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Hoarding behaviour and social care support

Written by Dr Flossie Caerwynt and Dr Kat Deerfield, edited by Dr Eleanor Johnson and Dr Grace Krause

November 2026

In this evidence summary, we highlight relevant and up-to-date research on hoarding and social care support in Wales. 

Hoarding is when people accumulate so many possessions it threatens their safety, but they cannot throw them away. This means hoarding is both a mental health condition and a practical health and safety risk. Research can help find ways to support people experiencing hoarding behaviour in a way that helps keep them safe while respecting their autonomy and avoiding trauma.

An adult and a child with a large cardboard box

Identifying hoarding disorder

Presentation of hoarding behaviour

Hoarding is when the number of things someone has interferes with their daily life. People who experience hoarding behaviour may have so many things in their home they can’t store them effectively. This can make it difficult for them to cook, clean, or sleep. They can also find it very difficult – emotionally or practically – to organise or throw things away. People often feel a lot of shame and distress about this, which can lead them to try to isolate themselves from others, including loved ones and professionals.

‘Hoarding disorder’ is a specific mental health diagnosis, which we will explain in more detail later in this evidence summary. But not everyone who accesses hoarding-related support will have a diagnosis of hoarding disorder. 

In this summary, we use the term ‘hoarding behaviour’ to include all behaviour related to accumulating lots of things in a way that’s distressing or that may pose a risk to someone’s health or well-being. This is how Steils et al. (2022) use the term ‘hoarding behaviour’ in their review of hoarding-related research.

Other terms researchers have used to describe hoarding include (Steils et al., 2022):

  • clutter or cluttering

  • squalor, where hoarding behaviour is judged to have led to unhygienic conditions

  • Diogenes syndrome, where the person experiencing hoarding behaviour is an older adult.

Hoarding objects is the most well-known form of hoarding, but people can also hoard other things such as animals or digital material (Mind, 2022a). The social care needs of people experiencing these types of hoarding behaviour are fundamentally different to those experiencing object hoarding behaviour (Arluke et al., 2017; Nathanson, 2009). Because of this, we’re focusing on object hoarding behaviour. 

Hoarding behaviour is a complicated concern for social care because there aren't always clear routes for support. Research shows it’s important to:

  • centre the individual needs and concerns of people experiencing hoarding behaviour

  • focus on underlying difficulties rather than just removing  possessions

  • work with other professionals to provide multi-agency support.

A person’s head with a medical cross symbol

‘Hoarding disorder’ is a specific mental health diagnosis.

Diagnostic criteria

The World Health Organisation (WHO)’s most recent International Classification of Diseases (ICD-11) identified hoarding disorder as a medical condition and set out diagnostic criteria. It defines hoarding disorder as:

“Hoarding disorder is characterized by accumulation of possessions due to excessive acquisition of or difficulty discarding possessions, regardless of their actual value. Excessive acquisition is characterized by repetitive urges or behaviours related to amassing or buying items. Difficulty discarding possessions is characterized by a perceived need to save items and distress associated with discarding them. Accumulation of possessions results in living spaces become cluttered to the point that their use or safety is compromised. The symptoms result in significant distress or significant impairment in personal, family, social, educational, occupational or other important areas of functioning (WHO, 2021).”

The development of hoarding disorder as a diagnosis has led to some controversy. Experts have argued that diagnosis can lead to positive outcomes by opening up opportunities for treatment. But understanding hoarding behaviour as a diagnosable disorder may also create or increase stigma (Brown and Pain, 2014; Steils et al., 2022; see also Orr et al., 2019). 

The psychiatric terms used to describe hoarding disorder can increase stigma around hoarding. One example that often comes up in hoarding literature is ‘lack of insight’. This is when a person lacks self-awareness about their behaviour and does not recognise it could be a problem (Autonomy Project, 2025). This is an important part of hoarding diagnoses (Samuels et al., 2007; BPS, 2015). 

In one study of people who hoard, 21 per cent were described as lacking insight (Samuels et al., 2007). But this description does not accurately capture the complexity of how people see their problems (BPS, 2015). This has significant implications for care, as we will discuss in more detail in this summary.

A person looking through a window

The psychiatric terms used to describe hoarding disorder can increase stigma around hoarding.

