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Typical Stage 2 family room. The furniture is starting to disappear under the stuff, but the room is still functional and pathways exist.

If Brad and Ellen hadn’t sought some help early on, their house could soon have faced some safety issues, where an exit from the house is blocked, or there’s one room that’s basically an uninhabitable dumping ground. Everyone has a junk drawer that holds odds and ends of stuff. When that junk drawer becomes a junk room, it’s a signal that you are moving up to another stage. Or if a major appliance like a dishwasher or air conditioner hasn’t been working for several months because it’s difficult to get to it for repair, it is most definitely a sign of a Stage 2 hoarder. And along with this, there is less attention to housekeeping: Dishes pile up in the sink and shelves remain dusty. If there are pets, there may be some odor from a dirty litter box or one too many accidents.

Hoarders at this stage are starting to focus more on clutter than on life. They tend to invite fewer people to their homes from a sense of embarrassment, which is exactly what happened to Jackson.

Jackson hoarded items having to do with the rock group Blondie. He collected every bit of memorabilia he could find with Blondie’s name on it, from music to souvenirs. His house was very clean; he had his collection carefully cataloged and arranged. But it was overflowing out of the two rooms he had dedicated to be more or less the “museum.” At some point, Jackson had stopped being discriminating in his collecting and it practically drove him out of his house.

Emotionally, there is some anxiety and mild depression at this stage. A Stage 2 hoarder begins to withdraw from friends and family. As a substitute, he or she begins to acquire more things to fill that void, and the cycle continues in earnest. As the hoarder brings home more items, managing those takes priority over personal relationships. At this point, the hoarder begins to shift from embarrassment to justification, explaining why he or she “needs” the possessions.

▶ Stage 3

It is at this stage that the signs of hoarding become evident to the outside world. There may be a little structural damage to the house—for example, a sagging porch. Some indoor items are stored or tossed outside. There’s some evidence of what I call “spaghetti” extending all around the house—tangles of power cords and phone lines jury-rigged to keep things operating when electrical outlets are blocked off. If there are pets, there are also some carpet stains and fleas. The sink is usually filled with dishes and standing water. Walkways and stairs are overtaken with clutter and difficult to navigate. Outside storage—a garage or shed—overflows.

Stage 3 hoarders are losing track of their personal care—bathing and haircutting aren’t a priority. Because kitchens at this stage are often borderline functional, Stage 3 hoarders tend to eat food that’s been cooked/reheated in the microwave oven or fast-food takeout. This almost always causes weight gain. For Stage 3 hoarders, physical activities are often limited. They’ll sit for hours in front of a TV or computer screen. The bad food and lack of exercise contribute to the weight gain, and the classic stereotypical picture of the hoarder emerges. The Stage 3 hoarder’s pathology is slipping into the workplace, and job performance suffers. Plus finances are probably becoming an issue.

Matt sorting through a Stage 3 animal hoarder’s living room, trying to find family jewelry among the dog feces.

At this stage the hoarder is often depressed and claims to want to be left alone. Many hoarders find their best companions in their pets—and often enter into another type of hoarding. (More on animal hoarding follows.) It’s likely that family members have tried to clean the house and were either rejected or withdrew, their attempts in vain.

▶ Stage 4

At Stage 4, there’s structural damage to the house in several areas—floors and ceilings may be