help for hoarding, family members and friends may consider making repeated attempts to convince them to get help, and over time, they may accept treatment. Loved ones may also decide to work with a mental health professional to learn how to best support the hoarder.
A person’s decision-making capacity is often limited in severe hoarding cases, so a family member may take guardianship and accept services on behalf of the person. This can include help with cleaning the home and mental health treatment.
Regardless of whether treatment is voluntary or the result of guardians making decisions on a hoarder’s behalf, therapy is typically needed to help people process the reasons behind their emotional connection to items. A specific type of therapy called cognitive-behavioral therapy can reduce the severity of hoarding. Certain medications may also be beneficial.
Hoarding is oftentimes the result of an underlying mental health condition. If you or a loved one are struggling with mental health, the Nobu app might be able to help. It is free and for anyone that is looking to reduce anxiety, work through depression, build self-esteem, get aftercare following treatment, attend teletherapy sessions and so much more. Download the Nobu app today!
American Psychiatric Association. “What is hoarding disorder?” July 2017. Accessed July 12, 2021.
Neziroglu, Fugen. “Hoarding: The Basics.” Anxiety & Depression Association of America. Accessed July 12, 2021.
Frost, Randy O., et al. “Comorbidity in Hoarding Disorder.” Focus, April 15, 2015. Accessed July 12, 2021.
Gleason, Andrew, et al. “Managing hoarding and squalor.” Australian Prescriber, June 2021. Accessed July 12, 2021.
Institute for Challenging Disorganization. “The ICD Clutter-Hoarding Scale.” Accessed July 12, 2021.
Substance Abuse and Mental Health Services Administration. “Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health.” June 2016. Accessed July 12, 2021.
Timpano, Kiara R., et al. “Exploration of anxiety sensitivity and distress tolerance as vulnerability factors for hoarding behaviors.” Depression & Anxiety, April 2009. Accessed July 12, 2021.
Tolin, David F., et al. “Quality of Life in Patients with Hoarding Disorder.” Journal of Obsessive-Compulsive and Related Disorders, April 2019. Accessed July 12, 2021.
- Medical Disclaimer
The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.