Hoarding as a symptom of other conditions

Hoarding behaviour is closely linked to mental health. It often starts as an attempt to cope with stressful or traumatic situations (Mind, 2022b). This means hoarding behaviour cannot be successfully treated without addressing its root causes. When providing care for people experiencing hoarding, the same principles apply as for caring for people experiencing other mental health conditions or people who’ve experienced trauma (McGrath et al., 2024). You can find out more about trauma-informed social care support in our evidence summary about trauma-informed approaches.

Hoarding is also linked to some other diagnoses, although not everyone who experiences hoarding behaviour will have these. As a diagnosis, it’s part of the obsessive-compulsive family of disorders, which also includes obsessive compulsive disorder (OCD), body dysmorphic disorder and health anxiety (also called illness anxiety disorder or hypochondriasis). These disorders all involve some form of repetitive thoughts or behaviour (ICD-11). As they share many of the same traits, hoarding disorder was thought to be a presentation of OCD before it became a standalone diagnosis. 

Hoarding behaviour is more common in people on the autism spectrum and people with Prader-Willi syndrome than in the population as a whole. There may also be a link between hoarding and learning disabilities, but more research is needed to fully understand this (BPS, 2015). 

In social care, hoarding and self-neglect are often discussed together. We talk about some of the reasons for this in more detail later in the summary. Self-neglect can offer a useful way of assessing if there’s a safeguarding concern around hoarding behaviour. But the language in some discussions around hoarding and self-neglect is unclear. Sometimes, hoarding is referred to as a type of self-neglect, but other times, self-neglect is seen as an outcome of hoarding. These inconsistencies make it difficult to understand the relationship  between hoarding and self-neglect (Thew and Salkovskis, 2016). 

Hoarding and self-neglect are two different things, and they can happen separately, as well as together. Not everyone who experiences hoarding behaviour will self-neglect, and not everyone who self-neglects experiences hoarding behaviour. This evidence summary focuses on hoarding behaviour, and we only discuss self-neglect where it's linked to hoarding behaviour in research and policy.

A person washing a dish in a sink

In social care, hoarding and self-neglect are often discussed together.

Socio-cultural context

Hoarding as behavioural continuum

Some researchers argue there are a range of normal human behaviours around possessions and their accumulation (Steils et al., 2022). From this perspective, hoarding is not a unique disordered behaviour but an extreme form of a normal human behaviour. This means it can be hard to tell when accumulating possessions becomes a problem because many of the traditional signs of hoarding behaviour (such as an emotional attachment to possessions or accumulating things for no clear reason) are also seen in non-disordered behaviour. 

Many people, for example, enjoy collecting specific objects, such as trading cards or other collectables. While this hobby has similarities with hoarding disorder, it doesn’t cause the same problems (Nordsletten and Mataix-Cols, 2012). Recognising the social context of hoarding and the stigma associated with it can help with developing a more nuanced and respectful view of people who hoard (Steils et al., 2022).

Older adults and hoarding

People of any age can experience hoarding behaviour, and research shows that for most, hoarding behaviour starts before adulthood (Steils et al., 2022; Thew and Salkovskis, 2016). But hoarding is often seen as a problem that mainly affects older people. There are many reasons why this may be. Stressful life events can be linked to more severe symptoms, and hoarding behaviour can become worse as someone experiences more stressful life events (Thew and Salkovskis, 2016). This is the same for linked disorders such as OCD, as well as other mental health problems (WHO, 2021). People also naturally accumulate possessions throughout their lives, regardless of hoarding behaviour.

This can lead to increased problems in later life, if the number of possessions reaches a potentially dangerous level. Older people can also be at greater risk from the impact of hoarding behaviour if they develop difficulties with mobility or balance (Steils et al., 2022). People may also lose social support as they age, for example, due to bereavement (BPS, 2015). Because of this, age can make it more likely that someone will be seen to be experiencing hoarding behaviour. But research suggests age doesn’t increase the likelihood of hoarding behaviour (Grisham et al., 2006).

