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Hoarding disorder involves compulsive accumulation of new items, keeping old ones, and clutter.

Those with hoarding disorder report suicidal thoughts and behaviours, and 13 percent have attempted suicide.

Hoarding disorder associated with depression and suicidality may be linked to isolation and poor functioning.

Co-authored by Shontae Cameron.

Approximately 2 to 6 percent of the general population meet criteria for hoarding disorder (HD), with similar rates found in men and women, across developed countries. Hoarding behaviours often emerge in adolescence or early adulthood and tend to worsen over time.

This disorder is characterized by difficulty letting go of material possessions, excessive or compulsive accumulation of new items, and disorganization that leads to overwhelming clutter. The 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, eviction, self-neglect, malnutrition, food contamination, medication mismanagement, and even death.

Hoarding disorder is often misunderstood and overlooked as common over-collecting. However, while collectors focus on acquiring specific items, organizing, and displaying them, individuals with the disorder tend to accumulate a wide variety of things in a disorganized manner, without any clear purpose or system.

Hoarding disorder was officially recognized as a stand-alone diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) in 2013. Before this, it was considered a subtype of obsessive-compulsive disorder, although, due to key differences such as the absence of intrusive, recurring thoughts, it is now classified as a related but distinct disorder.

People with it often have varying levels of awareness about the reality of their condition. Most struggle to recognize the impact of their hoarding, even though it causes significant distress. This lack of insight contributes to many individuals not seeking treatment for their symptoms, which can lead to worse outcomes, including increased risk of suicide.

A 2025 study conducted by researchers at Stanford University found that these individuals reported suicidal thoughts and behaviours at higher rates than the general U.S. population, with 13 percent of them having a history of suicide attempts, compared to around 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.

Dariana Gil-Hernandez, lead author, at Yale School of Medicine, explained that the high rates of suicidal thoughts and behaviours in individuals with hoarding disorder may be linked to shared factors like hopelessness, as well as the severity of the illness, its comorbidities, and poorer functioning.

The study differentiates between passive and active suicidality to better assess the varying levels of risk. Gil-Hernandez emphasizes that this distinction is crucial because “passive ideation encompasses thoughts about wishing to be dead or not alive anymore, without thinking of wanting to end one’s life by suicide. While active ideation involves thoughts of suicide, with or without details about methods, intent, or a 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.

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Hanna McCabe-Bennett, a specialist in treating anxiety disorders, as well as hoarding, explained that hoarding disorder is complex and requires sustained effort to make progress, often taking months or even years. Depression, which frequently co-occurs, can be a major barrier, affecting energy and motivation, creating a vicious cycle that leaves individuals feeling stuck and overwhelmed.

McCabe-Bennett points out that hoarding is more common than many realize, and it can feel overwhelming and shameful to discuss. She also stresses the importance of clinicians recognizing the interplay between depression and the core behaviours associated with hoarding disorder, as this relationship is crucial in shaping treatment strategies. “Depression often exacerbates the difficulty these individuals have in discarding items, with feelings of hopelessness or lack of motivation making it even harder to address the clutter, which in turn interferes with the safety and functioning of their homes.” Understanding how depression intertwines with these behaviours is vital, as these factors directly inform the treatment approach.

Cognitive-behavioural therapy (CBT) is considered the most evidence-supported intervention for this problem. The approach focuses on challenging unhelpful beliefs about the need to hold onto things, teaching strategies to cope with emotions like guilt, and providing techniques for discarding and organizing. Additionally, it addresses motivation barriers using reinforcement techniques. The goal is to help individuals build confidence in managing intense emotions while reducing the impact of hoarding on their lives.

While CBT has proven effective in treating hoarding behaviours, a more tailored approach may be needed for individuals with both hoarding disorder and major depression. Karen Rowa, clinical director of the Anxiety Treatment and Research Clinic at St. Joseph's Healthcare in Hamilton, Canada, states that, “When the symptoms are severe and there are major risks, like the risk of eviction, fire, or homelessness, or when other comorbidities are involved, individuals in these dire situations may not be able to engage in traditional CBT. They need support that is personalized to their risks and circumstances.”

Gil-Hernandez believes more research is necessary to understand the role of suicidality in those with hoarding disorder. This will improve the diagnosis and management of the disorder’s symptoms.

While managing the condition can be challenging, 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.

Shontae Cameron is a student at York University.

If you or someone you love is contemplating suicide, seek help immediately. For help 24/7, dial 988 for the 988 Suicide & Crisis Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. Outside of the U.S., visit the International Resources page for suicide hotlines in your country.

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