Clutter Unraveled: The Intersection of ADHD and Hoarding Disorder
Learn about the complex and seemingly shared causes of clutter in ADHD and hoarding disorder, from executive dysfunction and emotional dysregulation to decluttering avoidance.
Clutter and disorganization are mainstays of both hoarding disorder (HD) and ADHD, conditions that often co-occur and give rise to messy living and working spaces. A deeper dive into the ADHD-HD overlap, though, reveals important differences in the roots of clutter and disorganization across both conditions.
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Item Acquisition
In Hoarding Disorder
Driven by an intense urge to save, most people with HD acquire items excessively by accepting or taking free items, buying things, and/or stealing. They often experience distress if they cannot acquire items.
In ADHD
Acquisition can be seen in ADHD, too, though it’s often related to impulsivity, not an intense urge to save items, as seen in HD. Someone with ADHD is unlikely to experience distress if they are unable to acquire an item.
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Executive Dysfunction
In Hoarding Disorder
HD brings a range of EF weaknesses that are compounded with co-occurring ADHD. In individuals with HD alone, executive dysfunction does not often rise to the level of an ADHD diagnosis, but it is there nonetheless.
Difficulty organizing and planning make it challenging to identify the logical and explicit steps required to declutter and organize.
Indecision. People with HD are often unsure about when and where to start decluttering, if at all, and what to toss, if anything.
Difficulty with task-shifting, problem-solving, and managing distractions are also common.
In ADHD
Executive dysfunction is fundamental to ADHD, though some EF challenges are more relevant to ADHD-related clutter.
Time-management challenges, which are not commonly seen in HD alone, interfere with planning and scheduling tasks related to decluttering and organizing.
Working memory difficulties complicate the multi-step processes of decluttering and organizing.
Strong emotional attachments to items drive hoarding behaviors. Items are kept because they are believed to have practical use, unique significance, or sentimental value.
Perfectionism. People with HD often think that there’s a perfect way to acquire, keep, and store items. They are also preoccupied with lost opportunities associated with giving or turning away items.
Responsibility. People with HD often feel responsible for the appropriate use, removal, and fate of an item, which makes letting go difficult.
Doubts about memory. People with HD tend to question their recollection, which makes them likely to keep items, even multiple versions of the same thing. Due to fear and anxiety about misplacing an item, they will often keep as many items in sight as possible, resulting in cluttered surfaces.
Managing the overwhelm associated with decluttering and organizing is a challenge for people with ADHD, whose brains are prone to emotional flooding and whose weak EFs sabotage attempts at organization.
Effortful tasks, like cleaning and organizing, are likely to be viewed as boring, which is an excruciating state for people with ADHD.
Difficulty managing clutter and disorganization can cause strong feelings of shame and avoidance. Sensitivity to rejection and criticism amplifies shame.
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Task Avoidance
In Hoarding Disorder
Categorizing similar items into groups is hard for people who hoard because they believe that each and every item is unique. This makes the task of organizing overwhelming.
Churning — the act of moving around items without actually discarding or organizing them — is a common behavior in HD that comes from failed attempts to organize.
Attempts to maintain tasks of life can result in increased clutter. Take the activity of paying bills and all the tools it requires (checkbooks, stamps, envelopes, pens, etc.). When the desk where bills are paid becomes cluttered and unusable, a person with HD will move to another area, leaving a trail of bill-paying remnants that mixes with other items and causes more disorganization.
Poor insight. Some people with HD may not view their cluttered living spaces and hoarding behaviors as problematic.
In ADHD
Poor task initiation and persistence, common in people with weak EFs, are major barriers to decluttering and organizing.
Difficulty assigning categories to most possessions is not seen in ADHD. Distractibility is often what gets in the way of categorizing.
People with ADHD are more likely than those with HD to view their clutter and disorganization as problematic and therefore more open to accepting help. Accepting help for these issues, however, can be a problem due to shame and rejection sensitivity.
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Help for Clutter and Disorganization in ADHD and HD
Individuals with HD and ADHD should seek help from specialists who primarily treat the former. HD specialists are often well-versed in ADHD, whereas ADHD specialists are not always familiar enough with HD. Find specialists via the International OCD Foundation.
Cognitive behavioral therapy (CBT) is effective for ADHD and HD. Skills learned in this treatment that help control clutter and disorganization include:
task management (e.g., breaking down large tasks into small parts, using the Pomodoro technique)
time management (e.g., time-awareness building, using time effectively)
task initiation and persistence (e.g., prompting and cueing techniques)
CBT for HD, however, also focuses on sorting and letting-go skills, plus non-acquiring exposure.
Treatment for co-occurring conditions is essential. Depression and anxiety commonly occur with ADHD and HD. Loss of motivation in the former and excessive worry in the latter cause further difficulties with executive functioning and exacerbate problems with clutter and disorganization. All individuals with HD should be screened for ADHD. Stimulant medication can help reduce ADHD symptoms that contribute to disorganized living spaces.