Environmental factors

The spaces people live in can also make people more likely to be seen to be experiencing hoarding behaviour. Many people experiencing hoarding behaviour say their hoarding behaviour is only a problem because they live in a confined space (Orr et al., 2019). People with big homes can store lots of possessions without any problems, and this is generally seen as normal behaviour. But if someone with a small home, or who shares a home with lots of people, tries to store the same amount of possessions, their home will likely become very cluttered (Arnold and Lang, 2007). This is closely linked to the fact that people with lower incomes are more likely to be treated for hoarding behaviour (Kretzer et al., 2023; Prosser et al., 2024). There's also a connection between age and environmental factors, as older people can be more likely to downsize (Eckfield and Wallhagen, 2013). 

Social factors

Age and environment are two factors that play a part in deciding if hoarding behaviour poses a physical risk to someone. But there are other factors that determine if hoarding behaviour is a problem and/or whether an intervention is needed. These may include damage to someone’s quality of life. For example, if they cannot sleep in a bed or make full use of their kitchen appliances. 

Some research argues that adults who have decision-making capacity have the right to live without these facilities if they want (Larkin et al., 2024). But other research suggests social care workers may be too quick to assume that adults with capacity choose to live in poor conditions (Scourfield, 2010; Preston-Shoot, 2023). 

Self-neglect may happen because of many small decisions rather than one conscious lifestyle choice. So people may turn down offers of help because they’re too intimidated to admit their decisions have created a problem (Scourfield, 2010). In these cases, it's important to balance people’s right to autonomy with potential safeguarding concerns (Scourfield, 2010; Preston-Shoot, 2023; Millen, 2010). The presence of animals or children in a home may also increase the need for intervention (Larkin et al., 2024; McGrath et al., 2024).

A house

Hoarding in legislation and guidance

There’s relatively little legislation or guidance specifically about hoarding, in Wales or elsewhere. Where there are concerns about the well-being of a person who’s hoarding, it may be necessary to look at their situation through a safeguarding lens. But this can be challenging, as there’s no formal policy around social care responses to hoarding.

Policy in England links self-neglect and hoarding with each other. Self-neglect can be seen as a failure to care for oneself to the extent it becomes a health and safety threat (SCIE, 2024b). But in policy, self-neglect is not clearly defined, and its relationship with hoarding is also unclear. Professionals may link hoarding and self-neglect when they think the situation has become unsafe for the person experiencing hoarding behaviour. But hoarding behaviour can negatively affect a person’s life without necessarily leading to a situation where they’ll access social care support.

The Social Services and Well-Being (Wales) Act 2014 doesn’t specifically define self-neglect. But it defines neglect in general as “a failure to meet a person’s basic physical, emotional, social or psychological needs, which is likely to result in an impairment of the person’s well-being”. Some safeguarding boards have decided that self-neglect meets the criteria for neglect  under the Act (see, for example, Mid and West Wales Safeguarding Board, 2022; North Wales Safeguarding Board, 2016).

A signpost and a person walking in the opposite direction

There’s relatively little legislation or guidance specifically about hoarding, in Wales or elsewhere.

Social care support for hoarding

Supporting people experiencing hoarding behaviour can be complicated. Like other mental health conditions in the OCD family, hoarding affects people in many different ways. It isn’t just an accumulation of possessions. Because hoarding is often a response to trauma, people affected can also experience other trauma-related symptoms, such as feeling hopeless or stuck. It can also affect people’s abilities to form relationships (McGrath et al., 2024; Millen et al., 2017). 

There are three distinct aspects of hoarding behaviour, and they all need a different kind of support. This includes support to address:

  1. the underlying causes of hoarding behaviour, including talking therapies, cognitive behavioural therapy or medication (Mind, 2025)

  2. the hoarding behaviour itself, which may include training to build healthy organising skills and opportunities to practise sorting and discarding objects in less emotional settings (Gleason et al., 2021)

  3. any health and safety concerns, such as personal safety training, or arranging for a cleaning service to take care of cleanliness (without just discarding possessions ) (Kretzer et al., 2023; Gleason et al., 2021).

Multi-agency working

Providing support for all three dimensions of hoarding behaviour involves professionals from many different agencies. Depending on the person’s circumstances and the type of support they need, these agencies may include social care, health, fire and rescue, animal welfare, environmental health, and others (Haighton et al., 2023). This means that good multi-agency working is essential to providing effective support to people experiencing hoarding behaviour. 

