About Hoarding and Squalor

Hoarding is a psychological, emotional and behavioural issue!!!

It’s not uncommon to think that Hoarding Disorder (HD) & Sever Domestic Squalor (SDS) is more related to laziness rather than a mental health disorder thus adding to the stigma and shame. This is far from the truth. It’s not about the ‘stuff’ but rather about what the ‘stuff’ represents. If you think of an iceberg, what we can see above the water isn’t the problem but more about what we don’t see underneath the water - this is where the real challenge lies.


HD and SDS are two separate conditions and can present independently of each other or coexist together. People who experience SDS can be further impacted by long term health issues due to the neglect they have for themselves and their environment. It is also reasonable to expect that people living in squalid conditions will have other coexisting issues such as alcohol dependence, drug use and other mental health disorders. It severely impacts people’s ability to function daily and use the rooms in their home for their intended use. It impacts families, and can cause family breakdowns, shame and community judgement which may cause the person to isolate themselves, further exasperating the problem.

If you have a hoarding and or squalor problem, it may mean that your clutter could be a result of something that has happened many years ago which has developed into really strong beliefs and values about your possessions. It may have its roots in a trauma or grief and loss issues or childhood trauma. Whatever the reason, it is important to realise that living in a cluttered environment can affect your health, support networks, your finances and your ability to connect to the community around you.

What beliefs do you have about your possessions? Do they represent a monetary, instrumental, sentimental or emotional value or bring comfort or provide a sense of safety? Do they serve as reminders and without them do you feel like you will forget something or if you can’t see an item, do you feel like you will lose the memory it represents? Or perhaps you have a strong sense of responsibility believing that it is your responsibility to ‘save’ the item or that it could be useful either now or in the future and you shouldn’t be wasteful? Any of these beliefs can cause significant anxiety if you are asked to discard any of your possessions.  Extreme clutter dominates time, space and personal functioning for you and for other family members.

You may also be at risk of a range of other issues including health risks, homelessness, isolation and family breakdown. If you are living with hoarding and or squalor (H&S), you will need long term intervention that provides acknowledgment, support and acceptance of your problem

Hoarding is a Mental Health Issue.

Hoarding Disorder is a mental health issue.

It is estimated that approximately 600,000 Australians live with Hoarding and or Squalor issues. This represents 2.6% of the population. If we extrapolate this number across the population of South Western Sydney, there may be as many as 23,000 people struggling to get their clutter under control.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) recognises H&S as a mental health disorder and is clasified as either Hoarding Disorder (HD) or Severe Domestic Squalor (SDS). If you experience HD or SDS, you will exhibit very strong psychological, behavioural and emotional attachments to your possessions which results in an extremely cluttered environment.

The Diagnostic Statistical Manual of Mental Disorders – 5 (DSM-5) defines Hoarding Disorder (HD) and Severe Domestic Squalor (SDS) as the following:


DSM-5 Hoarding Disorder

‘Hoarding Disorder is characterized by the persistent difficulty discarding or parting with possessions, regardless of the value others may attribute to these possessions. The behaviour usually has harmful effects – emotional, physical, social, financial, and even legal – for the person suffering from the disorder and family members. For individuals who hoard the quantity of their collected items sets them apart from people with normal collecting behaviours. They accumulate a large number of possessions that often fill up or clutter active living areas of the home or workplace to the extent that their intended use is no longer possible’


Diagnostic Criteria for Hoarding (DSM-5)

  1. Persistent difficulty discarding or parting with possessions

  2. A perceived need to save the items

  3. Resulting in the accumulation of possessions

  4. The hoarding causes significant clinical distress or impairment in other areas of their life

  5. The hoarding is not attributed to another medical condition

  6. The hoarding is not better accounted for by the symptoms of another DSM-5 disorder


Specify if:

  • With Excessive Acquisition:  if symptoms are accompanied by excessive collecting or buying or stealing of items that are not needed or for which there is no available space


