The Five Stages of Hoarding
Understanding the different levels of hoarding.
The Institute for Challenging Disorganization (ICD) categorizes hoarding into five stages based on the severity of the hoarding behaviors:
STAGE 1
The first stage of hoarding is the least severe. You may not even think there is a problem.
The residence of a stage 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. These items may be “hidden” in one or a few rooms or areas within the living space or within a secondary building like a garage, shed or storage facility.
STAGE 2
In the second stage of hoarding, the amount of clutter starts to increase and the state of cleanliness starts to decrease.
Signs of hoarding at stage two can 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
Hoarding stage two is a little more severe, with at least one major exit from the house blocked and at least one significant home appliance, like a stove, not working. In contrast to level one hoarding, stage two hoarding happens when the amount of clutter in the home starts to become visible and consistently increases. The cleanliness of the house starts to deteriorates, leaving a stench from a lack of cleaning.
As a result, those within hoarding level two may feel too embarrassed by their home’s state and avoid inviting people over. This can lead individuals to withdraw from social interactions and find themselves struggling with anxiety or depression as a result.
STAGE 3
In this third stage of hoarding, the amount of visible clutter has exceeded the space available.
Signs of hoarding at stage three can include:
Clutter has made certain areas of the home unusable and at least one space in the home, is not functional (like a bathroom)
Similarly, heating and /or air-conditioning devices have been unusable for more than one season
Evidence of improper sanitation, such as overflowing garbage cans, dirt and debris throughout the house, and obvious, foul odors
A light bug infestation and/or moderate evidence of spiders in the home
Those living within this stage of hoarding have visible clutter both inside and outside their home because the items that are usually indoors have made their way outdoors due to a lack of space. Typically, multiple household appliances are now non-functional, with at least one area of the house having light structural damage.
For someone living within this stage, they might find themselves struggling with poor personal hygiene and weight issues due to misfunctioning or unusable bathrooms and appliances and an unhealthy diet. An individual in this level of hoarding typically becomes dismissive, angry or defensive when approached by friends or family members about the state of their home.
STAGE 4
The fourth stage of hoarding shows noticeable damage and unsanitary conditions.
The following are indicators of hoarding within stage four:
Rotting food in the home
Expired cans and bottles
No usable dishes and utensils
Infestation of bugs and pests in beds and furniture
Excessive presence of spiders and webs
Bats and other rodents in the attic and walls
Flammable substances are stored everywhere
Those homes within hoarding level four have noticeable structural damage that is at least six months old. This can include mold and mildew throughout the building, odors and sewage buildup, and evidence of water damage, damaged walls or broken windows. Due to the amount of clutter in the home, the doorways, hallways and stairs are now inaccessible. If there are animals in the residence, the number of pets in the home exceeds regulations, and animal sanitation is poor.
For those living within hoarding level four, the poor conditions and unsanitary conditions not only contribute to poor hygiene but can lead to physical aliments from potentially hazardous infections or diseases. As a result, these individuals tend to have worsening mental health issues as their health declines. Instead of tackling the problems of their hoarding, they tend to focus their emotional energy on grandiose plans or nostalgic memories.
STAGE 5
The final and fifth stage of hoarding is the most severe type of hoarding disorder.
The following are indicators of stage five hoarding:
Clutter fills the bathrooms and kitchen, to the point that the rooms are usable
If applicable, animals at the property present a risk to people due to their poor health and behavior
There is a heavy infestation of spiders, rodents, bed bugs, fleas, cockroaches, etc.
There is noticeable human waste and feces
Rotting food is found on surfaces and inside a non-working refrigerator
Within hoarding stage five, the most severe type of hoarding disorder, severe structural damage to the residence is obvious. There are broken walls, no electricity or running water, fire hazards, and visible rodents and other non-pet animals roaming around.
Individuals within hoarding level five often cannot actually live at their residence because of the condition of their home. Instead, they may have to stay at a friend or family member’s house or find themselves living in cars, make-shift shelters or even outside. They may also get rid of their personal waste into bottles or buckets that remain inside the home. Individuals within this stage of hoarding usually suffer depression and often find themselves involved in legal proceedings to either evict them or condemn their properties.
It’s important to remember that compulsive hoarding is a mental health disorder and that recovery from hoarding disorder is a process that requires a professional diagnosis and treatment… and that treatment will take time and effort.
In most cases, individuals who hoard are typically resistant to accepting treatment and in some cases do not have the capacity to make ‘rational’ decisions about dealing with the behaviours that have led to the circumstances they find themselves and how they are a hazard to themselves and others.
When a person’s capacity to make decisions is limited due to severe hoarding, it may be up to a family member to look for services on the behalf of the person. This can include help with cleaning the home or facilitating mental health support.
However, regardless of whether treatment is voluntary or enforced (legally), therapy will be required to help those who hoard process the reasons behind their emotional connection to the items they can’t seem to let go of or the items they continue to buy and collect.
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