Social care workers have to work alongside other professionals to understand what care is needed in each case (Gleason et al., 2021). An analysis of safeguarding adults reviews in England showed the important factors in successful multi-agency support include (Martineau et al., 2021):

  • good attendance at whole system meetings

  • effective information sharing

  • good knowledge and use of safeguarding and legal routes to addressing self-neglect, including when hoarding's involved.

One study found that most adult safeguarding managers say that coordinated, multi-disciplinary, person-centred interventions are successful in supporting and improving the well-being of older people who self-neglect and hoard (Owen et al., 2022).

Focusing on underlying needs

Any support provided to people experiencing hoarding disorder needs to take the underlying causes of the behaviour into account whenever possible. Interventions that try to address hoarding behaviour without understanding the wider context, such as forcibly clearing out clutter, are unlikely to help in the long term (SCIE, 2024b). 
Most people would feel upset if someone threw away lots of their possessions, and people who are experiencing hoarding behaviour (with or without a diagnosis of hoarding disorder) are no exception. As hoarding behaviour often includes an especially strong attachment to possessions, the idea of getting rid of them can be very distressing (BPS, 2015).

A person with a hand raised in front of their face

Most people would feel upset if someone threw away lots of their possessions.

Understanding perspective

The British Psychological Society (BPS) stresses that it’s important to try to understand how a person views their own behaviour or experiences (BPS, 2015). In the case of hoarding behaviour, a person’s accumulation of things means their behaviour is often visible to others. 

But there are often significant differences between how a person experiencing hoarding behaviour understands their situation and how the people close to them understand it. This can lead to people who hoard being described as having ‘poor insight’ or being ‘delusional’ (Tolin et al., 2010). As discussed earlier in this summary, these are stigmatising terms which do little to address the underlying problems of hoarding behaviour. 

People experiencing hoarding behaviour describe their problems in different ways. Some focus on the fact that they don’t have enough storage, while others say they have difficulty organising. People working in social care should avoid using stigmatising terms to describe these experiences, as this can make people experiencing hoarding behaviour reluctant to engage with services. Instead, it’s better to try to understand people’s own perspective. This can make people more likely to engage in hoarding interventions and treatment (BPS, 2015). 

Many people experiencing hoarding behaviour can find talking about their situation embarrassing, so conversations need to be handled compassionately and without judgement (Millen et al., 2017). Creating a supportive environment and respecting autonomy are essential, too (Kretzer et al., 2023).

A person knocking on a door

People can be reluctant to ask for help and face many barriers to doing so.

Self-neglect interventions and hoarding

There’s a lack of social care-specific guidance or research about how to support people experiencing hoarding behaviour who don’t also self-neglect. There also is not much guidance about how to support people who experience both behaviours. While professionals agree on areas of best practice, there haven’t been any formal evaluations to provide evidence to support these areas (Owen et al., 2022). Most guidance deals with self-neglect in general, rather than hoarding specifically.

The Social Care Institute for Excellence (SCIE) has found that most successful interventions for self-neglect (including hoarding) share three traits. These interventions are usually (SCIE, 2024a):

  1. flexible, to fit the person’s circumstances

  2. negotiable, to adjust to the person’s tolerance levels

  3. proportionate, respecting the person’s autonomy and focusing on reducing rather than completely getting rid of any risk.

SCIE also gives general pointers for self-neglect interventions, suggesting that they should incorporate these tactics. They say that support should involve (SCIE, 2024b):

  1. multi-agency working to make sure the right approach is used for each person

  2. listening to and respecting the views of the person, working towards the outcomes they want

  3. understanding that good risk management, not behavioural change, may be the best achievable outcome

  4. identifying underlying causes to help address the issue

  5. a long-term approach, as short interventions are unlikely to be successful

  6. incorporating regular, encouraging engagement and gentle persistence to help with progress and risk management.

These principles match the guidance from researchers for supporting people who are looking for help for hoarding behaviour. People can be reluctant to ask for help and face many barriers to doing so. These include internal barriers, such as fear of being judged or feeling overwhelmed, and external barriers, such as gaps in services. Services can support people seeking help by taking a compassionate and person-centred approach (McGrath et al., 2024). 

But developing interventions based on what makes someone feel safe and well cared for, while respecting their own decision-making, is challenging. There’s a lack of research and guidance on how to support people who experience hoarding behaviour, but who don’t also self-neglect.

