Executive dysfunction is about much more than chronic disorganization. In the same vein, hoarding disorder is about much more than clutter. Executive dysfunction and hoarding are also both pressing topics, considering that roughly 2.6% of the population is believed to meet the threshold for hoarding disorder (and executive dysfunction affects everyone at some point in time).
While research is still ongoing as to the precise cause of hoarding disorder, there are a number of believed possibilities as to how it develops. This blog post comes from a place of curiosity and genuine desire to better understand the underlying causes of hoarding, as well as offer validation, explanation, and support for those who struggle with these and related issues, as well as those who love someone who does.
What Hoarding Disorder Is and Isn’t
Pop culture is obsessed with hoarding disorder, as seen in shows like Hoarder House Flippers Dirty Rotten Cleaners, and Hoarders. But it’s misguided to view hoarding as a behavioral or cleanliness issue, as some might be led to believe.
This didn’t happen because the person had lower standards on hygiene or organization. In fact, hoarders frequently experience overwhelming levels of shame over these challenges, and it can even lead them to self-isolate, which makes the situation even worse.
So in order to understand the underlying factors and contributors, you’ll need to closely listen to lived experience, shed the stigma, and approach the topic with curiosity and compassion—especially self compassion.
What is Executive Dysfunction?
Hoarding disorder is closely linked to executive function impairments, often referred to as executive dysfunction. Executive functions—the brain’s control center—let us plan, start tasks, juggle information, and manage emotions. When these skills are underdeveloped or impaired, as in ADHD or autism, day-to-day tasks (even throwing out an old receipt) can feel insurmountable.
We all develop executive function skills as we grow, and certain circumstances or experiences can lead these skills to be underdeveloped to varying degrees.
For example, those considered neurodivergent, such as those with ADHD or Autism Spectrum Disorder (ASD), frequently struggle with executive function challenges and tend to need additional supports to help them perform daily tasks and responsibilities.
Executive Dysfunction and Hoarding vs. What Strong Executive Function Looks Like
Even if a person wanted to sort through, organize, and manage their accumulation of items, animals, or belongings, those struggling with executive dysfunction may not possess the necessary skills at levels adequate to take on the overwhelming size of the problem.
Here are a few examples of where executive function skill deficiencies might come into play:
1. Decision-Making Difficulties / Paralysis
🧠 Challenge: “I might need this later” → leads to indecision and keeping everything just in case.
✅ Strong Executive Function: Clear internal criteria for decision-making.
Example: “I haven’t used this in 12 months and I have no specific plan to. I trust I’ll manage if I need it again.”
💡 This involves:
- Cognitive flexibility (evaluating usefulness in changing contexts)
- Impulse control (resisting the urge to “just keep it”)
- Self-confidence in future problem-solving
2. Task Initiation Problems
🧠 Challenge: “I want to clean but don’t know where to start.” → the task feels overwhelming and remains undone.
✅ Strong Executive Function: Breaking large tasks into small, manageable actions.
Example: “I’ll set a timer for 10 minutes and start with just the desk.”
💡 This involves:
- Planning and prioritization
- Goal-directed persistence
- Mental activation (the ability to start a task even without motivation)
3. Working Memory Gaps
🧠 Challenge: “I forgot what’s in that pile or why I kept it.” → leads to keeping everything to avoid mistakes or emotional loss.
✅ Strong Executive Function: Ability to mentally “hold” information and make decisions with it.
Example: “I remember I kept this stack to review last week. I can now sort it into donate and discard.”
💡 This involves:
- Working memory (holding and manipulating mental information)
- Organization of materials and thoughts
- Meta-awareness (knowing why a decision was made and updating it)
4. Emotional Regulation Deficiencies
🧠 Challenge: “It feels wrong or guilty to throw this away.” → emotional distress blocks functional action.
✅ Strong Executive Function: Managing emotions so they don’t override decisions.
Example: “I feel sad throwing this away, but I know my space will feel calmer without it—and the memory doesn’t live in the object.”
💡 This involves:
- Emotional self-regulation
- Reframing and cognitive restructuring
- Mindfulness or distress tolerance strategies
5. Planning and Prioritization
🧠 Challenge: “There’s so much to do, I don’t even know what matters anymore.” → chaos builds without a clear system.
✅ Strong Executive Function: Ability to create a plan, sort by importance, and follow a sequence.
Example: “Today I’ll focus on the kitchen. Tomorrow, I’ll do the hallway. I don’t need to do everything at once.”
💡 This involves:
- Future thinking
- Sequential organization
- Time estimation and resource allocation
The Role of Emotional Attachment, Trauma and Hoarding Behavior
For many people who struggle with hoarding, the issue isn’t just about physical clutter—it’s about emotional survival. Past experiences of neglect, abandonment, or traumatic loss can lead to deep emotional attachments to objects, because those objects come to represent something much larger: safety, identity, connection, or control.
