hoarding, messy, clutter, tbi, brain injury

Hoarding and Brain Injury 

Hoarding is the excessive need to save and hold onto items. Items may be significant or the most minute items you can think of such as packets of salt or mustard. Throwing away items can be emotionally difficult for an individual and can lead to unsanitary and unsafe conditions such as an infestation of bugs or barely being able to walk through the home without tripping on an item due. This condition can greatly affect the hoarder’s life socially as well from the strain it can put on relationships of the members that live in the home or from the embarrassment of having friends, family, or even home repair workers. 

It was not until the early 2000s until researchers began looking at the neurophysiological impairment of hoarding after a rise of evidence began to gather with individuals who developed hoarding issues after frontal lobe damage. Studies have shown that in addition to this unusual collecting behavior, individuals also exhibited increased symptoms of attention deficit-hyperactivity disorder (ADHD) and have challenges in attention and nonverbal intelligence, memory (and memory strategy use), and decision making. Impairments in these executive function skills in addition to decrease initiation and planning skills can make it challenging to organize or discard their belongings.  

Possible reasons for Hoarding due to Brain Injury  Strategies 
  • Deficits in decision-making 
  • Individual has difficulty making decisions on items that are useful and important and which are acceptable to discard 


  • Deficits in attention 
  • Highly distractible and decreased attention, making their ability to clean and manage clutter difficult 


  • Deficits with organization 
  • Difficulty categorizing items making spaces look disorganized 


  • Deficits in memory 
  • placing items in sight to not forget where things were placed 


  • Decreased of motivation or insight 
  • Decreased motivation or insight to problem 
  • Buying containers of bins to help organize items (e.g., accordion folders with tabs to separate documents, a shoe rack that hangs in your closet, or a storage bin to store items for different occasions 
  • Place labels on storage areas to reduce losing items and to find items quicker 
  • Set aside 10-15 minutes a day to go through items to declutter 
  • Go through one room at a time 
  • Asking yourself, when was the last time you used this item? If it has been more than 1 to 2 years (e.g., clothing item), throw the item out 
  • Make immediate decisions about the importance of mail rather than letting them sit around for a while 
  • If unsure, place non urgent mail in a certain folder 
  • Seeking help from a licensed professional 
  • Cognitive-behavioral therapy (CBT) has considerable evidence for hoarding 
  • There should not be clutter on the floor 
  • Everything should have a specific place and will make cleaning the home easier 



Grisham, J. R., & Norberg, M. M. (2010). Compulsive hoarding: current controversies and new directions. Dialogues in clinical neuroscience12(2), 233–240. 

Tolin, D. F., Villavicencio, A., Umbach, A., & Kurtz, M. M. (2011). Neuropsychological functioning in hoarding disorder. Psychiatry research189(3), 413–418.  https://doi.org/10.1016/j.psychres.2011.06.022 

Paula Spencer Scott. (n.d.) Clutter vs. hoarding: What’s the difference? WebMD.  https://www.webmd.com/balance/features/clutter-hoarding#1 

For more TBI Glossary Terms, click here.

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