Indicate whether hoarding beliefs and behaviours are currently characterised:

  • Good or Fair Insight: The individual recognises that hoarding–related beliefs and behaviours (pertaining to difficulty discarding items, clutter or excessive acquisition) are problematic

  • Poor Insight: The individual is mostly convinced that hoarding -related beliefs and behaviours (pertaining to difficulty discarding items, clutter or excessive acquisition) are not problematic despite evidence to the contrary

  • Absent Insight: (i.e. delusional beliefs about hoarding): The individual is completely convinced that hoarding–related beliefs and behaviours (pertaining to difficulty discarding items, clutter or excessive acquisition) are not problematic despite evidence to the contrary


What is Squalor?


“Severe Domestic Squalor is defined as an environment where a person’s home is so unclean, disorganised and unhygienic that people of similar culture and background would consider clearing and cleaning essential. Accumulation of dirt, grime and waste material extend throughout living areas of the dwelling along with possible presence or evidence of insects and other vermin. Rotting food, excrement and certain odours may cause feelings of revulsion among visitors. As well as accumulation of waste, there may have been purposeful collection and or retention of items to such a degree that it interferes with occupant’s ability to adequately clean up the dwelling”. 

(Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

What is the treatment for HD or SDS?


Whether you live in a cluttered environment or you recognise that you have any of the H&S criteria, it will be important to get your behaviours under control. You will need to be honest about your situation and be prepared to seek help if change is what you would like


The purpose of an assessment is to assess both the level of squalor/hoarding and also the impact that this has on your life and on other people who live in the home


If you believe that you may have either a HD or SDS or both, your local GP will be able to make a diagnosis. However, it will be important to let your GP know if you believe you have a hoarding issue.  If you think you may be at risk, you will find self-assessments and questionnaires for you to complete under Resources to help you know if you may be at risk. Other health professionals that can provide you with a diagnosis are Clinical Psychologists, Psychiatrist or a Mental Health Nurse Practitioner.

You may feel shame and embarrassment and a reluctance to disclose the problem for fear of being judged or stigmatised, however in order to receive the help and appropriate links to services, you will need to be open and honest about your situation. Your GP or other health professionals will ask you questions to identify and diagnose if HD is present

Is Change Possible?


YES absolutely!!

Change is possible, but it will be vital to implement a holistic approach that includes psychological and collaborative interventions in developing a Model of Care that includes a variety of support networks and community engagement to work with and support you. Intervention has to be planned and targeted with you directing the level of intervention according to your needs and ability to implement change.

However, understanding the extent of your problem will depend on your level of insight. Some people have good insight while others may have very little insight and do not believe they have a problem.

Research highlights that the best intervention is for therapy to be provided in your home and increasing your organising and home environment skills. Psychological intervention will teach you the skills to challenge your strong beliefs so that you learn how to do the critical analysis of your situation. This will help you to make better decisions about what you keep and what you discard. The diagnostic criteria for HD are based around people’s beliefs about discarding and sorting and the responsibility and usefulness of the items they have. Intervention will work to break down these thoughts and in doing so will help you change your hoarding behaviours and eventually you will be able to live a life less cluttered.

Cognitive Behaviour Therapy (CBT)

In home intervention will have a strong focus on a CBT model of care with other therapies used to help you achieve your goals of recovery


It will be important for you to learn the strategies to dispute your beliefs by testing out what you believe and seeing if what you believe actually comes true. This will help you to form new beliefs that will help you to challenge these thoughts when you have them. Once you have new beliefs about the event and able to change behaviour, you will be able to make better decisions about your life and your possessions.

At Inside Out Recovery, I come to you to help you develop a plan to assist you to implement change. I will assess your situation and work one on one with you so that you can achieve the changes you want. I work from a CBT focus while at the same time recognising any trauma and or grief and loss issues that have impacted in you developing a HD. We will work together to achieve change and move you towards recovery.