When you’ve lived through neglect or chaotic environments, letting go can feel like inviting danger. Discarding an object isn’t just trashing a thing—it can feel like erasing a piece of your story. In this context, possessions often take on symbolic meaning. The emotional weight of these items becomes entwined with the person’s inner world.
Trauma and the Drive to Keep
Trauma often leads to patterns of hypervigilance, distrust, and a need to hold on to whatever feels safe or familiar. In hoarding behavior, this shows up as:
- Holding on to objects “just in case”
- Avoiding discarding items due to guilt, fear, or shame
- Feeling emotionally undone by the thought of something being gone
These aren’t random behaviors—they’re protective adaptations, shaped by the need to feel secure in a world that hasn’t always felt safe.
Dissociation and Disconnection
For some, trauma also leads to dissociation—a psychological state where thoughts, feelings, or memories become disconnected from the present moment. In a dissociative state, a person might:
- Accumulate items without remembering doing so
- Lose track of time while surrounded by clutter
- Feel emotionally numb until something threatens to be taken away
This overlap between trauma, dissociation, and hoarding can make even small decisions—like recycling an old catalog—feel destabilizing. The clutter becomes a kind of buffer, a way to anchor oneself when the inner world feels fragmented. These adaptations—though protective—can entrench hoarding behaviors over time.
Why Shame Hurts (And What Helps)
Circling back to the TV shows and IG accounts, I really appreciate the difference between the ones that use shame-based versus compassion-led cleaning methods.
Harm reduction is critical in lasting changes in the person, as confidence and a sense of safety is the only way to achieve the sense of stability that person needs to maintain a better quality of life. Compassionate support comes in the form of patience with decision-making and sitting by to offer support as a person goes through objects, explains their significance, and then works through their relative importance to other possessions.
Tailored strategies to support someone in overcoming hoarding disorder include:
- Engage the Individual Through Every Step: While some may find it tempting to “surprise” an individual with hoarding disorder by cleaning out space without their knowledge, this can cause incredible distress for the loved one, shatter their sense of trust in the person, and all without resolving the underlying issues.
- Use motivational interviewing: Motivational interviewing is a research-supported set of techniques is used to “help gently nudge” a loved one towards organizational and other goals with the patience to avoid unproductive arguments and miscommunications.
- Offer skills training: This strategy involves teaching loved ones problem solving methods for organizing and decision-making, which essentially strengthens executive function skills and allows the individual to have more productive, decisive approaches to tackling clutter.
- Consider medication: Medications can help in a variety of ways, from improving an individual’s mood and outlook to reducing their anxiety to levels where decluttering becomes more manageable.
Next Steps for a Better Life
1. Throw one item away
The simplest next step you can take is locating a piece of trash, no matter how big or how small. Look on the floor for a straw wrapper, napkin, or anything else that you feel can be safely discarded immediately.
Here’s a checklist with an example of what you can do if things don’t go as planned:
If you happen to land on something like a button that needs to be sewn back onto a shirt, take care of that now.
If you can’t find your sewing needles or thread, now’s the time to designate a spot in the house for all sewing materials where you can place the button, as well as the sewing materials once you locate them.
If you have a working memory challenge, it might be good to label that spot “Sewing” so you will more easily remember going forward.
2. Seek out executive dysfunction and hoarding support
And of course, an invaluable next step is seeking out professional therapeutic help, support groups, and executive function coaching expertise to help guide you through these struggles.
Please share your experiences with executive dysfunction and hoarding below, and feel free to check out other blog posts, as well as additional resources available from the Executive Function Toolkit!
References:
Fontenelle LF, Muhlbauer JE, Albertella L, Eppingstall J. Traumatic and stressful life events in hoarding: the role of loss and deprivation. Eur J Psychotraumatol. 2021 Jul 22;12(1):1947002. doi: 10.1080/20008198.2021.1947002. PMID: 34367527; PMCID: PMC8312593. https://pmc.ncbi.nlm.nih.gov/articles/PMC8312593/.
“How is Hoarding Disorder Treated?” International OCD Foundation. https://hoarding.iocdf.org/about-hoarding/how-is-hoarding-disorder-treated/.
“What is hypervigilance?” WebMD. https://www.webmd.com/mental-health/what-is-hypervigilance.
“How to Help a Loved One with HD.” International OCD Foundation. https://hoarding.iocdf.org/for-families/how-to-help-a-loved-one-with-hd/.
“What is Hoarding Disorder?” American Psychological Association. https://www.psychiatry.org/patients-families/hoarding-disorder/what-is-hoarding-disorder.
“What is Hoarding Disorder?” Spaulding Decon. https://www.spauldingdecon.com/blog/5-stages-of-hoarding.
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