Hoarders

Each 60-minute episode profiles one or two interventions. During most of the first season, the hoarder worked with either a psychiatrist/psychologist, a professional organizer, or an "extreme cleaning specialist," each of whom specialized in some aspect involving the treatment of obsessive compulsive disorders, anxiety disorders, and/or hoarding. A crew of professional cleaners (usually a local franchise of the series' major corporate sponsor) performed actual cleanups. Two episodes in the first season featured a cleanup with both a psychologist and an organizer: Jill (episode "Jennifer and Ron/Jill") and Patty (episode "Patty/Bill"). From season 2 onward, all hoarders were given a psychologist and an organizer. The final episode of the first season, "Paul/Missy and Alex", featured professional organizer Geralin Thomas, CPO-CD, working with Missy, while a child psychologist, Dr. David Dia, worked with Missy's seven-year-old son Alex. Beginning in the second season, each hoarder had a psychologist-plus-organizer/cleaning specialist team assisting them in their cleanup. This specialist combination leads a group of cleaning professionals, family, friends, and relatives of the hoarder in conducting a two- to three-day decluttering session. The cleanups aim to teach the hoarder new ways of thinking and patterns of behavior, and to make the home a liveable and usable space. In most instances a crisis prompts the intervention, such as the threat of eviction or the removal of minor children from the home.

At the end of each episode, on-screen text indicates the short-term outcome of the cleanup effort, including the subjects' decisions on whether to seek further assistance from organizers and/or therapists. The show provides six months of aftercare funds to pay these professionals and, occasionally, to carry out vital repairs to the home.[5]

Beginning with the season nine finale, episodes were expanded to two hours and focused on a single hoarder.

Each of the "Update" episodes revisits hoarders from previous episodes, showing clips from their original appearances followed by newer footage detailing the progress they have made since they were featured.

With the release of the DSM-5 in 2013, hoarding was classified as a separate disorder. During the show's original run, hoarding behaviors were considered symptoms of obsessive–compulsive disorder (OCD). Hoarding does show links to obsessive and compulsive behaviors; however, it also shows connections to major depressive disorder as well as attention deficit hyperactivity disorder (ADHD).[6]

Hoarding could have simply remained a symptom and been included under multiple disorders. However, treating the comorbid disorders in a patient often does not eliminate hoarding behaviors. Another significant factor in the disorder's reclassification was the discovery that more people could be diagnosed with hoarding behaviors than could be diagnosed with OCD.[7] This showed that hoarding could not be a subtype of OCD. Rather, it had to be a separate illness with similarities (the fear of letting go being the obsession, and the hoarding of unneeded items as the compulsion). These similarities are recognized in the DSM-5, as hoarding is classified under obsessive compulsive related disorders. Other disorders in this category include body dysmorphic disorder, trichotillomania, and excoriation. These disorders share common features such as "obsessive preoccupation and repetitive behaviors."[8]

The role of documentary shows like Hoarders in this change of classification is unclear. However, some believe the rise in awareness caused by such shows was a significant contributing factor.[7] When hoarding became a buzzword, it "commanded a significant amount of professional…attention".[7]