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Levels of Hoarding

The National Study Group on Chronic Disorganization (NSGCD) created the NDGCD Clutter Hoarding scale to allow doctors, professional organizers, or interventionists to further examine their patients.

Assessment Tools

These questionnaires evaluate patients with possible hoarding tendencies:

• Diagnostic and Statistical Manual of Mental Disorders
• Mini-international neuropsychiatric interview
• Yale–Brown Obsessive Compulsive Scale (Y- BOCS)

These surveys help professionals understand the conditions present in a subject’s behavior in order to properly diagnose.

Four Categories of Evaluation

The rating of hoarding is an evaluation of four characteristics of a patient's home. These characteristics are:

Structure and Zoning

The Structure and Zoning measures the structural integrity of the home. Structural walls, entrances, exits, the function of plumbing, electrical, HVAC (heating, ventilation, or air conditioning), all appliances and areas of the home that are exposed to the build- up of items are inspected for functionality.

Pets and Rodents

The Pets and Rodents include the wanted and unwanted animals within the home. The assessment of care and control of each animal is taken into account. Infestations of pests are examined and measured.

Household Functions

The Household Functions coves all safety, functionality, and accessibility of useable space for intended purposes of each room within the home.

Sanitation and Cleanliness

The Sanitation and Cleanliness of the home is the assessment of the amount of clutter, and build-up of soiled objects that can affect an individual’s hygiene.

Five Levels of Hoarding

Compulsive hoarding disorder can be rated on a scale of one (least severe) to five (most severe).

Level 1

A level one diagnosis is consistent of a resident within a standard household.

• The subject is still capable of getting inside his or her home safely with no evident difficulty
• All doors, stairways, windows are accessible
• All appliances and systems work effectively
• There are no pests or excess of animals
• A small amount of clutter is evident
• The living space is still considered healthy
• There are no present odors

This is commonly an individual who has an overlooked pile of cartons, newspapers, or food boxes within their home. In 2003, a study was conducted on college students, where their potential level of hoarding was assessed through the Y- BOCS questionnaire. This level of hoarding was found most consistent with the subjects.

Level 2

Level two subjects have:

• One appliance out of order for at least 6 months
• At least one entrance or exit is inaccessible
• There is inoperative plumbing and electric
• Pet odor and waste is evident
• There are frequent sightings of insect and rodent infestation
• Hallways are cluttered and narrowed slightly
• There is an evident lack of maintenance
• There is a build up of mold
• The sanitary conditions are compromised

Level 2 marks the need for a professional organizer or doctor to help manage the chronic disorganization.

Level 3

The Institute for Challenging Disorganization describes level three as the turning point for an individual’s home between fixable common clutter and a home with unmanageable conditions of hoarding. Level three conditions have:

• Visible clutter outdoors
• Two or more appliances are broken
• There is excessive light and electrical damage
• The HVAC detector and the Carbon monoxide detector detector are not working
• The pets exceed a normal limit allowing multiple animals to freely breed
• There is mild insect infestation
• There is a presence of multiple spider webs
• There is severe rodent evidence
• There are obvious, hazardous spills
• The resident’s hallways have narrowed more severely
• One of the rooms is unreachable or blocked by clutter
• There are strong odors from feces, soiled food, and dirty laundry present

The patient and his/her residence are in clear need of professional assistance (professional organizer or psychologist) with sufficient knowledge of the chronic characteristics of this disorder. The professional involved should help the subject become involved in a community of resources that will advance treatment of the individual. The mental and physical health characteristics of the individual and his or her household are examined. In 2010, research was performed on 18 adults older than the age of 60, who had significant characteristics of compulsive hoarding disorder. They were evaluated using Diagnostic and Statistical Manual of Mental Disorders, Mini-international neuropsychiatric interview, and Yale–Brown Obsessive Compulsive Scale questionnaires, where most participants showed characteristics of Level Three Hoarding or higher.

Level 4

A level four classification has:

• excessive clutter present outdoors and indoors
• There is an extreme excess of:
  • mold
  • hazardous electrical wiring
  • odor
  • pet waste
  • sewage problems
  • spoiled food
  • spider webs
• There is significant structural damage present from at least 6 months prior to discovery
• There is damage from animal activity and feces
• There is excessive population of animals, rodents and insects, which cause hazardous and unsanitary living conditions
• The HVAC detector and Carbon monoxide detector have not worked for over a year
• Most household appliances are unusable
• Most bathrooms are unusable
• The main bedroom is unreachable and potentially stricken with lice

This level four household environment desperately needs a collaborative team of professionals. These experts can include:

• professional crime scene investigators or cleaners
• financial counselors
• Building contractors
• handy men
• pest control service providers
• psychologists
• professional organizers

The mental and physical health characteristics of the hoarder and household are fully examined.

Level 5

Level five quarters have:

• Obvious structural damage throughout the entire home
• Broken walls and windows
• There is an absence of:
  • Electric services
  • Sewage services
  • Water services
• The HVAC detector, Smoke dectector, and carbon monoxide detector are not even present
• There are abandoned cars
• There is an obvious overgrowth of foliage outside the home
• The water and foundational damage are seen both in and outside the residence
• There is mold and mildew build up
• There is tremendous rodent, animal, insect infestation, along with their feces
• There is a lot of rotting food

The unsanitary living conditions deem the house unlivable. The individual cannot use the home for anything, but an unsanitary storage unit. This level five household environment needs a team of professionals:

• Professional organizers
• family members
• mental health
• professionals
• social workers
• building managers
• Pest and Animal Control
• lawyers
• conservators or trustees
• building and zoning workers
• fire and safety specialists
• landlords
• legal aid and/or legal representatives

Before any detailed assessment of the home begins, all health specialists and cleaners initiate a full service to the unsanitary conditions. All of the professionals need to help the patient to create a written strategy or contract to make future steps for recovery of his or her home and mental/ physical health.