Amanda Uhle’s recent book Destroy This House (Summit Books, 2025) opens with an unsettling image of her parents’ home: “The garage in their Pontiac home was filled with food, much of it perishable. Animals got into it. Summer arrived. The toxic smell of rotted food was inescapable.” Uhle hoped someone would intervene, but no one did. Had her parents lived elsewhere, perhaps the story would have ended differently. Gleason and colleagues (2021) address this dilemma directly in “Managing hoarding and squalor,” noting that general practitioners often play a key role in recognizing and managing these situations before they become dangerous.

Many people think hoarding and squalor are the same thing—a cluttered house piled high with stuff and difficult to clean. But while they often overlap, they are separate problems that require different kinds of help.

Hoarding disorder is a recognized mental illness listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). It centers on emotional resistance to discarding possessions. The distress of throwing things away, even items most would call trash, is intense. Over time, the buildup can make rooms unusable.

By contrast, squalor describes the physical state of a severely unclean environment. It can result from hoarding but also from neglect, poor health, or cognitive decline. About a quarter of people in such conditions have physical issues—limited mobility, incontinence, or significant vision loss—that contribute directly to their living situation.

The risks associated with both hoarding and squalor are serious: Fires spread quickly among piles of debris, emergency responders struggle to access the area, and falls are common. Some people have been crushed under their own belongings. For relatives, this isn’t just unpleasant—it can be life-threatening. Recognizing the danger helps families understand why intervention sometimes cannot wait.

Between 1.5 and 6 percent of people live with hoarding disorder. It often starts early in life and worsens gradually. According to diagnostic criteria, individuals experience distress when discarding possessions, regardless of actual value, leading to extensive clutter that prevents rooms from being used for their intended purpose.

A major challenge is that about half of those affected do not believe they have a problem. They may admit that others find their homes chaotic, but still see their behavior as reasonable. Comorbidities are common: mood and

© Psychology Today