Conclusion

This evidence summary outlines up-to-date research about hoarding, and how best to support people experiencing hoarding behaviour. It discusses how hoarding behaviour relates to age, environment and social context. Research shows that hoarding interventions should include support to address: 

  • the hoarding behaviour’s underlying causes

  • the behaviour itself

  • associated health and safety concerns. 

The best way to do this is by prioritising multi-agency working, avoiding forceful interventions that are likely to cause trauma, and taking a non-judgemental approach that recognises people’s own view of their behaviour.

Additional reading

Here is a list of the five most relevant resources on hoarding that are either open access or freely available on the NHS Wales e-Library. 

  1. Gleason, A., Perkes, D. and Wand, A.P.F. (2021) ‘Managing hoarding and squalor’, Australian Prescriber, 44(3), pp. 79-84, doi:10.18773/austprescr.2021.020.
  2. McGrath, M., Russell, A.M. and Masterson, C. (2024) ‘‘A more human approach … I haven’t found that really’: experiences of hoarding difficulties and seeking help’, Behavioural and Cognitive Psychotherapy, 52(1), pp. 1-13, doi:10.1017/S1352465823000425.
  3. Social Care Institute for Excellence (2024b) ‘Self-neglect at a glance’, available at https://www.scie.org.uk/self-neglect/at-a-glance/ (accessed 19 March 2025).
  4. Steils, N., Woolham, J., Manthorpe, J., Martineau, S., Owen, J., Stevens, M. and Tinelli, M. (2022) What do we know about hoarding behaviour and treatment approaches for older people? A thematic review, NIHR Policy Research Unit in Health and Social Care Workforce, The Policy Institute, King’s College London, available at https://kclpure.kcl.ac.uk/portal/en/publications/what-do-we-know-about-hoarding-behaviour-and-treatment-approaches/ (accessed: 11 May 2026).
  5. Thew, G.R. and Salkovskis, P.M. (2016) ‘Hoarding among older people: An evaluative review’, The Cognitive Behaviour Therapist, 9(32), doi:10.1017/S1754470X16000180.
References - click to expand

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Arnold, J.E. and Lang, U.A. (2007) ‘Changing American home life: trends in domestic leisure and storage among middle-class families’, Journal of Family and Economic Issues, 28, pp. 23-48, doi:10.1007/s10834-006-9052-5.

Autonomy Project (2025) ‘Insight and Capacity’, available at https://autonomy.essex.ac.uk/our-research/insight-capacity/ (accessed: 1 Sep 2025).

British Psychological Society (BPS) (2015) A psychological perspective on hoarding - DCP good practice guidelines, available at https://hoardingdisordersuk.org/wp/wp-content/uploads/2019/03/A-Psychological-Perspective-on-Hoarding-%E2%80%93-DCP-Good-Practice-Guidelines.pdf (accessed 19 March 2025).

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Gleason, A., Perkes, D. and Wand, A.P.F. (2021) ‘Managing hoarding and squalor’, Australian Prescriber, 44(3), pp. 79-84, doi:10.18773/austprescr.2021.020.

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Larkin, P., Bratiotis, C. and Woody, S.R. (2024) ‘Assessment of Critical Health and Safety Risks in Homes where Hoarding is Prevalent’, Journal of Community Health, 49, pp. 8-16, doi:10.1007/s10900-023-01238-0.

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McGrath, M., Russell, A.M. and Masterson, C. (2024) ‘‘A more human approach … I haven’t found that really’: experiences of hoarding difficulties and seeking help’, Behavioural and Cognitive Psychotherapy, 52(1), pp. 1-13, doi:10.1017/S1352465823000425.

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Nordsletten, A.E. and Mataix-Cols, D. (2012) ‘Hoarding versus collecting: Where does pathology diverge from play?’, Clinical Psychology Review, 32, pp. 165-176, doi:10.1016/j.cpr.2011.12.003.

North Wales Safeguarding Board (2016) ‘North Wales Regional Safeguarding Board Policy and Procedures to Support People who Self-Neglect’, available at https://www.northwalessafeguardingboard.wales/wp-content/uploads/2019/02/North-Wales-Self-Neglect-Protocol-V2-1-1.pdf (accessed 19 March 2025).

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