Hoarding Rating Scale

What is the Hoarding Rating Scale?

The Hoarding Rating Scale (HRS) is a clinician-administered or self-report tool used for assessing hoarding behavior and its severity (International OCD Foundation, 2010). This 5-item measure evaluates core hoarding symptoms including clutter, difficulty discarding, excessive acquisition, emotional distress, and functional impairment. Each item is rated on a 0–8 scale, with higher scores reflecting increased severity.

The Hoarding Rating Scale Interview (HRS-Interview) version is often used in clinical contexts to determine the presence of hoarding disorder and differentiate it from related conditions like obsessive compulsive disorder (Tolin et. al., 2010). A total score of 14 or higher typically suggests clinical relevance. The HRS has shown high internal consistency and aligns strongly with other tools such as the Clutter Image Rating and Saving Inventory Revised.

It is particularly useful for identifying impairments in living spaces, emotional distress linked to challenging disorganization, and behaviors associated with compulsive hoarding. The scale is frequently used alongside cognitive behavioral therapy protocols to monitor treatment progress.

How does it work?

The Hoarding Rating Scale is straightforward to administer and interpret, making it a reliable tool for clinical use. Carepatron’s digital template streamlines the entire process, from accessing the form to scoring and documentation, so practitioners can focus on accurate assessment and effective treatment planning for hoarding-related concerns.

Step 1: Access the scale template

To begin, click the “Use template” button on this page. This will direct you to the Carepatron app, where you can access and edit the Hoarding Rating Scale template. You can also click "Download" to get a PDF copy.

Step 2: Use the scale in patient assessment

Once opened, the template can be used to assess key hoarding symptoms during clinical interviews. The form is structured to help you evaluate clutter, difficulty discarding, excessive acquisition, and the emotional and functional consequences associated with hoarding behavior.

Step 3: Conduct the assessment

Use the template during your session to rate each of the five dimensions on a 0–8 severity scale. Following the Hoarding Rating Scale interview format, you may conduct this as part of a structured conversation to guide your clinical judgment and obtain accurate, patient-specific data.

Step 4: Gather and interpret findings

After completing the scale, total the scores to assess severity. A score of 14 or higher generally indicates clinically significant hoarding symptoms. The template helps identify patterns of clutter, difficulty discarding, and excessive acquisition that align with diagnostic criteria for hoarding disorder and related conditions.

Step 5: Provide patient support and next steps

Based on the results, document any follow-up actions such as referrals, treatment plans, or therapeutic interventions like cognitive behavioral therapy. Use the findings to inform collaborative care decisions and support the patient’s progress through structured treatment for hoarding behavior.

Benefits of using this scale

The Hoarding Rating Scale (HRS-I) is a practical assessment tool developed to help medical professionals quickly and accurately assess the severity of hoarding symptoms across various stages of the disorder. The scale, designed by experts, including Randy Frost, focuses on key aspects of hoarding disorder, such as clutter, difficulty discarding items, and excessive acquisition. It is especially useful in differentiating hoarding from related conditions like obsessive-compulsive disorder. Clinicians benefit from its brief interview format or self-report version, which have shown high internal consistency and reliability.

The total score offers a clear snapshot of severity and potential risk, supporting evidence-based decision-making when determining cutoff scores for diagnosis or intervention. The tool complements standardized measures such as the Saving Inventory Revised (Frost et. al., 2004), and it integrates well with cognitive behavioral therapy workflows. By using this scale, professionals can better understand the extent to which hoarding affects living spaces, main rooms, and overall living conditions, including the impact on social life and daily function. It also helps guide targeted interventions for patients facing challenging disorganization and difficulty managing their environments.

Scoring and interpretation

Scoring for the Hoarding Rating Scale involves summing the ratings from five items, each scored from 0 to 8, to produce a total score ranging from 0 to 40. Higher scores indicate greater severity of hoarding symptoms. In clinical practice, a total score of 14 or higher is considered a significant cutoff, suggesting probable hoarding disorder. Additional thresholds include a score of 4 or greater on questions 1 (clutter) and 2 (difficulty discarding), and a score of 4 or greater on either question 4 (emotional distress) or question 5 (functional impairment), which further supports clinical relevance.

Normative data show that nonclinical populations have a mean total score of 3.34 (SD = 4.97), while individuals with hoarding problems show a mean of 24.22 (SD = 5.67).

References

International OCD Foundation. (2010). Hoarding Rating Scale. http://www.philadelphiahoarding.org/resources/Hoarding%20Rating%20Scale%20Assessment%20Tool.pdf

Frost, R. O., Steketee, G., & Grisham, J. (2004). Measurement of compulsive hoarding: Saving inventory-revised. Behaviour Research and Therapy, 42(10), 1163–1182. https://doi.org/10.1016/j.brat.2003.07.006

Tolin, D. F., Frost, R. O., & Steketee, G. (2010). A brief interview for assessing compulsive hoarding: The Hoarding Rating Scale-Interview. Psychiatry Research, 178(1), 147–152. https://doi.org/10.1016/j.psychres.2009.05.001