Understanding hoarding behaviours in the context of homelessness

To examine cognitive beliefs associated with hoarding in the context of homelessness, focusing on fear of future material deprivation, and to compare housing-related adversities across groups with hoarding difficulties, homelessness or both.

Cross-sectional, three-group comparative study.

Adults in the UK/Ireland were recruited between July 2023 and April 2024 through third-sector and clinical partners via online, postal and in-person routes. Participants were grouped as hoarding difficulties with homelessness in the past 10 years (H&H; n = 47), hoarding difficulties without homelessness (HD; n = 43) and homelessness without hoarding difficulties (HM; n = 39). Hoarding difficulties were identified by professional referral and eligibility screening, mapping onto DSM-5 criteria (self-report endorsement of all criteria). Primary outcomes were Beliefs About Hoarding Questionnaire-Revised (BAH) subscales (fear of material deprivation, harm avoidance, attachment disturbance). Secondary outcomes included negative housing experiences, hoarding severity (SI-R), depression (PHQ-8), anxiety (GAD-7), functioning (WSAS) and early material deprivation (EEMD). Mixed-model ANOVA tested group differences in BAH subscales, and Kruskal-Wallis tested housing experiences.

A significant group-by-belief interaction emerged. Fear of material deprivation and attachment disturbance were higher in H&H and HD than in HM. Harm avoidance was highest in H&H. H&H reported more negative housing experiences than HD and did not differ from HM (H&H ≈ HM > HD). Exploratory analyses showed higher depression, anxiety and impairment in H&H. HD showed the greatest hoarding severity (SI-R total, clutter, discarding), whereas excessive acquisition was similar in H&H and HD.

Hoarding difficulties in homelessness contexts appear embedded in cumulative psychosocial vulnerability rather than explained by deprivation alone. Harm avoidance may be particularly salient when hoarding co-occurs with homelessness, suggesting potential targets for formulation and intervention in homelessness services.